PRP, or "platelet-rich plasma," is a revolutionary new treatment for chronic sports and musculoskeletal injuries that is taking the sports medicine and orthopedic community by storm. Pittsburgh Steelers stars Hines Ward and Troy Polamalu credit PRP treatment for enabling them to play in the 2009 Super Bowl but is being used widely in professional sports.

What is Platelet Rich Plasma (PRP)?

• A tissue graft incorporating autologous growth factors and undifferentiated cells placed into or around diseased tissue invoking an inflammatory and proliferative response
• Promotes remodeling of normal Healthy Tissue
• Uses your own blood to concentrate you platelets for injection into diseases tissue

Why Does PRP Work?
Most people associate platelets with clot formation. While that certainly is an important function of platelets, they are also very much involved in injury healing. Human platelets are naturally extremely rich in connective tissue growth factors. Injecting these growth factors into damaged ligaments, tendons, and joints stimulates a natural repair process. But in order to benefit from these natural healing proteins, the platelets must first be concentrated. In other words, PRP recreates and stimulates the body's natural healing process.

Common Uses:
PRP treatment works best for chronic ligament and tendon sprains/strains that have failed other conservative treatment. In addition, PRP can be very helpful for many cases of osteoarthritis (the "wear & tear" kind). PRP can help stimulate a "smoothing over" of the roughened and arthritic cartilage, reducing the pain and disability of arthritis. Examples include:

• Knee arthritis
• Hip joint arthritis
• And other joint arthritis
• Muscle Tears
• Tendon Injuries and Disease
• Ligament Injuries
• Rotator cuff injuries
• Shoulder pain and instability
• Tennis & golfer's elbow
• Hamstring and hip strains
• Knee sprains and instability
• Patellofemoral pain syndrome and patellar tendinosis
• Ankle sprains
• Achilles tendinosis & plantar fasciitis
• Other chronic tendon and ligament problems

Benefits:

• Autologous (Your Own Blood)
• Inexpensive Compared to Surgery
• Less Aggressive Than Surgery
• Heals Tissue with Minimal to No Scar
• Mitigates Further Tissue Degeneration

When to use PRP:

• PRP can be very effective in patients who have failed other conservative therapies
• No desire for surgery
• Poor surgical candidate due to other medical disease or illness

Risks:
As with any procedure which breaks the skin, there are associated risks

• Risk of Infection 1:50,000
• Local Bleeding
• Allergy to Local Anesthetic
• Syncope with Pain or Blood
• Tissue Injury Causing Numbness or Pain
• Pain and/or Function May Worsen, Very Rare

How is PRP Done?
In the office, blood is drawn from the patient (just like getting a blood test) and placed in a special centrifuge. The centrifuge separates the RBCs, and the remaining platelets and plasma are then highly concentrated. (The WBCs, which comprise only a fraction of the total cells, go along for the ride with the platelets and plasma.) The red blood cells are discarded, and the resulting platelet concentrate is used for treatment.

 

While the blood is spinning in the centrifuge (about 18 minutes), the painful area is injected with lidocaine to numb it.

In most cases the injections are given under direct ultrasound guidance to insure accurate placement of the platelet concentrate in the damaged area. The entire treatment, from blood draw, to solution preparation, to injection, takes 30-40 minutes.

Before PRP:

• Blood Test for Blood and Platelet Counts
• No Anti-inflammatories for 48 Hours
• No Steroids for 2 Weeks
• No Recent Fever or Systemic Illness Within 2 Weeks

After PRP:

• Expect an Acute Inflammatory Phase Lasting 3-7 Days
• Use Tylenol or Prescription Pain Medications for Acute Pain
• No Anti-inflammatories for 2 Weeks
• Use Ice Sparingly During This Phase
• Immobilization and/or Non-weight Bearing May Be Recommended for Up to 2 Weeks

Do PRP Injections Hurt?
Because the injured area is first anesthetized with lidocaine, the actual injections are only mildly to moderately uncomfortable. Once the lidocaine wears off in a few hours, there is usually moderate pain for the next few days. For the first week after the injections it is critical to avoid anti-inflammatory medications, including Advil, Motrin, ibuprofen, Aleve, Celebrex, etc. These will interfere with the healing response. Tylenol is OK. Your doctor may prescribe pain medication also.

Expectations:

• May Require Up to 4 Treatments Over a Period up to 6 Months
• Up to 85% Success For Many Conditions
• Results Less Effective if a Smoker or a Diabetic
• You Must Retrain the Kinetic Chain with Physical Therapy Typically Starting 2 Weeks After the Procedure

How Often are Injections Given?
After the initial treatment, a follow up visit is scheduled in 2 weeks. Then another follow-up is scheduled after another 4 weeks to check on healing progress. Some patients respond very well to just one treatment. However, typically 2-3 treatments are necessary. Injections are given every 8-12 weeks.

Cost:

• Not Typically Covered By Insurance
• Cash Payment Expected Before Each Treatment
• Frequent Discounts Offered
• Will Receive a Reimbursement If Insurance Pays for the Procedure

Additional Resources:
View a CNN news story on PRP.
View a Fox News story on PRP.
Download a 2009 review article on PRP from the American Academy of Orthopedic Surgeons.
Download our informational handout.
Download a scientific review article on PRP.
Read a New York Times article on PRP.
Read a Philadelphia Inquirer article on PRP.