Platelet Rich Plasma (PRP) Therapy

Platelet Rich Plasma, or PRP, is blood plasma with concentrated platelets and other growth factors. The concentrated platelets found in PRP contain huge reservoirs of bioactive proteins, including growth factors and signaling proteins that are vital to initiate and accelerate tissue repair and regeneration. The most important of these are Platelet-Derived Growth Factor (PDGF), Transforming Growth Factor (TGF-beta), and Epidermal Growth Factor (EGF). Treatment of tissues with PRP activates the Adult Stem Cells, which are found in all tissues, to "wake up" and begin directing the healing process. The stem cells then direct the surrounding tissues to regenerate, primarily through release of Hepatocyte Growth Factor (HGF), Vascular Endothelial Growth Factor (VEGF) and Stromal Cell-Derived Growth Factor 1 (SDF-1). These factors then promote development of new blood vessels and stimulate the wound healing process.

PRP is still considered to be cutting edge technology here in the U.S., but studies on PRP have been carried out for over 20 years, and it is widely used in Europe and many Asian countries. We offer PRP at Nouveau Jeunesse because we believe in the science of PRP therapy and know first-hand how effective it can be in helping our patients heal. PRP is typically used for soft tissue injuries involving muscle, ligaments, and tendons. PRP is a treatment option for various orthopedic and soft tissue injuries and conditions, arthritis of virtually any joint, tendonitis, muscle sprains and tears, and ligament injuries. These include many common conditions, such as tennis and golfers’ elbow, Achilles and knee tendonitis, rotator cuff injuries and meniscus injuries.

PRP is prepared from a small amount of the patient’s own blood, which is then placed in a centrifuge. The centrifuge spins and separates the plasma, now rich in platelets, from the rest of the blood components. The entire process takes less than 20-25 minutes. By using the concentrated platelets in plasma, we increase the dramatically increase the concentration of growth factors necessary to start the healing process.

The healing process that is initiated by the PRP injections is not immediate. Healing takes time, usually between one to three months. Depending on the severity of the injury and the individual’s healing response, one to several injections of PRP may be needed. Also, the number of Adult Stem Cells in your body decreases with age, and therefore older patients usually require more injections. Typically, younger people generally need fewer injections for the same condition since they have a greater number of stem cells.

There are several ways to maximize the results of PRP treatment. Smoking and alcohol diminish stem cell function and therefore should be avoided. Also, the initiation of tissue healing and activation of the stem cells is caused by an inflammation. For this reason, NSAIDS (non-steroidal anti-inflammatory drugs, such as aspirin, ibuprofen, Naprosyn, etc.) should not be taken for 4 weeks after PRP injections. The use of omega 3-fish oil and other natural anti-inflammatory agents, such as fish oil, do not work the same way and are thus not restricted.

After the injection is given, there may be an increase in pain for variable periods of time. Tylenol and possibly a mild narcotic can be used during this period of time. The pain may wax and wane, going up then down like a roller coaster ride, several times during the healing process. Ultimately, most patients gets significant healing and improvement of function, and decreased or totally absent pain.

ADDITIONAL GENERAL READING LINKS

Pro Athletes Turn to Platelet-Rich Plasma Therapy, But Is it Cheating?
A Promising Treatment for Athletes, in Blood
Platelet Rich Plasma Accelerates Healing of Athletic Injuries
Platelet-Rich Plasma: Does It Work?
Platelet-Rich Plasma Helps Tennis Elbow- PRP Beats Cortisone Shots for Tennis Elbow
Clinical use of platelet-rich plasma in orthopaedics
The Value Of PRP In Orthopedics
Platelet-rich plasma debated as treatment for joints, tendons
Platelet Rich Plasma: Can It Have An Impact For Tendinosis And Plantar Fasciosis?

SCIENTIFIC PUBLICATIONS

Review Articles

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.
[Download full article]

Tate K, MD, Crane D.
Platelet Rich Plasma Grafts in Musculoskeletal Medicine
Journal of Prolotherapy. 2010 May; 2(2): 371-376.
[Download full article]

Crane D, Everts P.
Platelet Rich Plasma (PRP) M atrix Grafts. Practical Pain Management
2008:8 (1):11-26.
[Download full article]

Hall MP, Band PA, Meislin RJ, Jazrawi LM, Cardone DA.
Platelet-rich plasma: current concepts and application in sports medicine
J Am Acad Orthop Surg. 2009 Oct;17(10):602-8.
[View abstract]

Sánchez 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.
[View abstract]

Molloy T, Wang Y, Murrell G. 2003.
The Roles of Growth Factors in Tendon and Ligament Healing
Sports Med. 33(5):381-394
[View abstract]

