PRP or platelet rich plasma can be defined as a volume of plasma that has higher concentration of platelets than whole blood. However, PRP preparations vary in terms of platelet concentration, activation factors, white or red blood cell presence and fibrin production.
PRP represents a treatment option for stimulation of soft tissue healing. Activation of PRP initiates platelet activation, clot formation, and growth and healing factor release at the injection site.
Clinical studies have assessed the use PRP for the following sports medicine conditions: medial and lateral epicondylitis, patellar tendonopathy, plantar fasciitis, muscle injury, ligament injury, tendon injury (Achilles, patellar, quadriceps, rotator cuff).
I have personally used PRP to augment tendon repair at the rotator cuff, patellar and quadriceps tendons.
PRP is best utilized as part of a multiple modality approach to treatment of soft tissue conditions Activity restriction, bracing, ice, anti-inflammatory medications, and physical therapy are noninvasive options that should be attempted initially.
PRP injection is an office-based procedure. Patients can eat and drink the night before the procedure and no special precautions usually are necessary. Once the injection is scheduled after failure of appropriate treatment and proper counseling, the patient comes to the office where a staff member will draw a specific amount of blood.The volume of blood varies but typically is similar to that drawn for hospital labs (about 20 cc). The blood is then placed in a centrifuge and spun to separate the blood into platelet rich and platelet poor components. The total centrifuge time can vary from 5-21 minutes. Once the PRP has been isolated, the injection site will be cleansed and the injection given. For difficult to identify lesions a ultrasound may be necessary to help identify the injection site. The injection typically does not cause any more discomfort than other standard Orthopedic injections and the skin and tissue overlying the injection site can be numbed with local anesthetic. Following injection activity restriction for 10-21 days is recommended along with ice and over the counter pain relievers as needed. Gentle stretching exercises can be initiate at the direction of your physician. Return to work varies depending upon the nature of the work. This could be up to 3 weeks for heavy demand occupations depending upon the injection given. If symptoms recur, the injection may need to be repeated at 3 week intervals for up to a total of 3 injections depending upon the condition.
This is a blog entry by one of our sports medicine contributing experts Dr. Michael Merkley of Midwest Orthopedic in Peoria, IL.
