How platelet-rich plasma sends healing into warp speed!

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

The holy grail will be to one day institute treatments that help regenerate normal tissue in areas where normal tissue has been damaged or worn. Research into the use of stem cells for this purpose looks promising.

To date, one area where accelerated tissue healing has been demonstrated is wound healing with the use of platelet rich plasma. As it turns out, this substance is now being used to help speed up the healing of conditions such as tendonitis, ligament strains, muscle strains, arthritis, synovitis (inflammation inside the joint), and cartilage defects.

Platelet rich plasma is employed as a matrix graft, often referred to as an autologous tissue graft. This platelet-rich plasma (PRP) matrix is defined as a “tissue graft incorporating autologous growth factors and/or autologous undifferentiated cells in a cellular matrix where design depends on the receptor site and tissue of regeneration.” (Crane D, Everts PAM. Practical Pain Management. 2008; January/February: 12- 26) 2008)

The reason this substance is so useful is that platelets, which are a constituent of normal blood, contain multiple growth factors that stimulate tissue growth. This is particularly true for collagen which is the main component of connective tissue such as tendons and cartilage. These growth factors include the following:

• Fibrinogen: helps with clotting and framework making.
• Adhesion molecules: helps cells to bind to each other
• Platelets: initiates clotting and inflammation
• IL-1: promotes migration of macrophages
• Platelet derived growth factor: helps with healing; stimulates growth of blood vessels; attracts macrophages
• Transforming growth factor B: stimulates formation of collagen
• Epidermal growth factor: stimulates connective tissue growth
• Vascular endothelial growth factor: stimulates formation of new blood vessels; promotes healing

These growth factors recruit undifferentiated cells to the site of injury and stimulate their growth. Another constituent of platelets, stromal cell derived factor I alpha causes newly recruited cells to adhere to the area.

PRP needs to be prepared in a way to ensure a maximal amount of platelets along with a high concentration of growth factors. Obviously, the more growth factors that can be delivered to the site of injury, the more likely tissue healing takes place.

This type of autologous tissue graft (ATG) is currently being used in musculoskeletal medicine for patients with pain and injury in joints, tendons, and ligaments.

Contrast this approach with the traditional approach which has been to use non-steroidal-anti-inflammatory drugs as well as steroid injections, which, while reducing inflammation, also impede the healing process.

ATG is often used in conjunction with percutaneous tenotomy where a patient undergoes a procedure where there is purposeful needle irritation of the affected area using ultrasound guidance after which PRP is then slowly injected into the site.

Tenotomy induces an acute inflammatory response. Then, platelet rich plasma, obtained from a sample of the patient's whole blood is injected into the area where tenotomy has been performed.

The use of diagnostic ultrasound has revolutionized the field of musculoskeletal medicine in allowing tissue healing procedures like tenotomy which often prevent the need for open surgical procedures with their attendant morbidity and mortality. Diagnostic ultrasound allows the physician to place the PRP into the exact location where it will work the best. Blind administration of PRP is frowned upon.

The average number of treatments required is two to three separated by four to eight week intervals.

The PRP is prepared by drawing 20 cc’s of whole blood from the patient and then spinning the blood in a special centrifuge that layers out the platelets. This 20 cc’s of whole blood generally yields about 2-10 cc’s of platelet rich plasma.

Contraindications to the administration of PRP include platelet dysfunction, low platelet count, infection, anemia.

Prior to a PRP procedure, a patient needs to hold their non-steroidal anti-inflammatory drugs for at least 3-4 days. They may resume them one week after.

While most people respond to one course of treatment, about 10-20 per cent of patients will require a second procedure. Whether a second procedure is needed is usually determined at 3 months following the initial procedure. Diagnostic ultrasound using Doppler to assess the amount of residual inflammation is useful.

Following the procedure, patients must rest the affected area to prevent leakage of the PRP from the site.

Pain at the injection site is common for a 1-2 day period following the procedure.

Our institution has had some of the most extensive experience using PRP of any center on the East Coast.

For more information on tenotomy and platelet rich plasma, call the Arthritis Treatment Center at (301) 694-5800 or go to Arthritis Treatment Center The most advanced arthritis arthritis treatments available on the East Coast.

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