How Platelet-Rich Plasma Therapy is Used in Orthopedics
Platelet-rich plasma therapy is a form of regenerative medicine that the physicians at Integrated Orthopedics are trained in using to treat conditions such as arthritis, tendon injuries, and rotator cuff tears. Today, we’re going to discuss what Platelet-rich-plasma therapy (PRP) and stem cell therapy are, and how regenerative medicine can help you.
How do regenerative therapies typically work?
When there is a tissue injury in the tendon, muscle, cartilage, or ligament, the body will try to heal itself through its very own repair mechanisms. Though, in specific situations, especially around areas of the body that block blood flow, such as inside or around joints, the body can have trouble healing the injury on its own. Because of this, there might be a significant amount of pain, disability, weakness, catching, swelling, or locking of a joint. The point of regenerative medicine is to help augment the natural healing process or to even grow back tissue that was damaged.
What type of regenerative therapies are available?
Our orthopedic physicians are skilled in practicing both stem cell and platelet-rich plasma therapy. We’ll discuss platelet-rich plasma in further detail later, so let’s go into what stem cell therapy is now.
Stem cell-based therapy works on the regeneration or repair of a tendon or muscle. This is often done with mesenchymal stem cells that can differentiate into tissues during surgery. To use these specific stem cells, your orthopedic doctor must harvest them from your own body, such as from your bone marrow, tendon, muscle tissue, or adipose (fat). These procedures are usually done in an orthopedic clinic instead of an operation room which is less costly and more comfortable. Before this therapy is started, patients are premedicated and the pelvis, which the stem cells will be taken from, is anesthetized.
How does platelet-rich plasma therapy work?
Instead of using stem cells, PRP involves the use of platelets from the blood which is mostly a liquid composed of plasma, white cells, red cells, and platelets. In order to understand PRP therapy, you must understand that platelets contain hundreds of proteins often referred to as growth factors, which are important during the healing of surgeries. Unless PRP therapy is being done alongside a different surgery, it is also done in the clinic instead of in an operation room.
PRP therapy begins with blood (15 milliliters) being drawn from the patient. Once this is completed, PRP is prepared by separating the platelets from other blood cells and the increase of their concentration through a process called centrifugation. Centrifugation is completed with a centrifuge device, and the device is used by a trained representative from the device company. With the increase of platelets due to the centrifugation, the platelets are combines with the remaining blood and injected with the use of a guided ultrasound into the injured tissues. The ultrasound works as a guide for exact placement during the PRP therapy.
What are the benefits of regenerative medicine such as stem cell-based therapy or platelet-rich therapy?
As mentioned previously, both stem cell-based therapy and platelet-rich therapy are noninvasive and are typically done in the clinic instead of in an operations room. This is a huge benefit for patients because of the comfort that comes along with this. It is also a cheaper option than if the procedures were to be done within an operating room. Both of these procedures can also be done alongside surgery in order to enhance its effects or can be done alone.
Another major benefit to regenerative procedures is that it uses the natural healing elements that a patient’s body already has and uses the body’s own tissues. This means it is not artificial in any way and is often cheaper and more comfortable than alternative operations.
When are regenerative therapies typically used in orthopedics?
Osteoarthritis: With so much up-and-coming research being done on the use of PRP for the treatment of osteoarthritis, it has been indicated as having promising results.
- One study combined data from multiple different studies to take a look at common effects and found that the use of PRP over standard treatment led to significant improvements at six months after injection. Improvements began as early as two months after and lasted for up to 12 months.
- In another study, PRP and hyaluronic acid injections, which is a more traditional theory often used for osteoarthritis, both decreased joint breakdown, or catabolism. But it was found that PRP also resulted in the reduction of MMP-13 gene expression by a significant amount and increased HAS-2 expression and cartilage synthetic activity. These effects were compared to that of hyaluronic injections and were significantly higher. This means that PRP therapy stimulates the body to create its own internal hyaluronic acid, and this helps lubricate and cushion the joints and limit cartilage breakdown.
These studies, along with the clinical experience of physicians trained in using regenerative medicine demonstrate that PRP can be a very effective treatment for patients who have osteoarthritis. PRP therapy is often used for patients who are not responding to traditional treatments like hyaluronic acid injections. It has also been found in a recent review of randomized controlled trials (RCTs) that there was high efficacy for patient-reported outcomes.
Tendinopathy: For tendon injuries and regenerative medicine, an MRI is a first step to get a clear understanding of the exact injury. Stem cells and PRP can be used with positive results for instrasubstance, low-grade partial tendon tears but PRP would not be used for large to medium tears.
