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Specialties: PRP basics
 PRP BASICS
Prolotherapy is effective primarily through induction of growth and repair factors. It follows then that any way of concentrating and delivering growth factors to an area that the body is trying to repair would be of benefit. That is, in fact, what has been observed in the clinic and in the few clinical trials that have thus far been conducted using concentrated platelet solutions as the source for these growth and repair factors.
Platelets aggregate at the sites of trauma and bleeding. In addition, to helping stop bleeding by assisting in clotting they are repositories of growth factors. After they help stop the bleeding of an injury they release their growth factors into the area to initiate the healing process.
In the past whole autologous (the patient’s own) blood was injected at the site of injury, degeneration, or pain to get healing of the tissue. The use of autologous blood has a long history but few published studies, most of which were about the use of blood patches for patching leaking dural (spinal) punctures and more recently for elbow tendinopathies (tennis elbow). The therapeutic components of whole blood which help healing are the platelets and white blood cells both of which contain growth.factors.
It was found that platelets could be highly concentrated and isolated by specialized centrifugation in a cost effective way. Until 2007, the primary uses of this autologous platelet rich plasma (PRP) that was produced, other than for platelet transfusion in patients who had platelet deficiency or clotting disorders, had been to promote healing of non-union fractures, in oral surgery to prevent bone loss prior to implants and promote wound healing in those with compromised healing, and in maxillofacial and plastic surgery. More recently its use has expanded into preventing infection after thoracotomy, healing of skin ulcers with platelet gels, and in sports and musculoskeletal medicine.
The concentrated platelet product has approximately 4X to 8X the baseline level of growth factors of whole blood. Platelet concentrate has PDGF, IGF-1, TGF-1beta, EGF, VEGF and has the ability to attract mesenchymal stem cells to essentially regenerate any tissue. The few studies in sports medicine using PRP have been very positive. In a small study, nearly all symptoms of plantar fasciosis resolved within 4-8 weeks and ultrasound visualization showed increases in tissue integrity and organization. Rotator cuff tears showed marked reduction of symptoms and tissue healing after a single treatment. Elbow tendinopathies (medial and lateral) have responded to a single treatment in two different studies with a relief of symptoms.
Dr. Kochan has had significant success treating knee arthritis with a combination of prolotherapy and PRP. Patients have had relief of pain and return of function including returning to running and tennis in some cases and ability to walk and climb stairs in others.
It is Dr. Kochan’s feeling that PRP is not usually a stand alone treatment and generally needs to be coupled with prolotherapy. The ligaments and tendons around an injured structure whether a joint, tendon, ligament or muscle work to support it and protect it from over strain, further injury and guide its motion and normal function. The amount of PRP obtained from a single blood draw is often not enough to treat all areas of a problem. So, if all the supporting structures around a joint or injured ligament are not also evaluated and strengthened if necessary (and the only structure that is treated with PRP is the one structure that is causing the pain or dysfunction) then the underlying instability and weakness of the supporting tissues will eventually cause the repair to fail and the problem will recur.
There are few negative aspects of PRP. The pain after treatment can be significant for periods of time of up to a couple of weeks. It is generally controlled well with ice and acetaminophen but sometimes will require stronger analgesics. Another draw back is the cost which is not insignificant and not often covered by insurance (so what’s new?). This treatment may substitute for several prolotherapy treatments or be the only available alternative to a painful and costly surgery from which there is a long recovery even if it works well. Thus, it may be less costly and/or disabling in the long term than those treatments. This is something that can and should be discussed on a case by case basis with Dr. Kochan.
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