Human Studies: Tendon/Ligament

ELBOW

Rabago D, Best TM, Zgierska AE, Zeisig E, Ryan M, Crane D
A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma.
Br J Sports Med; 2009 Jul;43(7):471-81
[Go to article]

Alsousou J, Thompson M, Hulley P, Noble A, Willett K
The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: a review of the literature.
J Bone Joint Surg Br; 2009 Aug;91(8):987-96
[Go to article]

Hall MP, Band PA, Meislin RJ, Jazrawi LM, Cardone DA
Platelet-rich plasma: current concepts and application in sports medicine.
J Am Acad Orthop Surg; 2009 Oct;17(10):602-8
[Go to article]

Peerbooms, J. C., Sluimer, J., Bruijn, D. J., Gosens, T.
Positive Effect of an Autologous Platelet Concentrate in Lateral Epicondylitis in a Double-Blind Randomized Controlled Trial: Platelet-Rich Plasma Versus Corticosteroid Injection With a 1-Year Follow-up
Am J Sports Med 38: 255-262
[View abstract]

Mishra A, Pavelko T.
Treatment of chronic elbow tendinosis with buffered platelet-rich plasma
Am J Sports Med. 2006 Nov;34(11):1774-8.
[View abstract]

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

FOOT/ANKLE

Gaweda K.
Treatment of Achilles Tendinopathy with Platelet RichPlasma
International Journal of Sports Med, June 2010.
[View abstract]

P Robert J. de Vos et al.
Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy: A Randomized Controlled Study
JAMA 2010, 3003(2): 144-149.
[Full article]

Monto, R.
Platelet Rich Plasma (PRP) Effectively Treats Chronic Achilles Tendinosis
2010 Annual American Academy of Orthopaedic Surgeons meeting Podium Presentations.
[Read]

O’ Malley M.
Platelet-rich plasma (PRP) in managing Achilles tendinosis
2010 Annual American Orthopaedic Foot & Ankle Society (AOFAS) Meeting.
[Read]

Filardo, G, Lo Presti M, Kon E, Marcacci M. 2010.
Nonoperative Biological Treatment Approach for partial Achilles Tendon Lesion
Orthopedics 1;33(2):120-3.
[Full article]

Barrett S, Erredge S.
Growth factors for chronic plantar fasciitis
Podiatry Today 2004;17:37.
[Full article]

KNEE

Elizaveta Kon, Roberto Bnda, Ginseppe Filardo, Alessandro Di Martino, Antonio Timoncini, Annarita Cenacchi, Pier Maria Fornasari, Sandro Giannini, Maurilio Marcacci.
Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions
Knee Surg Sports Traumatol Arthrosc. Sept 2009: 0940-8.
[Download full article]

Sanchez M, Azofra J, Anitua E, Andia I, Padilla S, Santisteban J, Mujika I (2003).
Plasma rich in growth factors to treat an articular cartilage avulsion: a case report
Med Sci Sports Exerc 35:1
[Download Full Article]

Berghoff W, Pietrzak W, Rhodes R.
Platelet-rich plasma application during closure following total knee arthroplasty
Orthopedics. 2006;29(7):590–8.
[Full article]

Gardner MJ, Demetrakopoulos D, Klepchick P, Mooar P.
The efficacy of autologous platelet gel in pain control and blood loss in total knee arthroplasty: an analysis of the haemoglobin, narcotic requirement and range of motion Int Orthop. 2006;31:309–13.
[View abstract]

Everts P, Devilee R, Mahoney C, Eeftinck-Schattenenkerk M, Knape J, Van Zundert A.
Platelet gel and fibrin sealant reduce allogeneic blood transfusions in total knee arthroplasty
Acta Anaesthesiol Scand. 2006;50:593–9.
[View abstract]

Human Studies: Muscle

Hammond JW, Hinton RY, Curl LA, Muriel JM, Lovering RM
Use of autologous platelet-rich plasma to treat muscle strain injuries.
Am J Sports Med; 2009 Jun;37(6):1135-42
[Go to article]

Nikolidakis D, Jansen JA
The biology of platelet-rich plasma and its application in oral surgery: literature review.
Tissue Eng Part B Rev; 2008 Sep;14(3):249-58
[Go to article]

Borrione, Paolo MD; Gianfrancesco, Alessia Di PharmD; Pereira, Maria Teresa MD; Pigozzi, Fabio MD
Platelet-Rich Plasma in Muscle Healing
American Journal of Physical Medicine & Rehabilitation: October 2010 – Volume 89 – Issue 10 – pp 854-861.
[View abstract]

Mishra A, Woodall Jr. J, Vieira A. 2009.
Treatment of Tendon and Muscle Using Platelet-Rich Plasma
Clin Sports Med 28(1): 113-25.
[Download article]

