Platelets are a specialized type of blood cell involved in injury healing.

There is thought to be an optimal concentration of platelets for healing of injured tissue.  Different commercially-available PRP preparations vary in terms of their ability to concentrate platelets in plasma.  The absolute concentration of platelets in the PRP product has a direct bearing on the degree to which stem cell migration occurs, as well as the degree to which cell proliferation (the healing cascade) occurs.  Studies seem to indicate that the optimal platelet concentration ranges from 1.5 million to 3.0 million platelets per microliter.  Studies also show that platelet concentrations below 500,000 platelets per microliter have no more effect on cell recruitment than whole blood.  Platelets also contain large reservoirs of natural growth factors that are essential for the cell recruitment and multiplication involved in wound healing.  While a normal concentration of platelets circulating in your blood is 200,000 per microliter, the platelet count in Platelet Rich Plasma can exceed 2 million platelets per microliter.  To be considered PRP, the platelet count must be 4x or greater above baseline.  PRP can be formulated in the office independently or through use of commercially-available preparation systems.  Some of these commercial systems include Harvest, Emcyte, Arteriocyte, Arthrex, Cascade or Biomet.

After consultation with other clinicians who employ similar technology and review of the available data on PRP, Stadia elected to partner with Harvest Technologies for the provision of PRP services to our patients.  The platelet product that Harvest’s centrifuge creates has been shown to most consistently recreate a platelet concentration in the zone for optimal tissue healing, as well as recruit the highest concentration of growth factors to the wound site (see below).  Some technologies, such as Arthrex or Cascade, did not even concentrate platelets above the 500,000/microliter threshold thought to be necessary for greater treatment effectiveness than whole blood.

When PRP is injected into a joint, the platelets recruit healing cells to the area of injury and work to lessen the effect of the condition that is causing pain.  When PRP is injected into a chronically injured tendon or other soft tissue structure, the platelets activate into a gel-like substance which essentially functions as a graft between the edges of partial tears, holding the PRP in place and serving as a lattice or scaffold from which healing can occur.  Cells that have been shown to be recruited to the area of injury following PRP injection include:

• Growth Factors
  • Platelet-derived growth factor (PDGF), responsible for attracting stem cells and other healing cells to the injured area.
  • Transforming growth factor beta (TGF-β), which helps promote cell mitosis and differentiation for connective tissue and bone.
  • Vascular endothelial growth factors (VEGF), which helps stimulate blood vessel growth to the injured area.
• White cells, some of which serve as stem cell lines
  • Harvest’s spinning technology reduces the number of granulocytes (inflammation cells) by 60% while increasing the number of monocytes (cell types with stem cell lines) by 100%.
• Cytokines
  • A “homing agent” for WBC stem cell lines.  Stromal derived factor 1 alpha (SDF-1α), which modulates migration of stem cells to the wound site.

What happens during a PRP procedure?

A sample of blood is taken from a vein in the arm and then spun in a centrifuge in our office.  Spinning the blood in a centrifuge helps concentrate the platelets into the bottom of the collection tube.  Once this concentration is complete, the platelets can be injected into or around the injured area.  Guidance with ultrasound is always used to ensure proper placement of the PRP into the area of injury.  Precise placement of the PRP helps increase the likelihood of a good clinical outcome.

Depending on the condition being treated, a short period of immobilization might be recommended.  Typically, activity modification is necessary for several weeks following a PRP injection, to give the PRP-induced healing response adequate time to work.

What can PRP be used for?

