With growing popularity over the past decade, many patients want to learn more about platelet-rich plasma (PRP) and its potential benefits. There has been an increasing number of high-quality clinical research studies suggesting that this can be a safe and potentially efficacious treatment, and it is widely being adopted as a suitable nonsurgical treatment option in the world of musculoskeletal conditions. Ashkan Alkhamisi, MD, a board-certified, fellowship-trained sports medicine physician with HonorHealth Sports Medicine, provides insight into PRP injections and how they help patients get back to doing what they love.
What is platelet-rich plasma?
Platelet-rich plasma is an injection of the patient’s own blood that has been spun down in a centrifuge to increase the concentration of platelets. This concentrated blood has an increase in growth factors, proteins, cytokines and other bioactive molecules that initiate and regulate the basic aspects of wound healing. “We are focused on providing patients with the best and most advanced healing therapies,” says Dr. Alkhamisi. “The goal is to change the inflammatory process of the joint or diseased tendon in order to promote proper and long-term healing.”
Decrease in pain and inflammation
In orthopedics, there are a wide variety of uses, including:
- Arthritis (hip, knee and shoulder joints)
- Rotator cuff tendon issues
- Tennis/Golfer’s elbow
- Gluteus and Patellar tendon issues
- Achilles tendon problems
- Ligament/muscle injuries
PRP helps by decreasing the patient’s pain and inflammation and improving function. Compared to other nonsurgical or conservative options, PRP therapy is effective with most patients reporting up to a minimum of nine months and greater pain relief and improved function, according to Mayo Clinic. It can be repeated in the future as needed, depending on the recurrence of symptoms.
PRP candidates
PRP can be administered early in the treatment process, depending on the goals of the individual. Often, patients have tried other treatments like cortisone or gel injections, physical therapy or braces and didn’t experience any significant changes, which may lead them to pursue PRP therapy. Collegiate and professional athletes may want to try PRP first since their jobs and livelihoods depend on their ability to perform.
“I always look for active individuals aged 10 and up,” says Dr. Alkhamisi. “They want to achieve a certain activity level and other measures have failed. These patients are looking for an intervention that isn’t surgical in nature and are interested in trying orthobiologics such as PRP injections.”
When discussing PRP with your patients, it is important to let them know that it is a cash-pay procedure and not covered by insurance companies. This is because the FDA cannot regulate what patients own – their own blood and where PRP is derived from. Instead, the FDA currently regulates the centrifuge machine/equipment approval process to ensure that physicians are using a reliable machine whenever performing PRP therapy.
The healing power of PRP
Unlike cortisone or gel injections, PRP takes time to work as it incorporates growth factors and changes the body’s healing process. The patient will most likely feel more pain at first since the injection causes swelling in an area that was already sore to begin with; however, the swelling is necessary for the blood cells to start helping the patient heal. “The beauty in this is while PRP does take time, the results last a lot longer with the average relief period,” says Dr. Alkhamisi. “I would say it's absolutely worth the wait.”
Currently, we don’t have a full understanding of how the complete healing process works with PRP. Whether it can reverse arthritis is still unknown, so when it comes to joints and cartilage, we can’t say that it's a definitive cure, however it does alter the natural course of inflammation and provides a positive outcome for the patient.
With tendons, there are changes to the tendon anatomy on a cellular level. This is often seen in partial tears when PRP is most effective. If a patient has a complete tear, the gap is much too large for the fibers to properly heal, so we don’t see great results and often do not recommend PRP in this scenario.
The impact of PRP on platelets
PRP injections cause platelets to go through three phases, including:
Phase one: Vascular inflammation
- Occurs: Three to five days after the procedure, sometimes lasting up to two weeks. This is the phase that patients will feel the most soreness for the first 48 hours which will lessen over the next five days.
- Purpose: Localize and eliminate damaged tissue.
- Response: Increase in blood flow, permeability of blood vessels, and migration of fluid proteins and white blood cells.
Phase two: Proliferation
- Occurs: One to four weeks after the procedure, sometimes lasting up to eight weeks.
- Purpose: Platelet-derived growth factors recruit fibroblasts and synthesize collagen to begin to repair tissue. This is the phase that involves most cell-signaling pathways to begin tissue repair.
- Response: Soft tissue heals according to the way it is stressed. Rest is not advised in this phase.
Phase three: Remodeling
- Occurs: One to three months after the procedure.
- Purpose: Remodel, strengthen and improve cellular organization.
- Response: Increased organization of collagen. Tissue and scar maturation.
PRP will start to provide relief for most conditions within six to twelve weeks post-injection. Generally, a patient will require one to three PRP injections, depending on the location and severity of the issue.
Alternative treatments
There are alternative treatments to using PRP injections to relieve pain and promote healing, including:
- Orthobiologics: An innovative therapy using biological materials from within the patient’s own body (PRP, bone marrow, adipose and fat tissue) found naturally in the body.
- Extracorporeal shockwave therapy: A noninvasive treatment that has been around for more than 50 years and uses high-energy sound waves.
- Percutaneous ultrasonic needle tenotomy: An ultrasound-guided needle pierces the damaged tendon and tissue to promote a natural healing response.
Prevention methods
Prevention is key and that comes down to a few factors, including:
- Exercise/activity type
- Stretching/conditioning
- Diet
- Hydration
“Preventing dehydration, especially during our Arizona summers, is incredibly important as it can lead to an increased risk of injuries,” says Dr. Alkhamisi. “I also encourage my patients to stretch before and after exercising. It’s most effective during the cooldown period when muscles in the tendons and ligaments in the joints are in their most vulnerable stage. This helps promote healing.”
HonorHealth Sports Medicine
At HonorHealth Sports Medicine, we are a dedicated group of board-certified experts who have the skills and experience to treat injuries and conditions for athletes, recreationists and weekend warriors of all ages. We understand the unique causes of sports injuries and the effects that certain conditions can have on a patient’s performance. We will go the extra mile to ensure your patients get back to doing the activities and sports they love as quickly and as safely as possible.
To refer a patient to HonorHealth Sports Medicine, please call 623-683-8000. For more information, visit HonorHealth.com/sportsmedicine.