- One study or randomized controlled trial took 26 patients who had patellar tendinopathy which is an injury that is affecting the knee, and they were broken up into two different groups. 13 of the patients received ultrasound-guided dry needling with exercise, and the other 13 received ultrasound-guided leukocyte-rich PRP injection with dry needling. It was found that those who received PRP had accelerated recovery from their patellar tendinopathy.
- In a different study that looked at chronic lateral epicondylitis, also known as tennis elbow, 100 different patients were divided into two groups. One group was the PRP group of 51 patients, and the other was the standard treatment of corticosteroid injections, which was a group of 49 patients. The 51 patients who received PRP showed a reduction in pain and a significant increase in function more than the other group.
- In a meta-analysis and systematic review of 18 different PRP tendinopathy studies, there is good evidence that the use of a single injection of leukocyte-rich PRP under guided-ultrasound for tendinopathy works well.
Rotator Cuff Repair: There is great potential in the use of stem cells as a complement to rotator cuff surgery to enhance its outcomes.
- A study evaluated the effectiveness of cuff repair biological augmentation with the use of iliac crest bone marrow-derived mesenchymal stem cells, otherwise known as MSCs, to measure patient results in control and experimental groups. 45 patients received a concentration of bone marrow-derived MSCs as an adjunct to their rotator cuff repair at the time of their arthroscopic surgery. The other 45 patients did not receive the bone marrow-derived MSCs. Those who did receive the MScs showed an advanced healing rate and improved surface repair quality, as shown by ultrasound and MRI. In comparison, 100 percent of the MSC patients were healed by the six-month mark, while only 30 of 45 (67 percent) of the without MSC patients were healed by the six-month mark. Ten years later, 39 of 45 patients in the MSC group had intact rotator cuffs, while only 20 of the 45 non-MSC patients had intact rotator cuffs. This means that the MSc injection prevented further ruptures. This study shows an increased heal rate and decreased risk of rotator cuff retear with the use of MSCs.
- Other studies confirm the value of stem cells and PRP for arthroscopic repair of large to medium cuff tears.
At Integrated Orthopedics, our physicians have seen consistency with these research findings. In surgeries, where regenerative medicine has been used for rotator cuff repair. Though not every patient is a candidate for PRP or stem cell therapy for rotator cuff repair, we have seen many positive outcomes.
How do I make sure that my regenerative therapy is being done safely?
It is important to understand that not all regenerative medicine is created equal. Since this type of medicine is still emerging and is not yet FDA-regulated, it can be hard to make sure that it is being administered and practiced correctly by everyone who has their hands on it. It is incredibly important that your health care provider knows what they are doing and is using regenerative medicine wisely and only for a specific condition, in which medical research and studies have supported its effectiveness. When it comes to PRP and stem cell therapy, the preparation before your provider gets started is one of the most important aspects. Your healthcare provider should always be working with a reputable centrifuge company and device, with someone there on site to help prepare the PRP and stem cell preparation for the patient on an as-needed basis and to administer. If you come to the realization that your healthcare provider is preparing their own centrifuge device, that isn’t associated with a reputable vendor or company, this is a major red flag and should be a topic of conversation.
Next, we need to discuss another important factor in the PRP and stem cell process, which is the way in which it is administered. Your healthcare provider should implement the use of a guided ultrasound that will enhance their ability to accurately insert into the affected area of the body. While using ultrasound is a new and more recent advancement in regenerative medicine, your healthcare provider should be using one because it will increase the likelihood of a successful treatment outcome.
Will my results be recorded?
After receiving PRP or stem cell therapy at Integrated Orthoepedics, your results will be recorded in order to help us track your outcomes and to contribute to science. At our practice, we contribute and participate in a large-scale regenerative medicine outcomes tracking program which is called Surgical Outcomes Systems, otherwise known as SOS. This outcome tracking program uses standard medical scoring protocols in order to track patient results. Before a regenerative medical treatment, patients are measured and are measured once again at key interval post-treatment periods up to two years after the surgery. This program not only allows us to carefully track our patient populations’ outcomes, but it also enables us to access a larger database of patient outcomes from other SOS participant providers. This also allows us to be part of contributing to the evidence base and research for the regenerative medicine of the future.
How can I learn more about regenerative medicine to see if it will work for me and my condition?
Integrated Orthopedics offers PRP, stem cell therapy, and regenerative medicine through our physicians who are specifically trained in using regenerative medicine for osteoarthritis, rotator cuff repair, and tendinopathy. Our physicians will work with you to determine if you are a good candidate for regenerative medicine.
Schedule a consultation with an Integrated Orthopedics physician today by submitting a contact form through the Integrated Orthopedics website (someone from our team will be in touch with you) or by booking an appointment online immediately.