During the past 10 years, the sports medicine community has increased the use of non-operative treatments for musculoskeletal injuries. You may have even heard news reports of professional athletes pursuing non-operative treatments to try to avoid surgery and speed up the healing process of their injuries.
There are several non-operative alternatives, but the one that has gained the most attention in recent years is platelet-rich plasma (PRP), an evolving treatment modality where a concentrated platelet preparation of a patient’s own blood is made through centrifugation and separation. It is then injected into the injured area, typically using the guidance of ultrasound.
Platelets are cells that play a major role in the coagulation and healing process of the human body. When platelets are activated, they release key growth factors that modulate cellular functions, including cell proliferation, differentiation, tissue regeneration and wound healing.
At the time of a muscle, tendon or ligament injury, the body goes through different healing phases. The first phase that appears after an injury is the inflammatory phase followed by the proliferation phase and finally, a regenerative phase. There are occasions when the body takes longer to move from one healing phase to another. This is when PRP can be an effective, non-operative treatment alternative. The goal is to activate the growth factors and release them at the site of injury to aid in the healing process.
One major benefit of PRP is that it carries minimal or low risk. As with any kind of injection though, there is the risk of skin infection at the injection site. However, there is no risk of transmissible infection since the patient’s own blood is used. There is also a very low risk for allergic reaction.
As a non-operative sports medicine physician, I offer PRP treatments as appropriate to my patients when traditional conservative treatments such as oral non-steroidal anti-inflammatory medications, physical therapy or home exercises have failed to provide relief. Not everybody will be a candidate for PRP therapy. Your treating physician will conduct an initial evaluation. Most patients who are candidates will undergo at least two PRP treatments separated by several weeks. Your physician will evaluate you before the second treatment to see how you responded to the initial injection and determine if further treatment is needed.
Although there have been numerous studies on different types of injuries and the use of PRP, there are no formal guidelines yet for its use. Some of the injuries that have been successfully treated using PRP therapy include acute/chronic Achilles tendinosis, plantar fasciitis, patellar tendinosis, lateral epicondylitis (tennis elbow) and medial epicondylitis (golfers elbow), rotator cuff partial tears or tendinosis, along with others.
Recent studies comparing both steroid injections and PRP therapy for tennis elbow determined that in the short term, steroid injections were better, but they failed to provide long-term relief. However, PRP therapy patients progressively improved and had better pain relief and function long-term compared with the steroid group.
Patients should expect to have swelling and discomfort during the first three to four days after PRP therapy. By the fifth day, most patients experience less pain at the injected site. Patients are usually re-evaluated at four to six week’s post-PRP to evaluate improvement.
Luis A Gandara, MD, FAAPMR, CAQSM
Primary Care Sports Medicine Physician
Jewett Orthopaedic Clinic
Lake Mary, Florida
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