{"id":683,"date":"2017-02-21T21:22:44","date_gmt":"2017-02-21T21:22:44","guid":{"rendered":"http:\/\/stadiasportsmedicine.com\/info\/?p=683"},"modified":"2018-05-09T16:37:30","modified_gmt":"2018-05-09T16:37:30","slug":"prp-des-moines","status":"publish","type":"post","link":"https:\/\/stadiasportsmedicine.com\/info\/2017\/prp-des-moines\/","title":{"rendered":"PRP: Harnessing the body\u2019s own healing process"},"content":{"rendered":"

\"\"<\/a><\/h1>\n

Platelet-Rich Plasma Injections (PRP):<\/h1>\n

What is PRP?<\/h3>\n

Platelet Rich Plasma, PRP, has become a popular option for athletes or other injured patients who want to try to harness the body\u2019s own healing process to help treat chronic conditions that are not responding to other treatments, without resorting to surgery.\u00a0 It has been used by professional athletes in virtually every major sport to treat conditions ranging from chronic achilles tendonitis to cartilage injuries in the knee.\u00a0Put simply, PRP is the concentration of platelets within blood plasma.\u00a0 Traditionally, PRP has been used to assist with wound healing (plastic surgery application) or to assist with healing of chronic tendonitis or other soft tissue injuries.\u00a0 More recently, its use in osteoarthritis has been considered.<\/p>\n

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How is PRP thought to work?<\/h3>\n
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Platelets are a specialized type of blood cell involved in injury healing.<\/p>\n

There is thought to be an optimal concentration of platelets for healing of injured tissue.\u00a0 Different commercially-available PRP preparations vary in terms of their ability to concentrate platelets in plasma.\u00a0 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.\u00a0 Studies seem to indicate that the optimal platelet concentration ranges from 1.5 million to 3.0 million platelets per microliter.\u00a0 Studies also show that platelet concentrations below 500,000 platelets per microliter have no more effect on cell recruitment than whole blood.\u00a0 Platelets also contain large reservoirs of natural growth factors that are essential for the cell recruitment and multiplication involved in wound healing.\u00a0 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.\u00a0 To be considered PRP, the platelet count must be 4x or greater above baseline.\u00a0 PRP can be formulated in the office independently or through use of commercially-available preparation systems.\u00a0 Some of these commercial systems include Harvest, Emcyte, Arteriocyte, Arthrex, Cascade or Biomet.<\/p>\n

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.\u00a0 The platelet product that Harvest\u2019s 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).\u00a0 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.<\/p>\n

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.\u00a0 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.\u00a0 Cells that have been shown to be recruited to the area of injury following PRP injection include:<\/p>\n

    \n
  • Growth Factors<\/strong>\n
      \n
    • Platelet-derived growth factor (PDGF), responsible for attracting stem cells and other healing cells to the injured area.<\/li>\n
    • Transforming growth factor beta (TGF-\u03b2), which helps promote cell mitosis and differentiation for connective tissue and bone.<\/li>\n
    • Vascular endothelial growth factors (VEGF), which helps stimulate blood vessel growth to the injured area.<\/li>\n<\/ul>\n<\/li>\n
    • White cells, some of which serve as stem cell lines<\/strong>\n
        \n
      • Harvest\u2019s 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%.<\/li>\n<\/ul>\n<\/li>\n
      • Cytokines<\/strong>\n
          \n
        • A \u201choming agent\u201d for WBC stem cell lines.\u00a0 Stromal derived factor 1 alpha (SDF-1\u03b1), which modulates migration of stem cells to the wound site.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

          What happens during a PRP procedure?<\/h3>\n

          A sample of blood is taken from a vein in the arm and then spun in a centrifuge in our office.\u00a0 Spinning the blood in a centrifuge helps concentrate the platelets into the bottom of the collection tube.\u00a0 Once this concentration is complete, the platelets can be injected into or around the injured area.\u00a0 Guidance with ultrasound is always used to ensure proper placement of the PRP into the area of injury.\u00a0 Precise placement of the PRP helps increase the likelihood of a good clinical outcome.<\/p>\n

