PRP - Regenerative Injection Therapy
PRP, Platelet Rich Plasma, Vancouver
PRP, Platelet Rich Plasma Regenerative Injection Therapy, for the treatment of back pain, neck pain, tendonitis, shoulders, elbows, wrists, fingers, hips, knees, ankles, feet, an essentailly all joints of the body.
What is Platelet Rich Plasma (PRP)?
Platelet Rich Plasma, also known as PRP, is blood plasma with concentrated platelets. The platelets found in PRP are highly concentrated and include growth factors, as well as a large supply of bioactive proteins which are crucial to activate and accelerate tissue repair and regeneration. The bioactive proteins increase the production of stem cells which initiate the healing of connective tissue, regeneration and repair of bones, promotion of new blood vessels and stimulation of the wound healing process.
A normal platelet count concentration is 200,000/micro liter, whereas the platelet count in Platelet Rich Plasma can exceed 2 million platelets/micro liter. In order to be considered for PRP, the platelet count must be four times or more above the baseline.
|Normal Platelet Count||Concentrated Platelet Count|
PRP Regenerative Injection Therapy (Prolotherapy)
This new treatment for pain is becoming popular among orthopedic and pain specialists: the injection of platelet rich plasma (PRP). Most everyone thinks of blood platelets as being responsible for blood clotting after injury which is true. What many people do not know is that blood platelets serve two other important functions. Blood platelets are responsible for bringing white blood cells to the injured area to clean up the remains of dead and injured cells. Most importantly, blood platelets release growth factors that are directly responsible for tissue regeneration. PRP has been used for years in surgical centers around the US and abroad to improve the success of bone grafting (especially in dental surgery) and also by cosmetic surgeons for speeding healing time and decreasing the risk of infection after surgery. Only in the last few years have doctors and surgeons been experimenting with injecting PRP for the treatment of chronic pain. Tennis elbow, plantar fasciitis, Achilles tendonitis/tendonosis, rotator cuff tears, meniscal tears, osteoarthritis and chronic low back and neck pain are are all being treated with the prolotherapy injection of PRP with the goal of regenerating degenerated connective tissue with reports of great success at a magnitude greater than regular dextrose prolotherapy.
How is Platelet Rich Plasma made?
The first step in creating Platelet Rich Plasma involves drawing 20-60 cc of blood. This is a very small amount, compared to blood bank donations which take 500 cc's of blood.
The blood is then put into the Harvest SmartPReP®2 Platelet Concentrate System and spun down separating the red blood cells, plasma and concentrating the platelets.
|The Platalet Rich Plasma Making Process|
Here’s how it works:
After an injury has been incurred, the body's natural response to the injury is to deploy an organized process of both regenerating and remodeling damaged cells. This aims to return the damaged tissues to their normal state. This entire process is known as the healing cascade, which is controlled by the bioactive tissue growth components found in the platelets. PRP prolotherapy involves injecting these concentrated growth factors directly into the site of the injury.
|How PRP prolotherapy works|
Growth Factor Biology
Bioactive proteins replace, repair and regenerate tissue. Bioactive proteins are naturally found in the body and are considered to be a "new frontier" of clinical treatment. By increasing the bioactivity at the site of the wound, the healing process is accelerated toward its goal of naturally speeding up the body's normal healing process.
The bioactive proteins that are carried by platelets are already successfully used for homeostasis, would sealing, and wound sealing in surgical disciplines such as:
- Oral and maxillofacial
- General, plastic and reconstructive, non-healing wounds
Why use your own platelets?
