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PRP

Platelet rich plasma injections (PRP injections)


PRP injections are a new medical technology used in the treatment of knee/hip and other joint arthritis and also for many sporting injuries. This website aims to provide information about this therapy and where it can be performed.

The field of sports medicine is advancing at a rapid pace and is encouraging millions of people from athletes to the general population to participate in regular activity to stay healthy and active. However this increase in physical activity has also seen an increase in musculoskeletal injuries. The World Health Organisation has recently recognised that musculoskeletal injuries affect hundreds of millions of people worldwide and are the most common cause of severe long term pain and physical disability. In Australia alone, there are almost 4 cases of medically treated sporting injuries per 100 persons.

Soft tissue injuries which include ligament and tendons represent up to 45% of all musculoskeletal injuries. The increasing participation in sporting activities coupled together with improved modern imaging techniques such as MRI and high resolution ultrasound have helped sports medicine practitioners to better understand these injuries.

History

Autologous platelet rich plasma (PRP) injections were first used in 1987 in open heart surgery. Today, PRP injections have been safely used in many fields including sports medicine, orthopaedics, cosmetics, fasciomaxillary and urology.

PRP

Blood contains plasma, red blood cells, white blood cells and platelets. Platelets are small discoid cells with a life span of about 7-10 days. Inside platelets contain granules which contain clotting and growth factors. During the healing process, the platelets are activated and aggregate together. They then release the granules which contain growth factors which stimulate the inflammatory cascade and healing process.

Blood typically contains 6% platelets whereas PRP has a significantly increased supra-physiological platelet concentration. Although this level can vary depending on the method of extraction and equipment, studies have shown that clinical benefit can be obtained if the PRP used has an increased platelet concentration of 4x greater than normal blood.

Treatable Conditions

Platelet rich plasma injections (PRP injections) can be used in the treatment of many musculoskeletal injuries including that of tendons, muscles and joints.

Typically 2 or more injections are required, separated by 4-6 weeks apart. This may vary dependant on your injury.

Platelet Rich Plasma (PRP) Injections for Osteo-Arthritis

The use of PRP for treatment of OA of the knee is relatively new but has become a preferred choice for many surgeons in the country and around the world as the results that have been published have shown very strong improvement in patient satisfaction.
The main joint that has been treated with PRP is the knee. There are many recent research which shows very promising results in this field.
Joints that can been treated with PRP is as follows :

Platelet Rich Plasma (PRP) Injections for Tendons

What is the structure of tendons?

Tendons are made of special cells called tenocytes, water and fibrous collagen protein. These proteins weave together to make a strong durable structure that naturally anchor to bone.

Tendons can transfer great force and thus can be injured if they are overused or overwhelmed. If this occurs, micro tears start to form in the collagen.

How do tendons heal after injury?

Injured tendons heal by scarring - this affects their strength and hence increases the risk of re-injury. Also, because tendons do not have a good blood supply, they tend to heal slower than other soft tissues.

Why is my tendon injury not improving?

As tendons have a poor blood supply, there is only a minimal inflammatory response. Without inflammation, the tendon repair system is limited and an abnormal pathological response occurs called angiofibroblastic degeneration. This degenerative response to the micro tears in collagen is the essence of tendinopathy or tendinosis. Often pain, localised tenderness, swelling and impaired performance occurs.

How have tendons been treated traditionally?

Traditional therapies do not address the inherently poor healing properties of tendons. Corticosteoid is sometimes injected but adverse effects such as atrophy and permanent structural damage to tendons can occur. Non steroidal anti-inflammatory medications (NSAIDs) can cause gastrointestinal or kidney damage.

How is PRP different?

PRP injections aim to embrace and stimulate the inflammatory process which in turn will encourage the healing process. PRP focuses on restoring normal tissue composition while avoiding further degeneration.

Which tendon injuries can be treated with PRP?

PRP can be injected into:

Platelet Rich Plasma (PRP) Injections for Muscle Strains / Tears

PRP can potentially accelerate muscle healing and reduce injury time. The early blood clot can be substituted by PRP with its supraphysiological concentration of growth factors which stimulates the healing process.

PRP can be injected into the: PRP has the potential to heal other injuries including: Biomet Biologics-GPS-PRP includes

Reference

Filardo G, Kon E, Pereira Ruiz MT, Vaccaro F, Guitaldi R, Di Martino A, Cenacchi A, Fornasari PM, Marcacci M.
Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach. Knee Surg Sports Traumatol Arthrosc. 2011 Dec 28.

Kon E, Mandelbaum B, Buda R, Filardo G, Delcogliano M, Timoncini A, Fornasari PM, Giannini S, Marcacci M.
Arthroscopy.Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. 2011 Nov;27:1490-501. Epub 2011 Aug 10.

Sanchez M, Guadilla J, Fiz N, Andia I.
Ultrasound-guided platelet-rich plasma injections for the treatment of osteoarthritis of the hip.
Rheumatology (Oxford). 2012 Jan;51(1):144-50. Epub 2011 Nov 10.

Filardo G, Kon E, Buda R, Timoncini A, Di Martino A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M.
Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2011 Apr;19(4):528-35. Epub 2010 Aug 26.

Wang-Saegusa A, Cugat R, Ares O, Seijas R, Cusco X, Garcia-Balletbo M.
Infiltration of plasma rich in growth factors for osteoarthritis of the knee short-term effects on function and quality of life. Arch Orthop Trauma Surg. 2011 Mar;131(3):311-7. Epub 2010 Aug 17.

Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M.
Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010 Apr;18(4):472-9. Epub 2009 Oct 17.

Sampson S, Gerhardt M, Mandelbaum B.
Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 2008 Dec;1(3-4):165-74.

Antitua E, Andia I, Sanchez M, Azofra J, Del Mar Zalduendo M, De La Fuente M, et al.
Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF productions by human tendon cells in culture.
J Orthop Res. 2005;23:281-6.

Fenwick SA, Hazlelman BL, Riley GP.
The vasulature and its role in the damaged and healing tendon. Arthritis Res. 2002;4: 252-60.

Hayem G.
Tenology: a new frontier. Joint, Bone, Spine. Rev Rhum. 2001;68:19-25.

Mishra A, Pavelko T.
Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006;10(10):1-5.

Jobe F, Ciccotti M.
Lateral and medial epicondylitis of the elbow. J Am Acad Orthop Surg. 1994;2:1-8.

Edwards SG, Calandruccio JH.
Autologous blood injections for refractory lateral epicondylitis. Am J Hand Surg. 2003;28(2): 272-8.

Sanchez M, Anitua E, Orive G, Mujika I, Andia I.
Platelet-rich therapies in the treatment of orthopaedic sport injuries. Sports Med. 2009;39(5):345-54.








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