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At one time medical professionals thought the only purpose of platelets was to form a clot in order to heal cuts and other injuries. This is only a small part of the whole picture. Another crucially important function of platelets is the release of various growth factors responsible for almost all repair processes that occur in the body. These growth factors, also called cytokines, are extremely important in cellular communication, having both direct and indirect effects on stem cells and other types of more mature cells. They work as a communication network between the cells, among other functions.
Platelets and accompanying stem cells are responsible for repair, whether in healing an injury or recovering from surgery. Platelets are found circulating in the blood but typically occur in relatively small numbers. Around 20 years ago the idea of concentrating platelets became widespread in cardio-thoracic surgery. Further research was carried out in the field of oral surgery in 1998 by Dr. Robert Marx at the University of Miami, who revealed what constituted a platelet-concentrated product. In the years since his research concentrated platelets have become known as Platelet Rich Plasma, or PRP, which stimulates healing.
There are many different methods of preparing a PRP product, however all techniques use centrifugation. The type of centrifuge and the speed at which the centrifuge runs varies from one PRP producer to the next. The PRP product that various companies produce varies widely in the concentration and cell types that are found in a PRP product.
The problem PRP producers face is that current scientific literature has no good definition as to what constitutes a PRP. Thus, while one article may show significant positive effects from PRP the next may show that PRP is no better than a placebo. It is important to note that this problem stems largely from disparities in quality between the various companies that produce PRP products, not from lack of efficacy of PRP therapy. Later in this section we will explain the science behind what constitutes an effective PRP product.
The amount of blood needed to produce a PRP depends upon the joint or tendon requiring treatment and the type of system used. Some systems require up to 60 cc's (about 2 ounces) while others require about 10cc's. The amount of centrifugation time varies from one company to the next. Much variation exists in PRP products produced by various companies in terms of different concentration of platelets, red blood cells, white blood cells and other types of cells.
These concentrations can make a difference between success and failure of a PRP injection. While clotting agents such as thrombin have been used in the past to “activate” the platelets to release their growth factors, we do not employ any clotting agents with our PRP. It is not necessary and could actually be detrimental, since using a clotting agent releases the growth factors all at once rather than through a prolonged release.
The methods utilized to inject the PRP product depend on the area being treated. For certain joints, such as the hip, we utilize fluoroscopy, which is a "living X-ray." In other instances we utilize ultrasound guidance or simply give the injection into a joint.
The aftercare for most PRP injections is relatively simple—we allow the patient to resume activity at their own pace. We will typically restrict the use of non-steroidal anti-inflammatory drugs (NSAIDs) for a day or two. After a PRP injection we utilize a variety of techniques to help maximize stem cell output from the bone marrow, including various supplements and avoidance of smoking and alcohol intake, both of which diminish stem cell output.
We typically perform two PRP injections into an area, usually spaced four to six weeks apart. Occasionally, a third PRP injection is needed. PRP injections are replacing traditional orthopedic surgery in many instances for conditions ranging from soft tissue injuries (tendonitis, muscle tears, ligamentous injuries) to various joint afflictions, such as a torn meniscus or mild to moderate arthritis of the joint.
The pain from the process typically will last a few days, occasionally longer, and some patients have more severe or sporadic pain than others. We strongly encourage viewers to continue reading this section to learn more about the science of PRP injection. If you are considering having a PRP procedure done, you owe it to yourself to have a better understanding of the science.