Platelets are very small cells that critically contribute to the healing process. As the body's primary source of bioactive tissue growth factors, platelets include:
- CTGF (Connective Tissue Growth Factor)
- PGDF (Platelet Derived Growth Factor)
- TGF-β (Transforming Growth Factor-beta)
- EGF (Epidermal Growth Factor)
- IGF (Insulin Growth Factor)
- bFGF (basic Fibroblast Growth Factor)
- VEGF (Vascular Endothelial Growth Factor
|PRP provides a fibrin matrix graft. : Fibrin matrix provides the scaffolding for new collagen to form along damaged ligaments and tendons. With a fibrin matrix graft, even severely damaged tissues can re-organize and heal.|
PRP concentrates Mesenchymal stem cells (MSCs).
MSC's are multi-potent stem cells that can transform into several of types of cell during the tissue repairing process. The different types of cells that MSC's have been known to transform into include collagen secreting cells, bone forming osteoblasts and cartilage forming chondrocytes. Collectively, all of these cells can potentially rejuvenate tissues that have been damaged due to injury, osteoarthritis and degenerative changes.
What does it do?
The platelet rich plasma process concentrates fibrin, mesenchymal stem cells and platelets so that each cubic millimeter of the solution consists of 1.5 to 2 million platelets. This results in up to a five-fold increase in the platelets and bioactive growth factors. Platelet Rich Plasma acts as a tissue growth accelerator which amplifies the natural process of the tissue reparation and healing, due to its potency. Studies have revealed that PRP stimulates not only the production of new collagen at the fibroblasts, but bone and cartilage cells at the site of the injection. This strengthens injured ligaments and tendons by rebuilding the joint cartilage. This new, strong, collagen is naturally incorporated into the existing cartilage and ligaments making them thicker and more elastic.
How Does PRP Prolotherapy Compare With Cortisone Shots?
According to certain studies, cortisone injections may actually weaken tissue. Although cortisone injections have been known to provide temporary relief and to stop inflammation, they may not provide long-term healing. The process of Platelet Rich Plasma therapy heals and strengthens the tendons and ligaments, in some cases thickening the tissue up to 40%.
How Does PRP Regenerative Injection Therapy compare with regular Dextrose Prolotherapy?
When regular dextrose prolotherapy has provided positive results but recovery has not been ideal, PRP Regenerative Injection Therapy is especially useful. In these types of situations PRP is often the treatment option that will resolve the less responsive or more injured areas. In fact, clinical and anecdotal experience has demonstrated that using PRP as the prolotherapy injection solution creates a deeper healing effect and results in an accelerated healing process in fewer treatments than the regular dextrose prolotherapy..
Frequency Of Treatments
Usually patients feel the benefits of PRP injection therapy after only two treatments. Sometimes satisfactory results may occur even sooner, however this is not absolutely certain. Although individual responses to the treatment do vary, most people require 3-6 sets of injections. Each treatment is spaced four to six weeks apart.
So what conditions are successfully treated with PRP?
Because of the high success of normal Dextrose Prolotherapy, PRP is not something we normally think of as a first line solution. For really, really, bad tears or injuries, especially if someone has had some Prolotherapy elsewhere, it may be used as a first-line therapy. Because of the greater cost of PRP due to the cost of filters and PRP technology as well as preparation it is preferable to begin with regular prolotherapy as it provides excellent results 80% of the time. For those who do get PRP solution as their Prolotherapy solution, we typically see them for follow-up in four to six weeks. Generally, people know by the second PRP Prolotherapy whether it will work or not. Overall the results have been extremely positive. It is very safe. There have been no reactions related to the solution.
When to consider PRP solution as your Prolotherapy Option:
- regular prolotherapy has resulted in some success, you are confident the treatment has been done properly into the appropriate areas, but the results are not optimal.
- Your injury is very severe or complex
- labral or meniscal tears
- high performance athletes who put more demand on joints
- out of town patients who cannot return for visits frequently
- persons who wish to maximize their results with a minimum number of injection visits
Research In PRP Regenerative Injection Therapy: Platelet Rich Plasma (PRP) Matrix Graft by David Crane, MD and Peter A.M. Everts PhD
Dr. Hal Brown, PRP regenerative injection therapy, Vancouver, B.C.