Regenerative Injection Therapy

PRP:

HOW DOES PRP THERAPY WORK?

To prepare PRP (Platelet Rich Plasma), a small amount of blood is taken from the patient. The blood is then placed in a centrifuge. The centrifuge spins and automatically produces the PRP. The entire process takes less than 15 minutes and increases the concentration of platelets and growth factors up to 500%.

When PRP is injected into the damaged area it stimulates the tendon or ligament causing mild inflammation that triggers the healing cascade. As a result new collagen begins to develop. As this collagen matures it begins to shrink causing the tightening and strengthening of the tendons or ligaments of the damaged area. 

WHAT IS PLATELET RICH PLASMA?

Platelet Rich Plasma, or PRP is blood plasma with concentrated platelets. The concentrated platelets found in PRP contain huge reservoirs of bioactive proteins initiate and accelerate tissue repair and regeneration. These bioactive proteins initiate connective tissue healing, bone regeneration and repair, promote development of new blood vessels, and stimulate the wound healing process.

I'VE HEARD OF CORTISONE SHOTS; IS THIS THE SAME?

Studies have shown that cortisone injections may actually weaken tissue. Cortisone shots may provide temporary relief and stop inflammation, but may not provide long term healing. PRP therapy heals and strengthens these tendons and ligaments; thus strengthening and thickening the tissue up to 40% in some cases.

WHAT ARE THE POTENTIAL BENEFITS?

Patients can see a significant improvement in symptoms. This may eliminate the need for more aggressive treatments such as long term medication or surgery as well as a remarkable return of function.

WHAT CAN BE TREATED?

PRP injections can be performed in tendons and ligaments all over the body. Sports injuries, arthritic joints, lower back, degenerative disc disease and more specific injuries including tennis elbow, carpal tunnel syndrome, ACL tears, shin splints rotator cuff tears plantar fasciitis and iliotibial band syndrome may all be effectively treated with PRP.

HOW MANY TREATMENTS & HOW OFTEN IS THIS THERAPY?

While responses to treatment vary, most people will require 3 - 6 sets of injections. Each set of treatments is spaced approximately 4 to 6 weeks apart. There is no limit to the number of treatments you can have, the risks and side effects do not change with the number of injections.

IS PRP RIGHT FOR ME?

If you have a tendon or ligament injury and traditional methods have not provided relief, then PRP therapy may be the solution. The procedure is less aggressive and less expensive than surgery. It will heal tissue with minimal or no scarring and alleviates further degeneration of the tissues. There will be an initial evaluation with your doctor to see if PRP therapy is right for you.

PLATELET-RICH PLASMA (PRP) – AN EFFECTIVE INTERVENTION FOR THE MANAGEMENT OF EARLY KNEE OSTEOARTHRITIS

 

PRP IS BOTH AFFORDABLE AND MINIMALLY INVASIVE IN THE MANAGEMENT OF KNEE OSTEOARTHRITIS

 

Evidence and published data is gaining ground in proving the benefits of platelet-rich plasma (PRP) in the treatment of knee osteoarthritis. This evidence has emerged rapidly and has fueled  the desire to increase the use of affordable, minimally invasive treatments to reduce osteoarthritis-associated pain prior to surgical intervention.  Patients with mild-to-moderate knee osteoarthritis at Cleveland Clinic Florida have shown favorable clinical outcomes with ultrasound-guided intra-articular PRP injections.  Here at the Scottsdale Sports Institute, we perform approximately 2-4 injections per month.  PRP injections  have an 80% success rate with an average duration of pain relief of between 9 to 12 months.

 

HOW PRP WORKS

Platelets are activated by substances both inside and outside the blood including calcium chloride, thrombin and/or intra-articular cartilage.  Once activated, a-granules within the platelets degranulate and secrete growth factors and anti-inflammatory cytokines, including insulin-like growth factor, platelet-derived growth factor and interleukin receptor antagonists.  These mediators have been shown to inhibit cartilage degradation by regulating and promoting gene expression of tissue inhibitors of metalloproteinases.  This reduction in cartilage degradation makes PRP particularly beneficial in the treatment of osteoarthritis.  

