Platelet-Rich Plasma Treatment Enhanced Healing for Tendons, Labra, Ligaments, and Menisci
Platelet-rich plasma (PRP) treatments have been in clinical use for more than a decade, and thousands of patients across the U.S. receive PRP each year.1 However, PRP treatment remains somewhat uncommon, perhaps due to the special training and equipment necessary to perform them. PRP treatments involve the injection of autologous blood concentrated with platelets into the injured area. PRP contains numer-ous cytokines and growth factors which initiate and promote healing by stimulating cell migration, cell pro-liferation, angiogenesis, and matrix synthesis.2 PRP treatments are generally indicated for recalcitrant con-nective tissue and meniscus complaints. Below you will find a list of common uses found in an insurance record review.1 Any references shown cite studies connecting PRP with favorable outcomes for that specif-ic condition. • Epicondylitis/epicondylosis (level 1 and level 2 evidence)3 • Knee osteoarthritis (level 1 evidence; improvement per-
sists at 1-year follow-up)4 and other knee cartilage pa-thology
• Post ACL repair surgery • Rotator cuff tears5 and other shoulder complaints includ-
ing post-surgical recovery • Knee synovium surgery • Achilles tendinopathy6 • Achilles tendon tears7 • Jumper’s knee8 • Plantar fasciitis9 • Muscle strains10 • Osteoarthritis11 To perform PRP treatments at Primary Spine & Rehab, a clinician first draws 20-60cc of venous blood from the patient and spins it down in a specially designed centrifuge. The centrifuge process takes approximate-ly 15 minutes. A local anesthetic is administered to the skin and subcutaneous tissue to maximize comfort during the PRP injections. Treatments usually involve multiple PRP injections over the injured area. The treatments may only be needed once, or they may be repeated as needed once every four to eight weeks. There are no known side effects other than those typically associated with injections. The use of autolo-gous blood negates any risk of immunogenic reactions or disease transfer from the plasma. Many cases of tendinopathies and muscle strains will resolve with physical therapy from Primary Spine & Rehab for strengthening, conditioning, and activity modification. PRP treatment can be reserved for recal-citrant cases. Corticosteroid injections are common but may have some drawbacks compared to PRP, such as increasing the risk of future injury by masking pain, subcutaneous atrophy caused by superficial injec-tions, and permanent adverse changes within the ultrastructure of tendons caused by intratendinous injec-tion. Repeated, local corticosteroid injections have been linked to plantar fascia rupture.12 Peerbooms and colleagues found PRP treatments to be superior to corticosteroid injections for lateral epicondylitis (73% success vs. 49% success).13 When you have cases of soft-tissue failed-healing responses that do not re-spond fully to first-line approaches, please tell your patients about the physical medicine treatments avail-able at Primary Spine & Rehab.
Please offer Primary Spine & Rehab to your patients.
PrimarySpineRehab.com
Enfield
Phone: 860-763-2225 Fax: 860-763-3161 143 Hazard Avenue Enfield, CT 06082
Suffield Phone: 860-668-5222
Fax: 860-763-3161 162 Mountain Rd, Suite 203
Suffield, CT 06078
Hartford Coming in September 151 New Park Avenue
Suite 4 Hartford CT 06106
Physical Medicine
Physical Therapy
Chiropractic
One-to-One Treatment Always with a Licensed Professional
Rehab and Therapy for: Orthopedic Complaints Post-Surgical Rehab Work Injuries Auto Injuries Back Pain Neck Pain Vertigo / Vestibular Rehab Lymphedema Headaches Functional Capacity Evaluations
Physical Medicine Treatments Ultrasound-Guided Injections Hyaluronic Acid Joint Injections Platelet-Rich Plasma Injections Prolotherapy Regenerative Injections Botox for Recurring Headaches Trigger Point Injections Cortisone & Lidocaine Injections
Specialty Physical Therapy: McKenzie, Graston, and Mulligan Techniques Lymphedema Management Vestibular Therapy Dry Needling Kinesio Taping® Functional Capacity Evaluations
Payment
Accepting Medicare and most major insurance. Letters of
protection accepted.
Affiliations & Privileges St. Francis Hospital and Medical Center
The Center for Minimally Invasive Spine and Neurosurgery
REFERENCES
1. Zhang J, Fabricatn P, Ishmael C, et al. Utilization of platelet-rich plasma for musculoskeletal injuries: an analysis
of current treatment trends in the United States. The Orthopaedic Journal of Sports Medicine. 2016; 4 (12):
2325967116676241
2. Wasterlain A, Braun H, Harris A, et al. The systemic effects of platelet-rich plasma injection. Am J Sports Med.
2013: 41: 186-193.
3. Mishra A, Skrepnik N, Edwards S, et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind,
prospective, multi-center, randomized controlled trial of 230 patients. Am J Sports Med. 2014; 42: 463-471.
4. Vaquerizo V, Plasencia M, Aribas I, et al. Comparison of intra-articular injections of plasma rich in growth factors
(PRGF-Endoret) versus Durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a
randomized controlled trial. Arthroscopy. 2013; 29: 1635-1643.
5. Gamradt S, Rodeo S, et al. Techniques in Orthopaedics. 2007; 22: 26-33.
6. Gaweda K, Tarczynska M, Krzyzanowski W. Treatment of Achilles tendinopathy with platelet-rich plasma. Int J
Sports Med. 2010; 31 (8): 577-83.
7. Filardo G, Presti ML, Kon E, Marcacci M. Nonoperative biological treatment approach for partial Achilles tendon
lesion. Orthopedics. 2010; 33 (2): 120-3.
8. Filardo G, Kon E, Della Villa S, Vincentelli F, et al. Use of platelet-rich plasma for the treatment of refractory
jumper's knee. Int Orthop. 2010; 34 (6): 909-15.
9. Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physi-
cian. 2005;72:2237–2242.
10. Hammond J, Hinton R, Curl L. Use of autologous platelet-rich plasma to treat muscle strain injuries. Am J Sports
Med. 2009 Jun;37 (6): 1135-42.
11. Filardo G, Kon E, Buda R. Platelet-rich plasma intra-articular knee injections for the treatment of degenerative
cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2011; 19 (4): 528-35.
12. Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physi-
cian. 2005; 72: 2237–2242.
13. Peerbooms J, Sluimer J, Bruijn D, et al. Positive effect of an autologous platelet concentrate in lateral epicondyli-
tis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year
follow-up. Am J Sports Med. 2010; 38(2): 255-62.