• Tendonitis (Chronic tendonitis or non-operative treatment of partial-thickness tears)
  • Rotator cuff
  • Biceps
  • Golfers/Tennis elbow
  • Tendonitis around the thigh (Gluteus medius, hamstring)
  • Patellar or quadriceps tendonitis
  • Tendonitis around the ankle (Peroneal, Tibialis posterior)
  • Achilles
  • Plantar fasciitis
• Degenerative joint disease
  • Knee osteoarthritis
  • Symptomatic articular cartilage injury
  • Ankle osteoarthritis
  • Wrist osteoarthritis
  • Elbow osteoarthritis
  • Shoulder osteoarthritis
• Ligament Injury
  • Ulnar collateral ligament injury of the elbow
  • Medial collateral ligament injury of the knee
• Fracture Care
  • Delayed union or nonunion fratures

What does a PRP treatment cost?*

$870  (not covered by insurance & will not be submitted to insurance)

*Cost is subject to change based on an increase in our costs to obtain supplies/materials/resources, without notice.

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PRP resources:

Research concerning preparation of PRP and the underlying science:

Platelet-Rich Plasma Differs According to Preparation Method and Human Variability.  http://orthodoc.aaos.org/WilliamFBennettMD/PRP%20differs%20according%20to%20Preparation%20Method_Human%20Variability.pdf

Identification of an Optimal Concentration of Platelet Gel for Promoting Angiogenesis in Human Endothelial Cells. Transfusion, 2009;49:771-78.

Optimization of Ingredients, Procedures and Rehabilitation for Platelet-Rich Plasma Injections for Chronic Tendinopathy. Pain Management, 2011;1(6):523-32.

Platelet-Rich Plasma:  From Basic Science to Clinical Applications.  AJSM, 2009;37:2259-2272.

Platelet-Rich Plasma:  Current Concepts and Application in Sports Medicine.  Journal of the American Academy of Orthopedic Surgery (J Am Acad Orthop Surg), 2009;17(10):602-608.

Platelet Concentrate Preparation:  A Comparison of the Harvest SmartPReP APC with the Emcyte Genesis.

Platelet Rich Plasma Preparation:  A Comparison of the Harvest SmartPReP 2 APC+ with the Arteriocyte Magellan.

Platelet Rich Plasma Preparation:  A Comparison of the Harvest SmartPReP 2 APC+ with the Arthrex ACP.

Platelet Concentrate Preparation:  A Comparison of the Harvest SmartPReP 2 with the Biomet GPS III.

Platelet Concentrate Preparation:  A Comparison of the SmartPReP 2 with the B.T.I. PRGF System.

The Roles of Growth Factors in Tendon and Ligament Healing.  Sports Med 2007;35:245-51.

Use of PRP to treat various conditions:

Achilles Tendonitis:

Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy:  A Randomized Controlled Trial.  Journal of the American Medical Association (JAMA), 2010;303(2):144-149.

Treatment of Achilles Tendinopathy with Platelet-Rich Plasma.  International Journal of Sports Medicine (Int J Sports Med), 2010;31(8):577-583.

Articular Cartilage Injury:

Platelet-Rich Plasma:  Intra-articular Knee Injections Produced Favorable Results on Degenerative Cartilage Lesions.  Knee Surg Sports Traumatol Arthrosc 2010;18:472-9.

The Treatment of Severe Chondropathies of the Knee with Autologous Platelet-Rich Plasma Injections:  Preliminary Results.  Osteoarthr Cartilage 2008;16:126-7.

Articular Cartilage Defects:  Reconstruction By Plasma-Rich Growth Factors.  In:  Basic Science, Clinical Repair and Reconstruction of Articular Cartilage Defects:  Current Status and Prospects.  Bologna, Italy:  Timeo Edotor; 2006:801-7.

Effects of Autologous Platelet-Rich Plasma on the Metabolism of Human Articular Chondrocytes.  Osteoarthritis Cartilage.  2007;15(suppl 2):B134.

Fractures:

Benefit of Percutaneous Injection of Autologous Platelet-Leukocyte-Rich Gel in Patients with Delayed Union and Nonunion.  Eur Surg Res 2008;40:289-96.

General:

Applications of Platelet-Rich Plasma in Musculoskeletal and Sports Medicine:  An Evidence-Based Approach.  Physical Medicine and Rehabilitation (PMR), 2011;3:226-250.

