Platelet Rich Plasma
Platelet Rich Plasma (PRP) for Mulsculoskeletal Injury and Regeneration
PRP is a concentrate of platelets derived from the patient's own blood. PRP is used therapeutically to accelerate tissue healing. Platelets contain granules that release more than 300 growth factors and cell messenger molecules.
In the body platelets are the cells that arrive first to the site of an injury as soon as capillaries have been broken. They are the component of blood that initiates clotting around the site of injury. As they concentrate in the area they influence healing of the tissue by the release if a vast array of growth factors and cell messenger molecules (cytokines).
When PRP is accurately delivered to the site of tissue damage by ultrasound-guided injection, healing can be switched on in chronic degenerative conditions. In acute injury PRP injection accelerates healing.
Here is a situation everyone can relate to:
You have a minor cut to the skin it takes a few minutes to stop bleeding. A clot develops. The area gets sore and swollen for a few days, then the edges of the wound seal together, followed by scar formation, and then over time the scar gets smaller and the tissue loses its red colouration. Finally we forget about it because the skin is soft, supple and strong, and back to normal again.
That is the body responding to local injury. The clot that's developing is trapping billions of platelets and it's the platelets that are responsible for the clot closing. It is also the platelets releasing their GROWTH FACTORS and CYTOKINES that switch on the tissue repair that follows spontaneous healing which is something we expect, and take for granted.
The Science of PRP
Now we have a profound understanding of what happens in this apparently simple and reliable process, which is the result of hours of dedicated work by cellular biologists. The explanation that follows is a hug simplification of the truly fantastic work that is being done by the basic scientists every day all over the world.
Step by Step
- Tissue injury causes the damaged cells to release cell messengers;
- These messengers attract platelets to the injury like iron filings are drawn to a magnet;
- Once they arrive on site, the platelets release their growth factors and cytokines which in turn switch on the anti-inflammatory and repair mechanisms that assist in healing the tissue;
- Platelets release their vast array of signalling molecules called GROWTH FACTORS and CYTOKINES;
- The GROWTH FACTORS and CYTOKINES attach to receptors on the cells of surrounding tissues and blood vessel cells;
- This signals the DNA of those cells; and
- Causes release of molecules which reduce inflammation and increase tissue building in the joint, ligament or tendon.
Tangible Effects of PRP
Collagen is require to form the structure of all tissues, and blood vessels are required to nourish the area as it returns to normal function.
The multitude of GROWTH FACTORS and CYTOKINES released by platelets have time sequence effects whereby they keep the healing process in motion over weeks.
It makes sense that by therapeutically increasing the platelets concentration in the area of injury (by injecting them), the healing process is powered up.
How PRP is Obtained?
When we use PRP for accelerating the healing process, we concentrate the population of platelets from peripheral blood by 6-10 times.
In order to do this, we take blood from the arm of the patient and use a sophisticated device that is designed specifically to separate out various cell types from the blood. After separation and concentration of 100 ml of whole blood, there will be a yield of about 10 ml of PRP.
Research on PRP - Research PDF
PRP has been demonstrated to be clinically effective in healing tendon, ligament, bone, muscle and cartilage injury and degeneration.
Significantly, it has been demonstrated that it lowers the incidence of infection when used during surgery.
As PRP is a product from the patients' own blood which has not been chemically altered, there is no risk of allergy or immune reaction. In In the literature, side effects or complications of PRP injection are rare. The main risks include local infection (<1% chance) and pain or irritation at the site of injection.
The benefits of an Annual PRP Injection For Knee OA
Knee osteoarthritis (OA) is a chronic progressive disease involving the joint surfaces of the knee. The goal of OA treatments is to reduce pain and improve function and mobility and hopefully slow the progression of the disease.The conservation treatments for knee OA have short-term effectiveness and have their own benefits and disadvantages. numerous published studies suggest that intra-articular (within the joint) PRP injections can be an effective complement to conventional management strategies for knee OA. These studies have shown that injections of autologous platelet rich plasma (PRP) are considered to be a good option for patients with mild to moderate OA, and also for patients with more severe OA who are not yet suitable for joint replacement surgery.
