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.

Scar Care Hints and Tips

By Amy Price PhD

Scar care can make a difference in how you heal. In Europe and Canada scar aftercare is taught following an injury or surgery. It is important that the scar is allowed to heal shut before any attempt is made to cover it with silicone or massage it.

Your doctor is the best one to advise you about the best time to start. If the scar becomes hot, oozes, or bleeds a lot get medical attention. If the area turns black, is extremely painful or very dark, smells,or has dark lines leading way from the wound get it checked by a doctor. Remember some emergency rooms have as high as a 30%return visit ratio so being seen in emergency does not necessarily mean all is well.

If dissolving stitches were used to repair the wound follow your doctors advice for care. The surgeon who repaired my hand and wrist suggested using antibiotic ointment with Zinc oxide until the wound healed and using hand sanitizer for the areas that contained pins. I was urged not to get it wet because the pins go into the bone and infection can become systemic if bacteria is allowed to enter.

Once the wound has healed gentle massage using cream, vitamin E, olive oil, evening primrose oil will keep the area lubricated and help soften it. I was advised to use small circular motions in both directions to break up adhesions and to promote circulation. Gentle but firm consistent pressure is needed. Getting over enthusiastic can re-injure tissue and cause inflammation.

Silicone pads cut to the wound size are very effective in taking away redness,and to reduce raised scars. It does take a few weeks to show results so be patient. The silicone pads can be bought as washable reusable patches that last about a month or as disposable patches that you use and throw away.Best results come from leaving the patches on about 12 hours at a time. They should not be used on open wounds because of the risk of infection. First aid tape can be used to keep the scar sheet in place. Avoid getting it wet. If you are allergic to silicone there are polymer patches that work the same way.

Silicone gel is good to use on areas like knuckles, elbows or the face. It is very important to protect the scarred area from sun exposure for at least two years to avoid damage to skin.

If you are unfortunate enough to experience a road rash scar keep it covered and moist until the skin underneath heals. Burn dressings available at a pharmacy work quite well. Keep it clean with saline and antibiotic ointment rather than using hydrogen peroxide or other harsh disinfectants that will burn and damage the skin underneath. If it is a large area using a cut up tube sock over the dressing can protect it. Remember to keep the dressing and the area clean to promote healing.

Diet makes a difference this is a good time to eat fruits and vegetables plus sufficient protein. Fish oil, vitamin C and antioxidants will help to promote healing.

This Post is for educational patient to patient purposes only and is not meant to treat, diagnose or take the place of medical care or advice.