Carpenter, T et al.
Treatment of muscle injuries by local administration of autologous conditioned serum: a pilot study on sportsmen with muscle strains
Int J Sports Med, 2004. 25:589-594.
[View abstract]

Hammond, JW et al.
Use of autologous platelet-rich plasma to treat muscle strain injuries
American Journal of Sports Med, 2009. 37 (6): 1135-1142.
[Download article]

Human Studies: Arthritis/Cartilage

Sampson, S.
Injection of Platelet-Rich Plasma in Patients with Primary and Secondary Knee Osteoarthritis: A Pilot Study
American Journal of Physical Medicine & Rehabilitation. Nov 20, 2010 online, Dec 2010 print. Page numbers pending.
Hunziker EB, Driesang IM, Morris EA. Clinical orthopaedics and related research.
Chondrogenesis in cartilage repair is induced by members of the transforming growth factor-beta superfamily
Clin Orthop Relat Res. 2001;391(Suppl):S171–81.
[View abstract]

Nakagawa K, Sasho T, Arai M, Kitahara S, Ogino S, Wada Y, et al.
Effects of autologous platelet-rich plasma on the metabolism of human articular chondrocytes
Chiba and Ichihara, Japan. Electronic poster presentation P181. International Cartilage Repair Society Meeting, Warsaw Poland, October 2007.
Kon E, Filardo G, Presti ML, Delcogliano M, Iacono F, Montaperto C, et al.
Utilization of platelet-derived growth factors for the treatment of cartilage degenerative pathology
Bologna, Italy. Electronic poster presentation 29.3. International Cartilage Repair Society Meeting, Warsaw Poland, October 2007.
Anitua E, Sanchez M, Nurden AT, Zalduendo MM, De La Fuente M, Azofra J, et al.
Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients Rheumatology. 2007;46(12):1769–72.
[View abstract]

Kon E, Buda R, Mandelbaum B, Filardo G, Timoncini A, Delcogliano M, Fornasari P, Giannini S, Marcacci M.
PRP intra-articular injection versus viscosupplementation as treatments for early osteoarthritis
Podium Presentation, # 685. American Academy of Orthopaedic Surgeons, New Orleans LA. March 12, 2010.
[View]

Wu W, Zhang J, Dong Q, Liu Y, Mao T, Chen F
Platelet-rich plasma – A promising cell carrier for micro-invasive articular cartilage repair. [Journal Article, Research Support, Non-U.S. Gov't]
Med Hypotheses 2009 Apr; 72(4):455-7.
[View Abstract]

Sun, Y et al.
The regenerative effect of platelet-rich plasma on healing in large osteochondral defects
International Orthopaedics, 2010. 34:589-597.
[View abstract]

Animal Studies

Harris, N. Lindsay, MD; Purnell, Mark L., MD; Huffer, William E., MD; Larson, Andrew I.
The Effect of Platelet-Rich Plasma (PRP) on Normal Soft Tissues in the Rabbit BSME
Phinney, Shawn, MA; Von Stade, Eleanor F., MD. Aspen Orthopaedics Associates and Aspen Sports Medicine Foundation (AMSF).
[Download full article]

Wu W, Chen F, Liu Y, Ma Q, Mao T
Autologous injectable tissue-engineered cartilage by using platelet-rich plasma: experimental study in a rabbit model. [Journal Article, Research Support, Non-U.S. Gov't]
J Oral Maxillofac Surg 2007 Oct; 65(10):1951-7.
[View Abstract]

Bir SC, Esaki J, Marui A, Yamahara K, Tsubota H, Ikeda T, Sakata R
Angiogenic properties of sustained release platelet-rich plasma: characterization in-vitro and in the ischemic hind limb of the mouse. [Comparative Study, In Vitro, Journal Article]
J Vasc Surg 2009 Oct; 50(4):870-879.e2.
[View Abstract]

Aspenberg P, Virchenko O. 2004.
Platelet concentrate injection improves Achilles tendon repair in rats
Acta Orthop Scand 75(1):93-9.
[Download article]

Taylor M, Norman T, Clovis N, Blaha D.
The response of rabbit patellar tendons after autologous blood injection
Med Sci Sports Exerc. 2002;34(1):70–3.
[View abstract]

Carpenter, T, et al.
Treatment of muscle injuries by local administration of autologous conditioned serum: animal experiments using a muscle contusion model
Int J Sports Med, 2004. 25:1-6.
[Download article]

PRP Physiology

Eppley BL, Woodell JE, Higgins J
Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing
Plast Reconstr Surg. 2004 Nov;114(6):1502-8.
[View abstract]

Wang P, Qu Y, Man Y
Platelet-rich plasma as a scaffold for injectable soft-tissue augmentation. [JOURNAL ARTICLE]
Cytotherapy 2010 May 21.
[View Abstract]