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Tendons connect muscles to bones and make it possible to do all kinds of physical activities. Overuse or damage to tendons over a long period of time causes the collagen fibers that make up the tendons to form small tears, a condition called tendinosis. Over time this tendinosis can progress to more damage and bigger tearing of the tendons. Ligaments are collagen fibers that hold bones together, stabilize joints, and control the range of motion. Tendons and ligaments have a poor blood supply and do not easily heal from the damage caused by sprains, strains, and repetitive motion.
What is PRP?
Platelet Rich Plasma or PRP is concentrated platelets (the body’s repairmen for damaged tissue) and blood plasma. The concentrated platelets in PRP contain huge reservoirs of bioactive proteins, including growth factors vital to initiate and accelerate tissue repair and regeneration. These bioactive proteins initiate connective tissue healing, promote the development of new blood vessels, and stimulate the wound healing process.
Why does PRP work?
Platelets are a specialized type of blood cell. Blood is made of 93% red blood cells (RBCs), 6% platelets, 1% white blood cells (WBCs), all floating around the liquid part of the blood called plasma.
While platelets are associated with clot formation, they are instrumental in injury healing. 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 to benefit from these natural healing proteins, the platelets are first concentrated. In other words, PRP recreates and amplifies the body’s natural healing process.
How is PRP done?
A small amount of blood is taken from the patient. The blood is then placed in a centrifuge. The centrifuge spins and separates the platelets, red blood cells, and white blood cells. Under sterile conditions in our laboratory, the platelets are further isolated and concentrated into different versions of PRP with varying concentrations of platelets depending on the specific injury and patient being treated. Using ultrasound and or fluoroscopic/live x-ray image guidance, needles are directed safely and accurately to the area being treated. The entire procedure, from the blood draw to solution preparation and injection, is completed within 2-3 hours.
I’ve heard of Cortisone shots; is this the same?
Cortisone or steroids are powerful anti-inflammatory medications that can temporarily reduce inflammation and pain. Studies have shown that cortisone injections damage cartilage and can weaken tendons and ligaments and inhibit healing. Cortisone shots may provide a quick fix for temporary relief and lessening of inflammation, but the doctor can only do them a few times because of the known harmful effects. PRP therapy is able to heal and strengthen damaged tissue. Procedures with PRP have strengthened and thickened tendons up to 40%.
How often are injections given?
After the initial procedure, a follow-up visit is scheduled 6-8 weeks later to check on healing progress. Some patients respond very well to just one procedure. However, 2-3 procedures may be necessary.
What conditions benefit from PRP?
PRP procedure works best for chronic ligament and tendon sprains/strains that have failed other conservative procedures, 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
• Other chronic tendon and ligament problems
In addition, PRP can be beneficial 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
Does insurance cover PRP?
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, avoiding anti-inflammatory medications, including Advil, Motrin, ibuprofen, and Aleve, is critical. These will interfere with the healing response. Tylenol is OK. Your doctor may prescribe pain medication also.
Are there risks with PRP?
Because PRP uses your blood, you cannot be allergic to it. 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 rare complications can occur depending on the area being treated and will be discussed by your doctor before starting the procedure.
What is the success rate?
Studies suggest an improvement of 80-85%. Some patients experience complete relief from their pain. The results are generally permanent.
To get the maximum benefit from the procedure and help prevent re-injury, patients should follow a comprehensive and individualized procedure plan incorporating nutrition, nutraceuticals, exercise, and hormone balancing to get maximum benefit. This allows the newly developing connective tissue to mature into healthy and robust tendons or ligaments.