What is PRP?
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 (click here for more info).
Drs.
Tortland and Kozar have been performing PRP treatments since December 2007,
making them among the first physicians in the northeast offering this
treatment.
Why Does PRP Work?
Platelets are a specialized type of blood cell. Blood is made up of
93% red cells (RBCs), 6% platelets, 1% white blood cells (WBCs), and plasma.
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.
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.
How Often are Injections Given?
After the initial treatment, a follow up visit is scheduled 6-8
weeks later 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.
What Conditions Benefit From PRP?
PRP treatment works best for chronic ligament and tendon
sprains/strains that have failed other conservative treatment,
including:
- Rotator cuff injuries
- Shoulder pain and instability
- Tennis & golfer’s elbow
- Hamstring and hip strains
- Knee sprains and instability
- Patellofemoral syndrome and patellar tendinosis
- Ankle sprains
- Achilles tendinosis & plantar fasciitis
- Knee, hip, and other joint osteoarthritis
- Sports hernias & athletic pubalgia
- Other chronic tendon and ligament problems
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. This includes:
- Knee arthritis
- Hip joint arthritis
- And other joint arthritis
Is PRP Covered by Insurance?
Most insurance plans, including Medicare, do NOT pay for PRP injections.
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. These will interfere with the healing
response. Tylenol is OK. Your doctor may prescribe pain medication also.
Are There Risks With PRP?
Anytime a needle is placed anywhere in the body, even getting blood
drawn, there is a risk of infection, bleeding, and nerve damage.
However, these are very rare. Other complications, though rare, can
occur depending on the area being treated, and will be discussed by
your doctor before starting treatment. Because PRP uses your own blood, you cannot be allergic to it.
What is the Success Rate?
Studies suggest an improvement of 80-85%. Some patients experience
complete relief of their pain. The results are generally permanent.
Additional Therapies
To get maximum benefit from the treatment, and to help prevent
re-injury, a specially-designed rehabilitation and exercise
program is incorporated into your treatment. This helps the newly
developing connective tissue mature into healthy and strong tendon or
ligament fibers. In addition, nutritional support, such as glucosamine,
MSM, and increased protein intake can help the healing process.
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