          Depending on the condition being treated, a short period of immobilization might be recommended.\u00a0 Typically, activity modification is necessary for several weeks following a PRP injection, to give the PRP-induced healing response adequate time to work.<\/p>\n

          What can PRP be used for?<\/h3>\n
            \n
          • Tendonitis<\/strong> (Chronic tendonitis or non-operative treatment of partial-thickness tears)<\/span>\n
              \n
            • Rotator cuff<\/li>\n
            • Biceps<\/li>\n
            • Golfers\/Tennis elbow<\/li>\n
            • Tendonitis around the thigh (Gluteus medius, hamstring)<\/li>\n
            • Patellar or quadriceps tendonitis<\/li>\n
            • Tendonitis around the ankle (Peroneal, Tibialis posterior)<\/li>\n
            • Achilles<\/li>\n
            • Plantar fasciitis<\/li>\n<\/ul>\n<\/li>\n
            • Degenerative joint disease<\/strong>\n
                \n
              • Knee osteoarthritis<\/li>\n
              • Symptomatic articular cartilage injury<\/li>\n
              • Ankle osteoarthritis<\/li>\n
              • Wrist osteoarthritis<\/li>\n
              • Elbow osteoarthritis<\/li>\n
              • Shoulder osteoarthritis<\/li>\n<\/ul>\n<\/li>\n
              • Ligament Injury<\/strong>\n
                  \n
                • Ulnar collateral ligament injury of the elbow<\/li>\n
                • Medial collateral ligament injury of the knee<\/li>\n<\/ul>\n<\/li>\n
                • Fracture Care<\/strong>\n
                    \n
                  • Delayed union or nonunion fractures<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                    What does a PRP treatment cost?*<\/h3>\n

                    $870 \u00a0(not covered by insurance & will not be submitted to insurance)<\/p>\n

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

                    _______________________________<\/p>\n

                    PRP resources:<\/strong><\/p>\n

                    Research concerning preparation of PRP and the underlying science:<\/p>\n

                    Platelet-Rich Plasma Differs According to Preparation Method and Human Variability.\u00a0 http:\/\/orthodoc.aaos.org\/WilliamFBennettMD\/PRP%20differs%20according%20to%20Preparation%20Method_Human%20Variability.pdf<\/p>\n

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

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

                    Platelet-Rich Plasma:\u00a0 From Basic Science to Clinical Applications.\u00a0 AJSM, 2009;37:2259-2272.<\/p>\n

                    Platelet-Rich Plasma:\u00a0 Current Concepts and Application in Sports Medicine.\u00a0 Journal of the American Academy of Orthopedic Surgery (J Am Acad Orthop Surg), 2009;17(10):602-608.<\/p>\n

                    Platelet Concentrate Preparation:\u00a0 A Comparison of the Harvest SmartPReP APC with the Emcyte Genesis.<\/p>\n

                    Platelet Rich Plasma Preparation:\u00a0 A Comparison of the Harvest SmartPReP 2 APC+ with the Arteriocyte Magellan.<\/p>\n

                    Platelet Rich Plasma Preparation:\u00a0 A Comparison of the Harvest SmartPReP 2 APC+ with the Arthrex ACP.<\/p>\n

                    Platelet Concentrate Preparation:\u00a0 A Comparison of the Harvest SmartPReP 2 with the Biomet GPS III.<\/p>\n

                    Platelet Concentrate Preparation:\u00a0 A Comparison of the SmartPReP 2 with the B.T.I. PRGF System.<\/p>\n

                    The Roles of Growth Factors in Tendon and Ligament Healing.\u00a0 Sports Med 2007;35:245-51.<\/p>\n

                     <\/p>\n

                    Use of PRP to treat various conditions:<\/p>\n

                     <\/p>\n

                    Achilles Tendonitis: #AchillesTendonitis<\/span><\/p>\n

                    Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy:\u00a0 A Randomized Controlled Trial.\u00a0 Journal of the American Medical Association (JAMA), 2010;303(2):144-149.<\/p>\n

