Platelet-Rich Plasma (PRP) Injection
What is Platelet-Rich Plasma (PRP)?
Our blood consists of a liquid component known as plasma. It also consists of three main solid components which include the red blood cells (RBCs), white blood cells (WBCs), and platelets. Platelets play an important role in forming blood clots. They also consist of special proteins, known as growth factors, which help with our body's healing process. Platelet-rich plasma or PRP is a high concentration of platelets and plasma. A normal blood specimen contains only 6% platelets, while platelet-rich plasma contains 94% of platelets and 5 to 10 times the concentration of growth factors found in normal blood, thus greater healing properties.
What are the Indications for PRP Injections?
Platelet rich plasma (PRP) is a biologic treatment which is commonly used to treat a multitude of conditions involving the shoulder, elbow, and knee.
Tendonitis (Chronic tendonitis or partial-thickness tears)
- Rotator cuff
- Biceps
- Golfers/Tennis elbow
- Tendonitis around the hip (Gluteus medius)
- Patellar or quadriceps tendonitis
Ligament Injury
- Ulnar collateral ligament (UCL) injury of the elbow
- Medial collateral ligament (MCL) injury of the knee
Degenerative Joint Disease
- Knee osteoarthritis
- Shoulder osteoarthritis
- Elbow osteoarthritis
In general, PRP is unlike other commonly used injections such as steroid or cortisone. PRP will take time to provide therapeutic relief. It is common for PRP to take around 6-8 weeks to provide therapeutic relief. As such, PRP requires patience. I strongly recommend physical therapy during the recovery process after the PRP injection based off indication for the injection.
PRP is being studied and used for many orthopedic conditions.
For example, there are several high level academic research studies published showing that PRP is a better treatment than steroid or hyaluronic acid injection for knee osteoarthritis. PRP has now been used and studied for virtually every joint tendon, ligament injury in orthopedics.
Platelet-Rich Plasma Injection Procedure
The procedure is completed in the office during one visit. The entire visit will normally take around one hour, so please plan your schedule accordingly.
The procedure begins by having 60 mL of peripheral blood painlessly drawn from your arm. The blood is then spun in the Arthex Angel PRP centrifuge for approximately 20 minutes. This machine is highly specialized and allows the the doctor to choose one of two settings: leukocyte rich or leukocyte poor.
Leukocyte rich is commonly used for conditions such as rotator cuff partial thickness tear, bursitis or impingement, tennis/golfer's elbow, ligament sprains in the knee.
Leukocyte poor is commonly used for arthritis of the shoulder and knee.
After the sample is separated into approximately 4-6 mL of leukocyte rich/leukocyte poor PRP, the patient is prepared for the injection in the procedure room in the office. Under sterile technique the injection is performed using ultrasound guidance. Ultrasound guidance is paramount to ensure the injection is delivered to the precise location it is needed.
Post-Procedure Care following PRP Injections
After the injection, it is normal to feel some discomfort for up to a week at the injection site.
You may use cryotherapy or cold compression to help alleviate your symptoms.
It is OKAY to use anti-inflammatory medications as needed.
I strongly recommend avoiding impact activity for one week after the injection. Would recommend low impact activity and stretch activities for one week after the PRP injection.
Risks and Complications of PRP Injections
There are very minimal risks associated with PRP injections. Some of the potential risks include:
- Increased pain at the injection site
- Infection
- Damage to adjacent nerves or tissues
- Formation of scar tissue
- Calcification at the injection site
What growth factors and cytokines are in PRP?
Some of the growth and healing factors found in PRP include:
- Platelet Derived Growth Factor (PDGF)
- Fibroblast Growth Factor (FGF)
- Vascular Endothelial Growth Factor (VEGF)
- Interleukin 8 (IL-8)
- Transforming Growth Factor Beta (TGF-b)
- Insulin like Growth Factor 1, 2 (IGF-1,2)
- Epidermal Growth Factor (EGF)
