Platelet-rich plasma (PRP) is an innovative treatment option that recreates the body’s natural healing process. Platelets are a specialized type of blood cell. Blood is made up of 93% red cells (RBCs), 6% platelets, 1% white blood cells (WBCs), and plasma.
Most people associate platelets with clot formation. While that certainly is an important function of platelets, they are also very involved in the body’s natural healing process. Human platelets are extremely rich in connective tissue growth factors. Injecting these growth factors into damaged ligaments, tendons, and joints stimulates a natural repair process. But in order to benefit from these natural healing proteins, the platelets must first be concentrated. In other words, PRP recreates and stimulates the body’s natural healing process.
A PRP injection is generally recommended in the treatment of tendon or muscle injuries with a success rate of about 70% to 80%. Corticosteroid or “cortisone” injection, as they are commonly referred to, cannot be injected into weight bearing tendons such as the patellar tendon of the knee and Achilles tendon of the ankle because then can weaken the tendon and cause it to rupture. PRP can safely be used in these tendons without the risk of rupture.
In the office, blood is drawn from the patient (just like getting a blood test) and placed in a special centrifuge. The centrifuge separates the RBCs, and the remaining platelets and plasma are then highly concentrated. (The WBCs, which comprise only a fraction of the total cells, go along for the ride with the platelets and plasma.) The red blood cells are discarded, and the resulting platelet concentrate is used for treatment.
The injury site is then numbed with local anesthesia, and PRP is injected into the affected area. In most cases the injections are given under direct ultrasound guidance to insure accurate placement of the platelet concentrate in the damaged area. The entire treatment, from blood draw, to solution preparation, to injection, takes approximately 45 minutes.
Following the procedure, you can resume your daily routine activities but avoid strenuous activities such as heavy exercise or lifting.
You may experience some pain during the injection which may last for a couple of days. Cold compresses and pain medication may be prescribed for pain relief. Anti-inflammatory medications are to be avoided for up to 48 hours after the injection, as they can affect the platelet function.
Risks and complications are rare but can include infection, nerve or blood vessel injury, scar tissue formation, and calcification at the injection site following a PRP injection. Call your doctor immediately in case of persistent pain or the development of any adverse reaction after the injection.
After the initial treatment, a follow up visit is scheduled 3-4 weeks later to evaluate healing progress. Some patients respond very well to just one treatment. However, 2-3 treatments may be necessary in some injuries. If multiple injections are given, injections are typically given every 3-4 weeks.
Four to six weeks may be required for complete healing. Special precautions are required in individuals with low platelet count, bleeding disorders, those on blood thinning medications or anti-inflammatory medications, individuals allergic to local anesthetic agents, those with active infections and women who are pregnant or breast feeding.
PRP treatment works for acute and chronic ligament and tendon sprains/strains that have failed other conservative treatment, including:
In addition, PRP can be very helpful for many cases of osteoarthritis (the "wear & tear" kind). PRP can help stimulate a "smoothing over" of the roughened and arthritic cartilage, reducing the pain and disability of arthritis. This includes:
Most insurance plans, including Medicare, do NOT pay for PRP injections.
Lidocaine is not used during the PRP injection because it interferes with the platelet function. Unlike a steroid injection, there may be pain for the next few days after a PRP injection. It is critical to avoid anti-inflammatory medications, including Advil, Motrin, ibuprofen, Aleve, Celebrex and aspirin (unless prescribed by your heart doctor) during the days before and week after a PRP injection. These will interfere with the healing response. Tylenol is OK. Other pain medications may be prescribed.
There are risks anytime a needle is placed anywhere in the body. Even when getting blood drawn, there is a risk of infection, bleeding, and nerve damage. However, these risks are very rare. Other complications, though rare, vary depending on the area being treated, and will be discussed before treatment. Because PRP uses your own blood, adverse reactions are rare.
Studies suggest an improvement of 80-85%. Some patients experience complete relief of their pain.