Clinical Excellence

PRP: A Promising Treatment

While it’s not considered to be a “miracle cure,” platelet-rich plasma (PRP) has emerged in recent years as a useful new treatment option for some patients. Injecting PRP into certain inflamed or damaged areas of the body can help relieve pain and, in some cases, may enhance the body’s natural healing processes to help speed up recovery.

Undergoing a PRP treatment is fairly simple. All that’s involved is a couple of consultations, a blood draw and an injection.

“Platelets are the blood cells that help the body control bleeding by forming clots,” explains Benjamin Mwanika, DO, with Sentara RMH Orthopedic and Sports Medicine Specialists. “But platelets also naturally contain a huge amount of growth factors, which can act as healing agents. So when those growth factors are injected into damaged structures, they can actually start to activate and enhance the body’s natural healing process.”

PRP injection is especially effective in cases of inflammatory tendinitis, such as Achilles tendinitis and “tennis elbow,” and tendinitis of the rotator cuff and knee, according to Matthew Panzarella, MD, with Sentara Martha Jefferson Orthopedic and Sports Medicine Specialists.

“PRP is a therapy we may consider if other conservative treatments—such as rest, physical therapy and icing, for example—have proven ineffective,” he says. “There’s a lot of good data showing that PRP helps with inflammatory tendon problems, and in some cases it can help a patient delay or even avoid surgery.”

In addition to healing tendons, the FDA-approved PRP technique can be used in certain cases to help heal damaged muscles and ligaments, and it can help relieve pain associated with cartilage tears and arthritis.

Superconcentrated Healing Platelets

The key to how PRP works lies in superconcentration of the platelets. As part of the treatment, about 30 milliliters (approximately 1 fluid ounce) of the patient’s blood is taken from the arm. The blood sample is then put in a centrifuge and spun down to separate the platelets from the plasma. The spinning process superconcentrates the platelets, which are then injected into the injured area of the patient’s body.

The procedure itself can be carried out during a single outpatient visit. The whole process takes about 30 minutes—and most of that time, Dr. Mwanika points out, is spent filling out the paperwork.

Both Dr. Mwanika and Dr. Panzarella inject the PRP into the target site with the assistance of ultrasound guidance, which permits them to see exactly where the needle is being placed.

“We want to make sure we’re injecting the PRP into the exact location of the damage,” explains Dr. Mwanika. “The use of ultrasound guidance helps to ensure that the platelets are going directly into the damaged area where they’re most needed.”

What Platelet-Enriched Plasma Can—and Cannot—Do

Dr. Panzarella notes that patients often ask if PRP can help regrow or regenerate torn or arthritic cartilage.

“The answer is no,” he says. “Even though platelets have growth factors, they won’t regrow damaged or torn cartilage. But PRP therapy can still help with reduction of pain and inflammation in cases of torn and damaged cartilage. Platelets have a natural anti-inflammatory property, and PRP can help reduce inflammation and its associated pain in many cases of arthritis, torn meniscus and similar cartilage problems.”

Dr. Mwanika adds that he has seen “huge success” in pain relief involving many cases of arthritis, particularly in the knee, ankle, hip and shoulder.

In cases where PRP seems to have a direct healing effect on structures like torn tendons and torn ligaments, the effect is dependent on the extent of injury.

Who is a Candidate for PRP?

Dr. Panzarella and Dr. Mwanika consider a number of criteria in helping patients decide whether PRP is right for them. These criteria include the extent, type and location of the injury; whether the patient is obese or severely diabetic; whether the patient smokes; and, in the case of arthritis, the level of severity. A patient’s medication list also can exclude them as a candidate for PRP. This discussion takes place during an initial office visit, when treatment options, including PRP, are considered.

If the patient is a good candidate, the next step is typically to schedule an MRI (magnetic resonance imaging) scan to determine the extent and precise nature of the patient’s problem. If an MRI has been done in the previous six months, that MRI often can be used instead of obtaining a new imaging study. If the patient decides to go forward with PRP therapy, an outpatient office visit is scheduled, during which the patient’s blood will be taken and spun down to concentrate the platelets, and then the patient will receive the injection.

After the injection, patients follow up with their physician within a week or two, and frequently are referred to rehabilitation, if appropriate.

Are There Any Risks Associated with PRP?

PRP injections involve little risk because the patient is receiving his or her own blood product, so there is no concern with mismatched blood typing, transmission of disease or risk of rejection.

“Anytime you stick a needle under the skin, there’s a risk of infection,” says Dr. Panzarella. “But that risk is very low—we clean the injection site really well.”

There also may be some pain involved with the injection, apart from the needle stick, notes Dr. Mwanika.

“We inject platelets into a damaged area that already may have been causing the patient discomfort,” says Dr. Mwanika. “But the pain is usually not severe, and we can have them take medication prior to the injection to make the pain tolerable. We can also continue them on a pain medicine regimen for a short time after the injection to keep them comfortable.”

Probably the biggest risk with PRP is that the treatment may not work. Both physicians point out to their patients that there are no guarantees with PRP, and insurance does not currently cover the cost of the procedure.

To help ensure that their patients have the best outcome possible with PRP, the physicians have some recommendations for their patients.

“I ask patients not to take any anti-inflammatory medications like ibuprofen, naproxen or meloxicam for 48 hours before their injection, and for a week afterwards,” says Dr. Panzarella. “Certain chemicals in nonsteroidal anti-inflammatory drugs like these can inhibit the release of healing elements from the platelets.”

Dr. Mwanika says he is often strict with some of his PRP patients, asking them to take it easy for a few days afterwards.

“It depends on the location of the injury,” he explains. “If it’s a foot injury, for example, I typically recommend patients stay off the foot for three to five days, depending on the extent of the injury. If it’s a wrist injury, like a tendon tear, I’ll put them in a brace to keep the wrist immobilized. I want to inject the PRP into the injured area and keep it there long enough to let it seed and take effect. If you use the injured joint too much after the injection, it tends to move the platelets out of the area, and that can cause the injection to be ineffective.”

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