The PRP procedure is based in the intra-articular delivery of a component of the patient's own blood plasma that has a high concentration of platelets. When the platelets are injected within the joint they release an abundance of growth factors and proteins which are known to initiate and assist the body's natural tissue repairing mechanisms. The exact mechanism of how PRP relieves symptoms of osteoarthritis is not fully understood, but is thought that it likely alters the metabolism of the cells within the jopint in response to the growth factors released by the platelets. This in turn alters the intra-articular biology and reduces the osteoarthritic symptoms.
PRP therapy for knee OA has been assessed by numerous high quality clinical trials. These studies have proven that intra-articular PRP knee injections for symptomatic early stages of OA are a valid treatment option. Overall, the patients in the trials gained a significant reduction in pain and improvement in function after 6 and 12 months. A lesser nuimber of clinical trials have studied the long term benefits of PRP, and have shown that the beneficial effects of PRP can be sustained at 18 months after the first PRP injection by annual repetition of the treatment. It is important that patients understnad that PRP is not a quick-fix treatment to solve all their osteoarthritis symptoms and PRP achieves best outcomes when used in combination with weight loss, structure exercise and healthy lifestyle.
Our practice protocol is that patients would be recommended to have 2 or 3 injections depending on the severity of their symptoms, separated by an interval of 4 weeks. Our patient outcomes are in line with the published data, where majority of patients gain good to very good benefits at 6 months compared to the pre-PRP treatment pain and function scores (when the cause of patient's knee pain is cuased by osteoarthritis of the knee). For patients who gain a good response from the initial PRP injections, we usually recommend an annual 'top-up' treatment to prolong the improvements in function and reduced pain.
we can arrange a recall at the one year interval to discuss if you would like to have another PRP injection at that time. Please contact our staff on 08) 9446 9600 to request a one year review.
References to support our practice policy for an annual top-up treatment
Souzdalnitski, D., Narouze, S., Lerman, I. R., & Calodney, A. (2016). Platelet-rich plasma injections for knee osteoarthritis: Systematic review of duration of clinical benefit. Techniques in Regional Anesthesia and Pain Management.
Conclusion: 24 relevant studies encompassing 2,385 patients were included in the systematic review to assess the published data on the duration of clinical effect from intra-articular injection of autologous PRP. The results showed a consistent improvement in patient pain scores and functional indexes for 6 months after initiation of injections. The residual clinical effect was typically observed beyond 6 months of follow-up in most of the studies. Pain and functional scores decreased after 12months of ollow-up but remained higher than the base scores in the majority of studies. Some suggested that annual injection improved treatment outcomes after 18 months of follow-up.
Gobbi A, Lad D, Karnatzikos G. (2014). The effects of repeated intra-articular PRP injection on clinical outcomes of early osteoarthritis of the knee. Knee surgery, Sports Traumatology, Arthroscopy: official journal of the ESSKA European Society of Sports Traumatology Knee Surgery and Arthroscopy
Conclusion: Intra-articular PRP injections into the knee for symptomatic early stages of OA are a valid treatment option. There is a significant reduction in pain and improvement in function after 12 months, which can be further improved at 18 months by annual repetition of the treatment.
Who Could Benefit from PRP?
Anyone who has a tissue injury of any sort could benefit from PRP.
In this practice, it is used for stimulating repair of athletic injury and degenerative diseases of the musculoskeletal system.
- Osteoarthritis of any joint from knee to TMJ
- Facet joints of the spine
- Cartilage damage and degeneration
- Tendon injury of the following areas/such as:
- Achilles tendon
- Tennis elbow & Golfers elbow
- Rotator cuff injury; and
- Hamstring tendon
- Ligament injury and degeneration; and
- Muscle tear anywhere
PRP can also be used for epidural injection (instead of steroid injection) in the event of disc damage in the spine, with or without sciatica.
In BACK PAIN, PRP can be used in preference to hyaluronic acid and cortisone injections in our practice as it is usually better indicated for its healing effects.
Cortisone has collagen damaging effects which is already a problem in chronic injuries and tendon and arthritis, so is nor usually recommended, see the comparison studies between hyaluronic acid and PRP on the website.
PRP is the go-to first line therapy of professional athletes in Europe and the USA.
To book a consultation, please contact our team today.