Platelet-Rich Plasma is a term we have heard used when discussing the treatment of elite athletes such as Tiger Woods and Rafael Nadal[i]. What is it? Why is it used? What does it do? Should it be reserved for elite athletes, or can it be of benefit to us mere mortals?
Plasma is the straw colored portion of blood which contains platelets. Platelets are mainly known for their role in the clotting of blood; however, plasma also contains many other biologic growth factors and cellular signaling compounds used in the healing process. Platelet derived growth factor (PDGF), Insulin like growth factor (IGF), Vascular Endothelial Growth Factor (VEGF), Platelet Derived Angiogenic factor (PDAF), and Transforming growth Factor beta (TGF-B) have all been identified in the plasma portion of blood[ii]. These growth factors are important in wound healing. If you’ve ever scraped your knee, and most of us have, you have seen plasma. It is the straw-colored fluid which leaks out from the scrape and enables the wound to heal.
Techniques have been developed to harvest and concentrate this plasma portion of one’s own blood and then use it to augment a healing process. Blood is drawn, similar to a blood draw at a lab. It is then placed in a centrifuge and spun down. The heavier red blood cells settle to the bottom and the plasma portion remains on the top. A second spin can be performed on this plasma portion to separate the Platelet Rich plasma (PRP) form the Platelet Poor Plasma (PPP). This is then drawn up into a syringe and injected into a zone of healing.
Platelet-Rich plasma can be used to help the healing of chronic or acute injuries. Runners often experience Achilles injuries in the form of complete tears or a condition called Achilles tendonitis, a painful thickening of the Achilles tendon. In the acute tear setting, Platelet-Rich Plasma can be injected during surgery after the operative repair has been completed to augment the healing process. It can also be injected into the operative wound to assist with post-operative wound healing.
Runners also experience chronic injuries to the Achilles from overuse. Achilles tendonitis or tendonosis can take weeks or even months to heal when present. In this situation, Platelet-Rich Plasma, and its concentrated growth factors can be injected in and around the tendon to help relieve pain and improve function of the injured tendon through accelerated healing.
Normally, when an injury occurs, plasma comes to the zone of injury and the healing process begins. The use of Platelet-Rich Plasma allows the growth factors in this injectable form of plasma to be concentrated 5-10 times normal[iii], theoretically super-charging the healing process.
Platelet-Rich Plasma has been studied and used in many orthopedic conditions. While research is still ongoing and some studies inconclusive, athletes, and their treating physicians, have utilized PRP with the intent of speeding the healing of their injuries:
- Chronic Tendon or Ligament Injuries
- Plantar fasciitis (Heel pain and spurs)
- Achilles tendonitis
- Lateral Epicondylitis (Tennis Elbow)
- Muscle Tears
- Hamstring, Quadriceps, and Calf tears
While the benefits of Platelet-Rich Plasma injections have not been definitively scientifically proved, the risks are minimal – infection, damage to tissue, nerves, and blood vessels. PRP utilizes and athletes own tissue, eliminating the risk of disease transmission seen in allograft, or donated, tissue. Currently, most insurers, including workers compensation and Medicare, do not cover the cost of PRP injections, if at all. Be sure to discuss coverage of the injection with your provider prior to undergoing the procedure.
[i] American Academy of Orthopedic Surgeons. (2011, Sepatember). American Academy of Orthopedic Surgeons. Retrieved from Platelet-Rich Plasma (PRP): http://orthoinfo.aaos.org/topic.cfm?topic=A00648
[ii]Avila, H.-L. W. (2007, October). National center for Biotechnology Innovation. Retrieved from platelet Rich plasma: Myth or Reality?: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2609914/
[iii]American Academy of Orthopedic Surgeons. (2011, Sepatember). American Academy of Orthopedic Surgeons. Retrieved from Platelet-Rich Plasma (PRP): http://orthoinfo.aaos.org/topic.cfm?topic=A00648