Thursday, December 3, 2009

Does Platelet Rich Plasma Really Work?


By Amy Price PhD

What is Platelet Rich Plasma Treatment (PRP)?


PRP has been around since the 1980s but mostly as an adjunct to surgical or dental procedures. PRP patients have a small amount of their own blood removed and then processed through a centrifuge machine. The high speed rotation separates red blood cells from the platelets. A teaspoon or two of the clear platelet rich concentrate (3 to 10 times that of regular blood) will be returned and injected into damaged areas to catalyze the growth of new cells.

Various methods are now commercially available for preparing PRP and a similar material called “autologous growth factor,” which is PRP plus the white blood cell buffy coat obtained during PRP preparation. As a result, assessment of these strategies in clinical orthopedic practice has accelerated.

The platelet rich mixture can be injected where the area does not normally have a rich blood supply and has the advantage of not triggering a clotting response. Patients are their own donors so there is little risk of rejection, allergy or transmissable infections Some stem cell companies are combining PRP with stem cell therapy to increase healing results. The theory and technique behind PRP is similar to that of Prolotherapy (proliferation therapy). Typically Prolotherapy treatments are offered first, and mostly resolve musculoskeletal problems. When results from traditional Prolotherapy treatments are not adequate, PRP may be employed. PRP and Prolotherapy, are office procedures.

How does PRP therapy help?

The body’s responds to injury by mobilizing platelet cells. Platelets are packed with multiple healing and growth factors which initiate repair while attracting stem cells the bodies built in construction managers. PRP intensifies the body’s healing efforts by delivering concentrated platelets. The technique appears to help regenerate ligament and tendon fibers, which shortens rehabilitation time.

How long will it take?

One to two hours, including preparation and recovery time is the average time for the procedure. Advantages include pain relief and speedy healing without the risk of surgery, Many individuals can return to work right after the procedure.

How often can a person have PRP done?

The norm is three injections within a six-month time frame, two to three weeks apart. Relief is usually recognized after the first or second injection.

What are the expected results?

Initial improvement may be seen within a few weeks, gradually increasing as the healing progresses. Some doctors describe PRP as a growth factor cocktail. MRI images after PRP have shown definitive tissue repair. It seems to work better on soft tissue areas like tendons and ligaments, in bone injury it may even slow healing. Results are donor dependent and certain health conditions such as diabetes, thyroid disease or habits like smoking and heavy drinking may hinder the effectiveness as can hormone deficiencies. Younger patients and athletes have more growth factors resident in platelets so this makes them better overall candidates Research into the effects of platelet-rich plasma therapy has accelerated in recent months, with most doctors cautioning that more rigorous studies are necessary before the therapy can emerge as scientifically proven. Even with a 20-40% failure rate many researchers suspect that the procedure could grow in attractiveness treatment for reasons both medical and financial. PRP is about 2000.00 dollars, stem cell therapy is about 8000.00 per site plus travel, diagnostics, preparation and time whereas surgery is much more expensive with extensive recuperation time. PRP has also been used to augment surgery with promising results.

References

1. Rai B, Oest ME, Dupont KM, Ho KH, Teoh SH, Guldberg RE: Combination of platelet-rich plasma with polycaprolactone-tricalcium phosphate scaffolds for segmental bone defect repair. J Biomed Mater Res A 2007;81:888-899.

2. Sipe JB, Zhang J, Waits C, Skikne B, Garimella R, Anderson HC: Localization of bone morphogenetic proteins (BMPs)-2, -4, and -6 within megakaryocytes and platelets. Bone 2004;35:1316-1322.

3. Kark LR, Karp JM, Davies JE: Platelet releasate increases the proliferation and migration of bone marrow-derived cells cultured under osteogenic conditions. Clin Oral Implants Res 2006;17:321-327.

4. Gruber R, Kandler B, Fischer MB, Watzek G: Osteogenic differentiation induced by bone morphogenetic proteins can be suppressed by platelet-released supernatant in vitro. Clin Oral Implants Res 2006;17:188-193.

5. Ranly DM, McMillan J, Krause WF, Lohmann CH, Boyan BD, Schwartz Z: Platelet-rich plasma: A review of its components and use in bone repair, in Akay M (ed): Encyclopedia of Biomedical Engineering, vol 5. Hoboken, NJ: John Wiley & Sons, Inc., 2006, pp 2804-2815.

6. Ranly DM, Lohmann CH, Andreacchio D, Boyan BD, Schwartz Z. Platelet-rich plasma inhibits demineralized bone matrix-induced bone formation in nude mice. J Bone Joint Surg Am 2007;89:139-147.

7. Schwartz Z, Somers A, Mellonig JT, et al: Ability of commercial demineralized bone allograft to induce bone formation is donor age-dependent but not gender-dependent (abstract). Trans Orthopaed Res Soc 1997;22:230.

8. Weibrich G, Kleis WK, Hitzler WE, Hafner G. Comparison of the platelet concentrate collection system with the plasma-rich-in-growth-factors kit to produce platelet-rich plasma: A technical report. Int J Oral Maxillofac Implants 2005;20:118-123.

9. Thibault L, Beausejour A, de Grandmont MJ, Lemieux R, Leblanc JF: Characterization of blood components prepared from whole-blood donations after a 24-hour hold with the platelet-rich plasma method. Transfusion 2006;46:1292-1299.

10. Li H, Zou X, Xue Q, Egund N, Lind M, Bunger C: Anterior lumbar interbody fusion with carbon fiber cage loaded with bioceramics and platelet-rich plasma: An experimental study on pigs. Eur Spine J 2004;13:354-358.

11. Weiner BK, Walker M: Efficacy of autologous growth factors in lumbar intertransverse fusions. Spine 2003;28:1968-1970.

12. Muschler GF, Nitto H, Matsukura Y, et al: Spine fusion using cell matrix composites enriched in bone marrow-derived cells. Clin Orthop Relat Res 2003;(407):102-118.

13. Muschler GF, Matsukura Y, Nitto H, et al: Selective retention of bone marrow-derived cells to enhance spinal fusion. Clin Orthop Relat Res 2005;(432):242-251.

14. Brodke D, Pedrozo HA, Kapur TA, et al: Bone grafts prepared with selective cell retention technology heal canine segmental defects as effectively as autograft. J Orthop Res 2006;24:857-866.

15. Murray MM, Spindler KP, Ballard P, Welch TP, Zurakowski D, Nanney LB: Enhanced histologic repair in a central wound in the anterior cruciate ligament with a collagen-platelet-rich plasma scaffold. J Orthop Res 2007;25:1007-1017.

2 comments:

  1. Dr. Amy:

    Nice discussion of PRP. You may wish to considering adding some of the references about the clinical trials for chronic tendonitis. I have them listed via links off of my PRP sites: BloodCure.com and ApexPRP.com

    Keep up the excellent posts.

    AM

    ReplyDelete
  2. Thanks Doc,
    I had a look at your sites and there are a lot of great refs and info there!

    ReplyDelete