Platelet Rich Plasma (PRP) Therapy, like Dextrose Prolotherapy, is a method of injection designed to stimulate healing. PRP offers a promising solution to accelerate healing of tendon injuries and osteoarthritis naturally without subjecting the patient to significant risk. Blood is made of RBC (Red Blood Cells), WBC (White Blood Cells), Plasma, and Platelets. Platelets were initially known to be responsible for blood clotting. Medical research over the last twenty years has revealed that when activated in the body, platelets release healing proteins called growth factors. Numerous growth factors with varying responsibilities exist however as a group they accelerate tissue and wound healing.
Specifically, platelets contain several proteins, cytokines and other bioactive factors that initiate and regulate natural wound healing. Circulating platelets secrete growth factors. Examples of growth factors secreted by platelets include
- platelet-derived growth factor (stimulates cell replication, angiogenesis),
- avascular endothelial growth factor (angiogenesis),
- fibroblast growth factor (proliferation of myoblasts and angiogenesis), and
- insulin-like growth factor-1 (mediates growth and repair of skeletal muscle).
Platelet-derived growth factors are biologically active substances that enhance tissue repair mechanisms. Enhanced healing is possible when platelet concentration is increased with PRP.
Tissue repair is initiated with clot formation and platelet degranulation. This leads to a release of growth factors, described above, necessary for wound repair. After platelets are activated at a wound site, proteins are released that influence virtually all aspects of the wound healing cascade. Activated platelets “signal” to distant repair cells, including adult stem cells, to arrive at the injury site. Because the concentrated platelets are suspended in a small volume of plasma, the three plasma proteins fibrin, fibronectin, and vitronectin contribute to a repair matrix.
Studies have shown a direct correlation between the platelet concentration and the level of secretory proteins, and the amount of proliferation involved in the wound healing. Increasing the volume of platelets increases the later influx of repair and stem cells. For this reason, by increasing the baseline concentration of these platelets, with PRP, we deliver a potent cocktail of growth factors that can greatly enhance tissue recovery.
Tendons and ligaments have a very poor blood supply, which leads to an incomplete or much delayed healing response. PRP assists in recruiting these natural healing cells to an area that has been deficient, allowing the body to repair the tissue faster. This leads to a faster reduction in pain. Most important, this translates to a faster return to sports and activities of daily living.
Preparing therapeutic doses of growth factors consists of
- an autologous blood collection (blood drawn from the patient),
- plasma separation (blood is centrifuged), and
- application of the plasma rich in growth factors (injecting the PRP into the area).
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Platelet Rich Plasma (PRP) Prolotherapy is performed like dextrose prolotherapy or stem cell prolotherapy, except the solution used for injection is plasma enriched with growth factors from your blood. Patients receive PRP every 4-6 weeks like other prolotherapy patients. In general, two to six visits are necessary per area.
Soft tissue injuries that may be treated with PRP include tendinopathy, tendinosis, acute and chronic muscle strain, muscle fibrosis, ligamentous sprains and joint capsular laxity.
PRP has also been utilized to treat intra-articular injuries. Examples include arthritis, arthrofibrosis, articular cartilage defects, meniscal injury, and chronic synovitis or joint inflammation.
PRP has been used to enhance surgical outcomes in maxillofacial, cosmetic, spine, orthopedic, and podiatric surgery. Like other types of prolotherapy, PRP has low risk and few side effects. There have been no documented cases of carcinogenesis, hyperplasia, or tumor growth associated with autologous PRP despite the use of growth factors. PRP growth factors never enter the cell or its nucleus.
Instead, their mechanism of action is through the stimulation of external cell membrane receptors of adult mesenchymal stem cells, fibroblasts, endothelial cells, osteoblasts, and epidermal cells. This binding stimulates expression of a normal gene repair sequence, causing normal healing with a quicker onset. As a result, PRP cannot induce tumor formation. Because it is an autologous sample, the risk of allergy or infectious disease is negligible. Evidence also exists in studies that PRP may exhibit antibacterial properties.
In summary, Platelet Rich Plasma (PRP) Prolotherapy involves the application of concentrated platelets, which release a supra-maximal quantity of growth factors that stimulate recovery in non-healing injuries. PRP causes a mass influx of growth factors, such as platelet-derived growth factor, fibroblast growth factor, and others, which exert their effects on fibroblasts causing proliferation and accelerating the regeneration of injured tissues. Specifically, PRP enhances the fibroblastic events involved in tissue healing including chemotaxis, proliferation of cells, proteosynthesis, reparation, extracellular matrix deposition, and the remodeling of tissues. Tissues can heal faster with PRP.
Tania Faruque MD is the medical director of Palomar Spine & Pain, in Escondido, CA (North San Diego County).
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