Platelet Rich Plasma (PRP)
What is Platelet Rich Plasma?
Platelet-rich plasma, which is taken from a person’s own blood and delivered into an injured area of bone or soft tissue. Bone and soft tissue injuries heal in many stages, which is initiated by inflammation and an increase in cells essential for healing. Platelets are specialized cells that circulate through the blood as a source of both growth and cellular signaling factors that are required for healing. For this reason, the use of PRP treatment in orthopedics is becoming a more popular option for non-healing or chronic injuries given its potential to give a biological boost to the healing process using only one’s own blood.
Who is a Candidate for PRP?
PRP is a second line treatment for chronic injuries, usually in patients who have pain for more than several months. It is utilized in both bone and soft tissue injuries including but not limited to osteoarthritis, tennis elbow, hamstring tendinopathy, Achilles tendinopathy, rotator cuff tears, and plantar fasciitis.
How is PRP Performed?
A sample of blood is obtained from the patient (30-60ml), and the blood is placed into a centrifuge, which is a tool that separates the blood into many components. The portion of concentrated platelets is then injected into the site of injury with ultrasound guidance to ensure localization. The entire procedure takes about 45-60 minutes.
What Is Involved in Pre-Procedure Planning?
Anti-inflammatory medications (motrin, advil, aleve, ibuprofen, meloxicam, diclofenac, naproxen, indomethasin) should be stopped 1 week before and 2 weeks after an injection because they block the initial inflammatory response that PRP is designed to stimulate and optimize. You may utilize acetaminophen (Tylenol) before or after the procedure.It may be helpful to have a companion present for assistance with transportation home.
What Happens After PRP?
Patients may experience more pain the first 1-2 weeks after the injection. This is a normal reaction and part of the inflammation that triggers the healing process. Tylenol and ice may be utilized for pain management. Again, it is recommended to avoid NSAIDS. While responses to treatment vary, most people will require a series of 1 to 3 injections. Each injection should be spaced about 2 months apart. There is no limit to the number of injections you can have: the risks and side effects do not change with the number of injections.
For the day of the procedure and the day after, limit the activity to the injection site to activities of daily living. Slowly over the course of 3-4 weeks, you may begin to progress activity as tolerated. It is expected that it will take up to 8 weeks to adequately assess your response to therapy. A follow up appointment with be scheduled at this time to assess your response to therapy.
What are the Common Side Effects?
Although every medical procedure carries risk, serious complications are rare. Pain after the procedure is common and usually settles in a couple of days. Persistent pain is uncommon. The most commonly reported side effect of the procedure is tenderness at the site of the injection. Because the injection is conducted with the patient’s own blood, the risk of contamination and infection is greatly reduced. Please contact your provider if you have signs of infection at your procedure site (yellow discharge, abnormal pain, heat, swelling or a temperature), severe headache, severe pain at procedure site or any questions or concerns.
Is PRP Effective?
While PRP is currently undergoing additional studies and has been injected for many musculoskeletal disorders, carefully controlled studies are not available for the majority of musculoskeletal injuries. As such, how effective PRP will be in treating particular conditions is not known. Studies in animal models suggest that PRP treatment can improve healing in soft tissue and bone, noting increased number of healing cells and improved tendon strength after injection. Overall, more studies are needed to prove the effectiveness of PRP treatment, but because PRP is created from the patient’s own blood, it is considered a relatively low-risk treatment with the potential to improve or speed healing.
Will My Insurance Pay for PRP?
Currently, PRP is not approved by the FDA for musculoskeletal injuries. Thus, other than worker’s comp, PRP procedures are not covered by insurance. Each PRP injection costs $950 prior to an injection visit. For worker’s comp insurance, there will be pre-approved required prior to the procedure.
Supplemental Reading
Results of preliminary scientific studies and review ae reticles are listed below.
Dejnek, Maciej; Moreira, Helena; Płaczkowska, Sylwia; Barg, Ewa; Reichert, Paweł; Królikowska, Aleksandra (2022-06-27). "Effectiveness of Lateral Elbow Tendinopathy Treatment Depends on the Content of Biologically
Active Compounds in Autologous Platelet-Rich Plasma". Journal of Clinical Medicine. 11 (13): 3687.
Franchini M, Cruciani M, Mengoli C, Marano G, Pupella S, Veropalumbo E, Masiello F, Pati IVaglio S,
Liumbruno GM (November 2018). "Efficacy of platelet-rich plasma as conservative treatment in orthopaedics: a
systematic review and meta-analysis". Blood Transfusion = Trasfusione del Sangue. 16 (6): 502–513.
Griffin XL, Smith CM, Costa ML (February 2009). "The clinical use of platelet-rich plasma in the promotion of bone healing: a systematic review". Injury. 40 (2): 158–62.
Prodromos, Chadwick C.; Finkle, Susan; Prodromos, Alexandra; Chen, Jasmine Li; Schwartz, Aron; Wathen, Lucas (2021-05-29). "Treatment of Rotator Cuff Tears with platelet rich plasma: a prospective study with 2 year
follow-up". BMC Musculoskeletal Disorders. 22 (1): 499.
Shen L, Yuan T, Chen S, Xie X, Zhang C (January 2017). "The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials". Journal of Orthopaedic Surgery and Research. 12 (1): 16.
Zhang, YJ; Xu, SZ; Gu, PC; Du, JY; Cai, YZ; Zhang, C; Lin, XJ (August 2018). "Is Platelet-rich Plasma Injection Effective for Chronic Achilles Tendinopathy? A Meta-analysis". Clinical Orthopaedics and Related
Research. 476 (8): 1633–1641.
