January 2010 Newsletter

Archived Newsletters

Platelet Rich Plasma
By Dr. Stephen A. Hunt

Recently, Platelet-Rich Plasma, (PRP), has become a hot topic in the world of sports medicine. It has been widely publicized in the world of professional athletics, and may have great potential applications for common orthopaedic sports injuries. To understand this exciting new therapy, you need to know what PRP is, how it is made, what it’s used for, and ultimately whether it works.

What is PRP?
To understand PRP, it is important to understand platelets and plasma. Platelets are cells that are naturally made in human bone marrow. They have many functions because they carry a variety of proteins, but they are important in sports medicine because they are among the first cells involved in healing injured tissue. They play an important role in stopping bleeding by creating clots (aspirin helps prevent heart attacks by preventing platelet cells from creating clots in the heart vessels). These cells also help recruit other cells in the body to initiate the healing process.

Plasma refers to the fluid in the body that contains and transports the cells that compose blood, including platelets. PRP is plasma that has a higher concentration of platelets than normal (3-5x).

How is PRP made?
PRP is made from blood. To begin, a patient has blood drawn from their body – usually slightly more than would be drawn for typical blood work. This blood is then placed in a centrifuge to separate the various cells contained in blood into layers. The desired layer of plasma containing extra platelets can then be drawn into a syringe to be used in several ways.

What is PRP used for?
PRP may be used as a liquid injection into an area of damage, such as a ligament or tendon, or it can be created into a solid tissue that can be sutured into other tissues, such as the rotator cuff or an ACL graft.

PRP has been applied clinically in many different ways, to treat both acute and chronic disorders:

• Chronic Tendinopathy:
  • Lateral Epicondilitis (Tennis Elbow)
  • Patellar Tendinopathy (Jumper’s Knee)
  • Achilles Tendinopathy
• Plantar Fasciitis
• Acute Ligament injury (MCL)
• Acute Muscle injury
• Surgical Augmentation:
  • Achilles tendon repair
  • Rotator Cuff Repair
  • ACL reconstruction

Does PRP work?
The basic science (laboratory work) suggests great potential for PRP. However, the initial clinical application of this new technology has been driven more by enthusiasm than by convincing clinical data. Several published and on-going clinical trials are investigating the benefit of PRP. While some studies suggest improved healing from using PRP, other studies have not demonstrated any significant difference compared with current treatments. PRP is considered investigational. Therefore, some insurance companies may not cover the cost of the procedure, which may factor into its widespread use as a treatment. However, all studies seem to indicate it is a safe treatment, as it is basically injecting your own blood back into your body.

What does the future hold for PRP?
There are many more studies underway investigating the benefits of PRP. The next several years should yield useful information whether PRP is in fact working as well as we hope it is.

References

1. Hall MP et al. Platelet-rich Plasma: Current Concepts and Application in Sports Medicine. J Amer Acad Orthop Surg 2009; 17:602-8.
2. Jones GL. Basic Science and Clinical Applications of Platelet-rich Plasma. Sports Med Update 2010; Jan/Feb: 2-6.