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PRP Injections

The field of sports medicine is advancing at a rapid pace and is encouraging millions of people from athletes to the general population to participate in regular activity to stay healthy and active. However this increase in physical activity has also seen an increase in musculoskeletal injuries.

PRP injections are a new medical technology used in the treatment of many sporting injuries. 

WHAT IS PRP?

History:

Autologous platelet rich plasma (PRP) injections were first used in 1987 in open-heart surgery. Today, PRP injections have been safely used in many fields including sports medicine, orthopaedics, cosmetics, fasciomaxillary and urology.

Platelet Rich Plasma:

Blood contains plasma, red blood cells, white blood cells and platelets. Platelets are small discoid cells with a life span of about 7-10 days. Inside platelets contain granules, which contain clotting and growth factors. During the healing process, the platelets are activated and aggregate together. They then release the granules, which contain growth factors which stimulate the inflammatory cascade and healing process.

PRP is the source of concentrated platelet content present in blood. Apart from assisting blood clotting, platelets also release growth factors that assist the human body to repair itself by stimulating cells to regenerate new tissue.

TREATABLE INJURIES

PRP injections can be used in the treatment of many musculoskeletal injuries including that of tendons, muscles and joints.  Typically 2 or more injections are required, separated by 4-6 weeks apart. This may vary dependant on your injury.  PRP can be injected into:

PROCEDURE

  1. Assessment of injury
    At your first appointment, your doctor will take a detailed clinical history of your injury as well as any other medical conditions that may be relevant. This will be followed by a thorough physical examination. Depending on your situation, your doctor may use ultrasound to confirm the diagnosis and pinpoint the injury site for injection.
  2. Blood collection
    As your own (autologous) blood is used, it is first collected by venesection, the same procedure used in blood tests or blood donations. The site of the venesection is usually a large vein in your elbow. Up to 20ml of blood may be collected.
  3. Preparation
    This blood will then be spun down in a centrifuge to separate the components. The process takes 15 minutes. The platelet rich plasma (PRP) is then harvested and there are a variety of different ways this can be done. Some of these methods use commercially available kits, which can add to the cost.  Depending on your injury, up to 2-8mL of PRP will then be extracted from the centrifuged blood.
  4. The Injection
    The PRP will then be injected into your injury with or without the use of ultrasound guidance.

CONTRAINDICATIONS

You should not have a PRP injection if you have the following:

  • Cancer or metastatic disease
  • An active infection
  • A low platelet count.

You should also not have a PRP injection if you are pregnant or are breastfeeding.

You should not have a PRP injection if you have used non-steroidal anti-inflammatory medications (NSAID’s - examples include Nurofen, Voltaren, Mobic) in the 7-10 days leading up to your appointment. If you are considering having this injection, please switch to another painkiller such as paracetamol or for other options, check with your local doctor or chemist.

Please inform your doctor if you have an allergy to a local anaesthetic agent.

ADVERSE EFFECTS

Platelet rich plasma (PRP) is prepared from autologous or the patient’s own blood so there is no risk of developing a growth of tumour or cancer. Adverse effects are rare but as with any injection there is always the small risk of infection or injury to nerves or blood vessels. Scar tissue formation and calcification at the injection site are also possible.

References

  1. Engebretsen L, Steffen K. To PRP or not? British Journal of Sports Medicine 2010;44:1071.
  2. Engebretsen L, Steffen K, Alsousou J, Anitua E, et al. IOC consensus paper on the use of platelet-rich plasma in sports medicine. British Journal of Sports Medicine 2010;44:1072-1081.
  3. Angel MJ, Sgaglione NA, Grande DA. Clinical applications of bioactive factors in sports medicine: currents concepts and future trends. Sports Medicine and Arthroscopic Review 2006;14(3):138-45.
  4. Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. 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 1-year follow up. The American Journal of Sports Medicine 2010;38(2):255-262.
  5. Boswell SG, Cole BJ, Sundman EA, Karas V, et al. Platelet-rich plasma: A milieu of bioactive factors. Arthroscopy: The Journal of Arthroscopic and related Surgery 2012;28(3):429-439.
  6. Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. American Orthopaedic Society for Sports Medicine 2006;X(X):1-5.
  7. Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing positive effects of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up. The American Journal of Sports Medicine 2011;39(6):1200-1208.
  8. Creaney L, Wallace A, Curtis M, Connell D. Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet- rich plasma injections. Br J Sports Med 2011;45:966-971
  9. Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Current Reviews Musculoskeletal Medicine 2008;1:165-174.
  10. Kon E, Buda R, Filardo G, Di Martino A, et al. Platelet-rich plasma: intra-articular knee injections produced favourable results on degenerative cartilage lesions. Knee Surgery, Sports Traumatology, Arthroscopy 2010;18:472-479.
  11. Spakova T, Rosocha J, Lacko M, Harvanova D, et al. Treatment of knee joint osteoarthritis with autologous platelet-rich plasma in comparison with hyaluronic acid. American Journal of Physical Medicine & Rehabilitation 2012;91(4):1-7.
  12. Sanchez M, Anitua E, Azofra J, Aguirre JJ, et al. Intra-articular injection of an autologous preparation rich in growth factors for the treatment of knee OA: a retrospective cohort study. Clinical and Experimental Rheumatology 2008;26:910-3.
  13. Gobbi A, Karnatzikos G, Mahajan V, Malchira S. Platelet-rich plasma treatment in symptomatic patients with knee osteoarthritis: preliminary results in a group of active patients. Sports Health: A Multidisciplinary Approach 2012;4:162-172.
  14. Kloth DS, 2012. Platelet-Rich Plasma (PRP) Therapy, http://www.rsmedical.com/documents/337-0032-00-31RevB.pdf

For more information on PRP injections please visit the following website: http://www.prpinjection.com.au/

 

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