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PREPARATION AND EFFICACY OF PRP

PRP is prepared by the centrifugation of whole blood.  This process separates the patient’s blood into 3 layers:  plasma, platelets and white blood cells and red blood cells.  There are a few PRP systems which have a second centrifugation process by which there is separation of plasma-rich plasma from the plasma-poor plasma, thus further concentrating the platelets.  Various factors affect the efficacy of the PRP injectate, including the container size, the spin time and the spin rate among different PRP systems

PRP VERSUS HYALURONIC ACID

At least 11 studies have directly compared intra-articular PRP with intra-articular Hyaluronic Acid and 9 of the 11 studies showed better symptom scores and clinical outcomes 6-12 months post-treatment in the PRP groups.  

CLINICAL IMPROVEMENTS NOTED WITH PRP

Current literature suggests that patients with osteoarthritis of the knees have a positive response to intra-articular PRP treatments. Patients who are younger and more active with mild osteoarthritis tend to have better clinical improvements with PRP when compared to older patients with more severe osteoarthritis.  PRP is both affordable and minimally invasive and has a low complication rate with a rapid recovery time.  Patients are generally able to bear weight immediately after the procedure and can return to normal activities following completion of treatment.

 

IDEAS TO CONSIDER FOR THE FUTURE

Different preparations of PRP yield different results; it would thus be beneficial to focus on comparing leucocyte-rick PRP versus leucocyte-poor PRP in the treatment of osteoarthritis.  Another idea would be to look at protocols for injection technique, post-injection rehabilitation and longer follow-up times which will give better information regarding treatment outcomes.  

 

References

  1. Campbell KA, Saltzman BM, Mascarenhas R, et al.  Does intra-articular platelet-rich plasma injection provide clinically superior outcomes compared with other therapies in the treatment of knee osteoarthritis?  A systemic review of overlapping meta-analysis.  Arthroscopy.  2015;31:2213-2221.

  2. Meheux CJ, McCulloch PC, Lintner DM, et al.  Efficacy of intra-articular platelet rich plasma injections in knee osteoarthritis:  A systemic review.  Arthroscopy.  2016; 32:495-505.

  3. Sundman EA, Cole BJ, Karas V, et al.  The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis.  Am J Sports Med.  2013;42(1):35-40.

 

AmnioGenic Therapy:

What is AmnioGenic Therapy?

AmnioGenic Therapy is a cryopreserved, flowable human allograft that has been developed for clinical use as a soft-tissue defect filler and localized areas of inflammation.  It provides an abundant source of collagen that provides an extracellular matrix to act as a natural scaffold for cellular attachment in the body.  Collagen provides a structural tissue matrix that facilitates, among other things, cell migration and proliferation in vivo. 

This "micro-scaffold" includes the collagen, proteins, carbohydrates, lipids, hyaluronic acid, growth factors, and other chemical compounds naturally present in amniotic fluid and tissue. 

What areas respond best to AmnioGenic Therapy?

Patients have been successfully treated at many localized sites where a soft tissue defect or tear exists.  Physicians have used amniotic tissue for over a century as a biologic dressing in a broad range of therapeutic applications.  Commonly treated areas include decubitus ulcers, plantar fascia, tendonitis, soft tissue injuries, and muscle tears. 

How many treatments will I need?

Many patients with inflammation and pain caused by a soft tissue injury, defect or tear experience significant improvement after a single treatment.  However, each patient and each injury is different.  Your physician will advise you as to the number and frequency of treatments recommended on his or her professional assessment of your medical condition. 

What do treatments feel like?

The non-steroidal, anti-inflammatory injection will feel similar to any other injection into a localized area of pain.  By using our Musculo-skeletal Ultrasound, Dr Carfagno and his technician have the benefit of a precise evaluation of your injured area.  A local anesthetic may be used and many patients tolerated the procedure very well.  The procedure will last no longer than 20-30 minutes and patients go home right after the procedure.