                    Treatment of Achilles Tendinopathy with Platelet-Rich Plasma.\u00a0 International Journal of Sports Medicine (Int J Sports Med), 2010;31(8):577-583.<\/p>\n

                     <\/p>\n

                    Articular Cartilage Injury: #kneepain #articularcartilageinjury #degenerativecartilagelesions #reconstruction #osteoarthritis<\/span><\/p>\n

                    Platelet-Rich Plasma:\u00a0 Intra-articular Knee Injections Produced Favorable Results on Degenerative Cartilage Lesions.\u00a0 Knee Surg Sports Traumatol Arthrosc 2010;18:472-9.<\/p>\n

                    The Treatment of Severe Chondropathies of the Knee with Autologous Platelet-Rich Plasma Injections:\u00a0 Preliminary Results.\u00a0 Osteoarthr Cartilage 2008;16:126-7.<\/p>\n

                    Articular Cartilage Defects:\u00a0 Reconstruction By Plasma-Rich Growth Factors.\u00a0 In:\u00a0 Basic Science, Clinical Repair and Reconstruction of Articular Cartilage Defects:\u00a0 Current Status and Prospects.\u00a0 Bologna, Italy:\u00a0 Timeo Edotor; 2006:801-7.<\/p>\n

                    Effects of Autologous Platelet-Rich Plasma on the Metabolism of Human Articular Chondrocytes.\u00a0 Osteoarthritis Cartilage.\u00a0 2007;15(suppl 2):B134.<\/p>\n

                     <\/p>\n

                    Fractures: #fracture<\/span><\/p>\n

                    Benefit of Percutaneous Injection of Autologous Platelet-Leukocyte-Rich Gel in Patients with Delayed Union and Nonunion.\u00a0 Eur Surg Res 2008;40:289-96.<\/p>\n

                     <\/p>\n

                    General:<\/p>\n

                    Applications of Platelet-Rich Plasma in Musculoskeletal and Sports Medicine:\u00a0 An Evidence-Based Approach.\u00a0 Physical Medicine and Rehabilitation (PMR), 2011;3:226-250.<\/p>\n

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

                    Platelet-Rich Plasma Injection Grafts for Muscuolskeletal Injuries:\u00a0 A Review.\u00a0 Current Reviews in Musculoskeletal Medicine (Curr Rev Musculoskelet Med), 2008;1(3-4):165-174.<\/p>\n

                    How Can One Platelet Injection After Tendon Injury lead to a Stronger Tendon After Four Weeks?\u00a0 Interplay Between Early Regeneration and Mechanical Stimulation.\u00a0 Acta Orthop, 2006;77(5):806-812.<\/p>\n

                    The Use of Platelet-Rich Plasma in Arthroscopy and Sports Medicine:\u00a0 Optimizing the Healing Environment.\u00a0 Arthroscopy 2010;26(2):269-78.<\/p>\n

                     <\/p>\n

                    Muscle Strain Injury #musclestrain #musclestraininjury #injury<\/span><\/p>\n

                    Use of Autologous Platelet-Rich Plasma to Treat Muscle Strain Injuries.\u00a0 AJSM 2009;37:1135-42.<\/p>\n

                    Use of Growth Factors to Improve Muscle Healing After Strain Injury.\u00a0 Clinical Orthopedics and Related Research (Clin Orthop Rel Res) 2000;(370):272-285.<\/p>\n

                     <\/p>\n

                    Osteoarthritis: #osteoarthritis #kneeosteoarthritis<\/span><\/p>\n

                    Platelet-Rich Plasma Treatment in Symptomatic Patients with Knee Osteoarthritis:\u00a0 Preliminary Results in a Group of Active Patients.\u00a0 Sports Health, 2012;4(2):162-72.<\/p>\n

                    Infiltration of Plasma Rich in Growth Factors for Osteoarthritis of the Knee:\u00a0 Short-term Effects on Function and Quality of Life.\u00a0 Arch Orthop Trauma Surg, 2011;131(3):311-317.<\/p>\n

