Sports Medicine

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Platelet-Rich Plasma (PRP)

Anatomy

Although blood is mainly a liquid (plasma), it also contains small, solid components (red cells, white cells, and platelets.) Platelets are best known for their importance in clotting blood, however, they also contain hundreds of proteins called growth factors which are very important in the healing of injuries.

Description

Platelet-rich plasma (PRP) is plasma that contains many more platelets than are typically found in blood. This high concentration of platelets means that the concentration of growth factors can be 5 to 10 times greater, or richer, than usual. Although laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process, researchers are not clear on how PRP may actually work.

During recent years, PRP has received extensive publicity regarding its potential effectiveness in treating injuries. Famous athletes including Tiger Woods, Rafael Nadal, Hines Ward and others have received PRP for various problems such as sprained knees and chronic tendon injuries—conditions that have typically been treated successfully with medications, physical therapy or surgery. While some athletes have credited PRP treatments with allowing them to return to competition more quickly, research is ongoing and results regarding effectiveness remain inconclusive.

  • Developing a PRP preparation—First, blood is drawn from the patient and the platelets are separated from the other blood cells. Next, a process called centrifugation is used to increase the concentration of platelets.

PRP Therapy Options

An injury site can be treated with a PRP preparation in the following ways:

  • Injection into the injured area—For example, in Achilles tendinitis, a condition commonly seen in runners and tennis players, the heel cord can become swollen, inflamed and painful. A mixture of PRP and local anesthetic can be injected directly into this inflamed tissue. For the first week or two afterwards, pain at the area of injection may actually increase and it may be several weeks before the patient feels a beneficial effect.
  • During surgery—For example, an athlete with a completely torn heel cord may require surgery to repair the tendon. Healing can possibly be improved by treating the injured area during surgery, using PRP that has been specially prepared so it can actually be stitched into the torn tissues.

Conditions Potentially Treated

  • Chronic tendon injuries—According to current research studies, PRP is most effective in the treatment of chronic tendon injuries, especially tennis elbow—a very common injury of the tendons on the outside of the elbow. PRP use for the patellar tendon at the knee (jumper's knee) is also considered promising. Whether or not PRP therapy is any more effective than traditional treatments for these problems, however, remains unclear at this time.
  • Acute ligament and muscle injuries—In recent years, PRP therapy has been used to treat some professional athletes with acute sports injuries, such as knee sprains, pulled hamstring muscles in the thigh, and other ligament and muscle injuries. Although this treatment has gained publicity, there is no definitive scientific evidence that PRP therapy actually improves the healing process in these types of injuries.
  • Surgery—PRP has been used during certain types of surgery to help tissues heal. Initially, it was considered beneficial in shoulder surgery to repair torn rotator cuff tendons, and has also been used in the surgical repair of torn knee ligaments, especially the anterior cruciate ligament (ACL). To date, there appears to be little or no benefit from using PRP in these types of surgical procedures.
  • Knee arthritis—Some research is being conducted to evaluate the effectiveness of PRP in the treatment of the arthritic knee. Most studies indicate that PRP therapy is no more effective than current treatment methods.
  • Fractures—PRP therapy has been used in a very limited way to speed the healing of fractured, or broken, bones. So far, it has shown no significant benefit.

Effectiveness of PRP Therapy

Treatment with PRP could hold promise, and research is underway to evaluate this therapy. Currently, however, studies to back up recent media claims are lacking. Results remain inconclusive, in part, because effectiveness can be influenced by a variety of factors, including: area of the body being treated, patient health, and whether the injury is acute (as from a fall) or chronic (developed over a period of time).

Although PRP does appear to be effective in the treatment of chronic tendon injuries about the elbow, the medical community needs more scientific evidence before it can determine whether PRP therapy is truly effective in other conditions.

Risks and Side Effects

Although the success of PRP therapy is still questionable, the risks associated with it are minimal. There may be increased pain at the injection site, but the incidence of infection, tissue damage, nerve injuries, or other problems, appears to be no different from that associated with cortisone injections.

If you are considering PRP therapy, be sure to check your eligibility with your health insurance carrier. Currently, few insurance plans, including workers' compensation plans, provide even partial reimbursement for this treatment.