Overview
What is PRP?
Is PRP Treatment Effective?
In summary
Bone and soft tissue injuries heal in many stages. One of the most exciting areas of research in orthopedic surgery and sports medicine involves making use the most of the initial healing stages: inflammation and an increase in cells, or cell proliferation.
Platelet rich plasma (PRP) treatment is becoming a popular option for giving a biological boost to the healing process.It received significant attention from the media as it has been used by some popular professional and elite athletes overseas.
PRP is produced from a person's own blood. It is a concentration of one of its constituents, the platelets. Platelets circulate in the blood and are critical for blood clotting. Platelets and the plasma portion of the blood contain many factors that are essential for cell recruitment, multiplication and specialization. These processes are required for tissue healing.
A blood sample is obtained from the patient, and is then put into a centrifuge, a tool that separates the blood into its many components. Platelet rich plasma can then be obtained and treated before it is delivered to an injured tissues, bone or soft tissue, tendon or ligament.
PRP is given to patients through an injection into the region where it is required. This may be intralesional (as in the muscle or aponeurosis), intra-articular (as in ACL reconstruction), or surrounding the involved tissue bed (e.g. within the sheath of Achilles tendon after rupture repair). After the injection, a patient must avoid exercise for a short period of time and then follow a rehabilitation exercise program.
Several basic science studies in animal models suggest that PRP treatment can improve healing in soft tissue and bone. For example, increased numbers of cells and improved tendon strength have been noted in Achilles tendon injuries, and improved muscle regeneration has been shown in gastrocnemius (calf) muscle injuries.
These favorable findings in animal models have led to the widespread use of PRP treatment for a variety of conditions, including acute and chronic tendon problems, as well as injuries to ligaments and muscles. Some clinical studies in humans gave some promising early results. ,
The most promising early results have been seen in PRP treatment for chronic tendon conditions, such as lateral epicondylitis (tennis elbow) and Achilles tendinosis. Nonetheless, a recent study in the Journal of the American Medical Association reported no advantage with PRP injection compared to saline (placebo) injection for the treatment of Achilles tendinosis.
In a small study involving knee osteoarthritis, PRP treatment was shown to be more effective than hyaluronic acid treatment. PRP has also resulted in positive or comparable results when used in the treatment of rotator cuff tears in the shoulder and medial collateral ligament (MCL) injuries in the knee.
Overall, there is limited support of PRP treatment in published clinical studies. However, because PRP is created from a patient's own blood, it is considered a relatively low-risk treatment with a potential in improving or speeding up tissue healing.
More research are however needed to show the effectiveness of treatment with PRP as well as its stanadardisation in preparation.
•Platelet Rich Plasma (PRP) comes from a patient's own blood.
•PRP is a rich source of growth factors and cellular signaling factors that play a significant role in the biology of healing.
•There are some basic science studies that show PRP treatment may improve healing in many tissues.
•A few clinical studies in humans show the effectiveness of PRP treatment on soft tissue healing.
Anti-inflammatory medicines should be stopped before and after PRP treatment is given.
Dr. WONG, Sze-hung