Toronto SEMI is pleased to offer a brand new, very exciting therapy, for both chronic injuries, and, acute injuries where speeding up healing is a priority. Platelet Rich Plasma (PRP) injections involve withdrawing 20-60 cc of a patient’s OWN blood. Next, the blood is processed in a special centrifuge, which separates the blood into various components. One of the components, PRP, contains a high concentration of blood platelets, and as a result, a high concentration of Growth Factors. The PRP is then injected into the damaged tissue. This is where the excitement begins!
What are platelets and growth factors?
Platelets are one type of cell found in blood. These specialized cells have many functions, including helping blood clot when you are bleeding, providing a ‘scaffold’ for tissue healing when injured, and producing a myriad of ‘growth factors’ that help the body heal itself once injured. Growth factors are compounds that are made by platelets, examples of which include Platelet Derived Growth Factor (PDGF), TGF-B (Transforming Growth Factor-Beta) and VEGF (Vascular Endothelial Growth Factor). These compounds are instrumental in attracting other cells that aid in healing, stimulating new blood vessel formation helpful in the healing process and promoting reproduction of cells necessary for healing. Processing the blood into PRP results in an average 4-5 fold increase in the concentration of these important growth factors. Thus, when injected into the injured tissue, a big ‘hit’ of healing compounds flood the injury, stimulating healing.
What is PRP used for?
PRP is used in a variety of problemsbasically, anywhere an injury is slow in healing, or, when you may want to speed up healing beyond the averages that most people experience. Tendon injuries, ligament injuries and cartilage injuries are all potential targets for PRP injections. Conditions like plantar fasciitis, muscle tears, ligament tears, rotator cuff tendinopathy and cartilage tears may all respond to PRP. Speeding up ‘normal’ healing is also a very powerful part of PRP injections. For instance, any athlete with an upcoming important competition can benefit from PRP injections to speed up healing. An individual with a planned active vacation where an injury may negatively affect the trip can also benefit, with the hope of healing to the point where the vacation can be actively pursued and enjoyed.
How long has PRP been used?
The earliest work with PRP began about 20 years ago, but really has come to the forefront of sports medicine care only recently. In the past, it has been used to speed up surgical healing, and now it’s application has expanded to non surgical situations. In fact, PRP is often used prior to surgical intervention, and can definitely reduce the chances that you will need surgery for a stubborn injury.
Are the injections guided by ultrasound?
Many times, the structure being injected is very easy to localize, and the injection is very straight forward. These do not require ultrasound guidance. However, sometimes, ultrasound guidance is used to ensure accurate needle placement, especially for more difficult injections.
How many injections will I need?
Often one is it. Sometimes, more are needed depending on the injury and the individual.
Is there any science to support it’s use?
Absolutely more than you will care to read! See the reference list at the end of this article.
Questions?Call us to book an appointment at 416-223-SEMI (7364) to discuss!
1. Menetrey, J, et al, Growth Factors Improve Muscle Healing In Vivo, The Journal of Bone & Joint Surgery (Br), 2000; 82-B:131-137
2. Aspenberg, P, P, et al, Platelet Concentrate Injection Improves Achilles Tendon Repair in Rats, Acta Orthop Scand, 2004; 1:93-99
3. Yasuda, K, et al, The Effect of Growth Factors on Biomechanical Properties of the Bone-Patellar Tendon-Bone Graft after Anterior Cruciate Ligament Reconstruction,American Journal of Sports Medicine, 2004, 32:870-880
4. Anitua, E, et al, Autologous Preparations Rich in Growth Factors Promote Proliferation and Induce VEGF and HGF Production by Human Tendon Cells in Culture, Journal of Orthopaedic Research, 2005, 23:281-286
5. Murray, M, et al, Use of a Collagen-Platelet Rich Plasma Scaffold to Stimulate Healing of a Central Defect in the Canine ACL, Journal of Orthopaedic Research, 2006, 24:820-830
6. Schnabel, L, et al, Platelet Rich Plasma (PRP) Enhances Anabolic Gene Expression Patterns in Flexor Digitorum Superficialis Tendons, Journal of Orthopaedic Research, 2006
7. Sanchez, M, et al, Plasma Rich in Growth Factors to Treat Articular Cartilage Avulsion: A Case Report, Medicine & Science in Sports & Exercise, 2003, 1648-1652
8. Sanchez, M, et al, Application of Autologous Growth Factors on Skeletal Muscle Healing, 2nd World Congress on Regenerative Medicine Podium Presentation, May, 2005
9. Ventura, A, et al, Use of Growth Factors in ACL Surgery: Preliminary Study,Journal of Orthopaedic Traumatology, 2005, 6:76-79
10. Mishra, A, et al, Treatment of Chronic Elbow Tendinosis with Buffered Platelet-Rich Plasma, American Journal of Sports Medicine, May 30, 2006
11. W Weiler, A, et al, The Influence of Locally Applied Platelet-Derived Growth Factor-BB on Free Tendon Graft Remodeling after Anterior Cruciate Ligament Reconstruction, American Journal of Sports Medicine, 2006; 32:881-891
12. Wu, W, et al, Autologous Injectable Tissue-Engineered Cartilage by Using Plate-Rich Plasma: Experimental Study in a Rabbit Model, Journal of Oral Maxillofacial Surgery, 2007; 65:1951-1957
13. Murray, M, et al, Collagen-Platelet Rich Plasma Hydrogel Enhances Primary Repair of the Porcine Anterior Cruciate Ligament, Journal of Orthopaedic Research, 2007, 25:81-91
14. Sanchez, M, et al, Comparison of Surgically Repaired Achilles Tendon Tears Using Platelet Rich Fibrin Matrices, The American Journal of Sports Medicine, 2007, 35:245-251
15. Tortland, P, Regenerative Injection Therapy, Valley Sports Physicians & Orthopedic Medicine, www.jockdoctors.com
16. Adelson, H, Platelet Rich Plasma for Treating Chronic Pain, The Chinese Association for the Study of Pain Podium Presentation, 2007, March 17
17. Zavadil, D, et al, Autologous Platelet Gel and Platelet Poor Plasma Reduce Pain with Total Shoulder Arthroplasty, Journal of Extracorporeal Technology, 2007; 39:177-182
18. Schultheiss, H, Tendinoraphy in the Foot Utilizing Concentrated Autologous Platelet Grafting: Two Case Studies, 2007
19. Scarpone, M, Chronic Medial Collateral High-Grade Tear: Treatment with Autologous Platelet Concentrate Injection with Ultrasound Guidance: A Case Report, 2008
20. Scarpone, M, Non-Surgical Repair of High Grade Achilles Tendon Tear by Autologous Platelet Graft Placement: A Case Report, 2008
21. de Mos, M, et al, Can Platelet-Rich Plasma Enhance Tendon Repair? A Cell Culture Study, American Journal Sports Medicine, 2008