Platelet Rich Plasma

Platelets are well known for the ability to create clots and to stop bleeding. What is less well known is that platelets are excellent source of growth factors such as cytokines, proteins, and other factors which regulate wound healing. Platelet concentrations of 3 to 5 times what is found in blood have been associated with enhanced healing. Platelets are known to release natural chemicals such as transforming growth factor- B (TGF-B), platelet derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and many more. 

The question often arises of why use these healing factors when there are surgeries which "fix" the problem. 

What happens when we injure our body?

Once the integrity of the "fabric" has been violated by injury, the race to heal begins The body begins a cycle of inflammation in an effort to "call" growth factors into the area. Certain chemicals cause the blood vessels to dilate in order to flood the area with growth factors. Once sleeping giants, platelets are activated into sticky cells which then attach to the injury site and release their own growth factors. If all goes well, the injury is contained, sealed in minutes. Underlying the scab, a complicated dance of healing begins. 

Why does this not happen to other areas? Why does a tear in the rotator cuff refuse to heal? The fundamental problem when trying to heal a tendon is the lack of blood flow into the region. This is also true for the case of disc injury. In the field of surgical orthopedics, in order to repair these areas, tendons are replaced, meniscus tear flaps are removed, and discs are replaced. All of these surgeries involve removing tissue which eventually leads to degradation of tissue. The environment left behind after surgery is one of an angry planet, generating a constant storm of inflammation which slowly degrades the environment. 

With this said, there is nothing incorrect about a surgical repair. There are many cases when surgery is the only option. The truth is that most people who have injured discs or joint injuries will continue to deteriorate and most likeley will need a large surgical correction later in their life. The truth of regenerative therapy is that these procedures may re-establish the balance inside the joint, etc in order for the body to heal. 

What is the evidence?

PRP has been shown in studies to stimulate tendon stem cells to make more tendon cells and to also activate the support structures surrounding tendons (Zhang J, et al. Platelet-rich releasate promotes differeneitation of tendon stem cells in tnedon cells.) 

One study looked at proffesional soccer players with ACL knee partial tear injuries. These players were treated with PRP injections into the ACL and the knee joint. All but 1 of the players returned to play at their previous levels of play at 16.20 weeks (Seijas R, et al. Partial anterior cruciate ligament tears treated with intraligamentary plasma rich in growth factors.)

Another study looked at MRI findings in 100 ACL knee reconstructions with one group recieving PRPR and the other group recieving no PRP (control group). The PRP group's MRI showed complete integration of the graft at 179 days but it took the control group 369 days to achieve the same result. (Radice F, et al. Comparison of magnetic resonance imaging findings in anterior cruciate ligment grafts with and without autologous platelet derived growth factors).  

A Shoulder to Lean On.

Rotator cuff tears can be painful and limit a person's function. There is nothing worse than not being able to brush your hair or put on a belt because you feel a sharp pain in the shoulder. The injection of PRP directly into the tear using ultrasound to vusualize the needle, improved the patient's pain and she was able to sleep on her shoulder, lift her arm over her head, and exercise all without pain. 

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