                    Treatment of Knee Joint Osteoarthritis with Autologous Platelet-Rich Plasma in Comparison with Hyaluronic Acid.\u00a0 American Journal of Physical Medicine and Rehabilitation (Am J Phys Med Rehabil), 2012;91(5):411-417.<\/p>\n

                    Injection of Platelet-Rich Plasma in Patients with Primary and Secondary Knee Osteoarthritis:\u00a0 A Pilot Study.\u00a0 Am J Phys Med Rehabil, 2010;89:961-9.<\/p>\n

                    Intra-articular Injection of an Autologous Preparation Rich in Growth Factors for the Treatment of Knee OA:\u00a0 Retrospective Cohort Study.\u00a0 Clin Exp Rheumatol, 2008;26:910-3.<\/p>\n

                    Platelet-Rich Plasma Intra-Articular Knee Injections for the Treatment of Degenerative Cartilage Lesions and Osteoarthritis.\u00a0 Knee Surg Sports Traumatol Arthrosc, 2011;19(4):528-35.<\/p>\n

                    Treatment of Knee Osteoarthritis with Orthokine-derived Autologous Conditioned Serum.\u00a0 Expert Rev Clin Immunol 2010;6:335-45.<\/p>\n

                    Comparison Between Hyaluronic Acid and Platelet-Rich Plasma, Intra-articular Infiltration in the Treatment of Gonarthrosis.\u00a0 AJSM 2012;40(12):2822-27.<\/p>\n

                     <\/p>\n

                    Patellar Tendonitis: #patellartendonitis #jumpersknee #patellartendondefect<\/span><\/p>\n

                    Use of Platelet-Rich Plasma for the Treatment of Refractory Jumper\u2019s Knee.\u00a0 International Orthopedics (Int Orthop), 2010;34(6):909-915.<\/p>\n

                    Platelet-Rich Plasma:\u00a0 New Clinical Application:\u00a0 A Pilot Study for Treatment of Jumper\u2019s Knee.\u00a0 Injury, 2009;40(6):598-603.<\/p>\n

                    Immunohistochemical Study of Angiogenesis After Local Administration of Platelet-Rich Plasma in a Patellar Tendon Defect.\u00a0 Int Orthop 2010;34:143-148.<\/p>\n

                     <\/p>\n

                    Tennis Elbow: #tenniselbow #golferselbow #lateralepicondylitis #elbowtendinosis\u00a0<\/span><\/p>\n

                    Positive Effect of an Autologous Platelet Concentrate in Lateral Epicondylitis in a Double-Blind Randomized Controlled Trial:\u00a0 Platelet-Rich Plasma Versus Corticosteroid Injection With a One Year Follow-up.\u00a0 American Journal of Sports Medicine (AJSM), 2010;38:255-261.<\/p>\n

                    Treatment of Chronic Elbow Tendinosis With Buffered Platelet-Rich Plasma.\u00a0 AJSM, 2006;10(10):1-5.<\/p>\n

                    Ongoing Positive Effect of Platelet-Rich Plasma Versus Corticosteroid Injection in Lateral Epicondylitis:\u00a0 A Double-Blind Randomized Controlled Trial with Two Year Follow-up.\u00a0 AJSM, 2011;39(6):1200-1208.<\/p>\n

                    #Rotator cuff #Biceps #GolfersElbow #Tenniselbow #Tendonitis #thigh #Gluteusmedius #hamstring #Patellar #patellartendonitis #quadricepstendonitis #quadriceps #ankle #Peroneal #Tibialisposterior #PeronealTendonitis #TibialisposteriorTendonitis #Achilles #AchillesTendonitis #Plantarfasciitis #Degenerativejointdisease #<\/strong>Kneeosteoarthritis #articularcartilageinjury #AnkleOsteoarthritis #WristOsteoarthritis #ElbowOsteoarthritis #ShoulderOsteoarthritis #LigamentInjury #Ligament #<\/strong>UlnarCollateralLigamentInjuryElbow #Medialcollateralligamentinjuryknee #Fracture #<\/strong>Delayedunionfracture #nonunionfracture<\/span><\/p>\n<\/div>\n<\/div>\n