Treatment of Tendon and Muscle Using Platelet-Rich Plasma. Clinical Journal of Sports Medicine (CJSM), 2009;28(1):113-125.

Platelet-Rich Plasma Injection Grafts for Muscuolskeletal Injuries:  A Review.  Current Reviews in Musculoskeletal Medicine (Curr Rev Musculoskelet Med), 2008;1(3-4):165-174.

How Can One Platelet Injection After Tendon Injury lead to a Stronger Tendon After Four Weeks?  Interplay Between Early Regeneration and Mechanical Stimulation.  Acta Orthop, 2006;77(5):806-812.

The Use of Platelet-Rich Plasma in Arthroscopy and Sports Medicine:  Optimizing the Healing Environment.  Arthroscopy 2010;26(2):269-78.

Muscle Strain Injury

Use of Autologous Platelet-Rich Plasma to Treat Muscle Strain Injuries.  AJSM 2009;37:1135-42.

Use of Growth Factors to Improve Muscle Healing After Strain Injury.  Clinical Orthopedics and Related Research (Clin Orthop Rel Res) 2000;(370):272-285.

Osteoarthritis:

Platelet-Rich Plasma Treatment in Symptomatic Patients with Knee Osteoarthritis:  Preliminary Results in a Group of Active Patients.  Sports Health, 2012;4(2):162-72.

Infiltration of Plasma Rich in Growth Factors for Osteoarthritis of the Knee:  Short-term Effects on Function and Quality of Life.  Arch Orthop Trauma Surg, 2011;131(3):311-317.

Treatment of Knee Joint Osteoarthritis with Autologous Platelet-Rich Plasma in Comparison with Hyaluronic Acid.  American Journal of Physical Medicine and Rehabilitation (Am J Phys Med Rehabil), 2012;91(5):411-417.

Injection of Platelet-Rich Plasma in Patients with Primary and Secondary Knee Osteoarthritis:  A Pilot Study.  Am J Phys Med Rehabil, 2010;89:961-9.

Intra-articular Injection of an Autologous Preparation Rich in Growth Factors for the Treatment of Knee OA:  Retrospective Cohort Study.  Clin Exp Rheumatol, 2008;26:910-3.

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.

Treatment of Knee Osteoarthritis with Orthokine-derived Autologous Conditioned Serum.  Expert Rev Clin Immunol 2010;6:335-45.

Comparison Between Hyaluronic Acid and Platelet-Rich Plasma, Intra-articular Infiltration in the Treatment of Gonarthrosis.  AJSM 2012;40(12):2822-27.

Patellar Tendonitis:

Use of Platelet-Rich Plasma for the Treatment of Refractory Jumper’s Knee.  International Orthopedics (Int Orthop), 2010;34(6):909-915.

Platelet-Rich Plasma:  New Clinical Application:  A Pilot Study for Treatment of Jumper’s Knee.  Injury, 2009;40(6):598-603.

Immunohistochemical Study of Angiogenesis After Local Administration of Platelet-Rich Plasma in a Patellar Tendon Defect.  Int Orthop 2010;34:143-148.

Tennis Elbow:

Positive Effect of an Autologous Platelet Concentrate in Lateral Epicondylitis in a Double-Blind Randomized Controlled Trial:  Platelet-Rich Plasma Versus Corticosteroid Injection With a One Year Follow-up.  American Journal of Sports Medicine (AJSM), 2010;38:255-261.

Treatment of Chronic Elbow Tendinosis With Buffered Platelet-Rich Plasma.  AJSM, 2006;10(10):1-5.

Ongoing Positive Effect of Platelet-Rich Plasma Versus Corticosteroid Injection in Lateral Epicondylitis:  A Double-Blind Randomized Controlled Trial with Two Year Follow-up.  AJSM, 2011;39(6):1200-1208.