Platelet Rich Plasma (PRP) Therapy

Platelet Rich Plasma (PRP) therapy is a minimally invasive, non-surgical treatment that relieves pain by promoting long-lasting healing of musculoskeletal conditions.

The body’s natural reaction to an injury is to send platelets from the blood to the damaged tissues to initiate healing. Platelets store a vast array of growth factors which are released at the site of injury through cell signaling. PRP is injected directly into the injured tissue, stimulating the same healing response in a much more potent form. PRP treatments use your own concentrated platelets and growth factors to stimulate and enhance the body’s healing response to treat acute injuries, inflammation or chronic degenerative diseases.

PRP consists of a concentrated solution of platelets, growth factors, signaling molecules and other proteins that play vital roles in orchestrating tissue healing and joint stabilization. To yield therapeutic benefits, a dose of over 1 billion platelets per mL of PRP is targeted, containing the key growth factors and other molecules necessary to accelerate and augment the healing and stabilization process. [1]

The PRP used in our treatment contains a significant, industry-leading 7 to 10 fold increase in platelet concentration compared to whole blood. [2] Most patients experience pain relief and therapeutic benefits after their first injection. In some cases of chronic pain management, additional PRP injections may be needed to realize/achieve full therapeutic benefits. For over a decade, high level athletes have used PRP therapy to avoid surgery and benefit from a shortened recovery time. By enhancing the body’s natural healing capacity, PRP therapy has been shown to lead to a more rapid, efficient, and thorough restoration of tissues to a healthy state. Since PRP is prepared from your own blood, there is little to no concern of rejection or infection.

The characteristics of PRP composition is critical to final outcomes. Commercially available PRP processing kits vary in white blood cell count, red blood cell count, platelet yield and integrity, and the total volume of product produced. Variances in these categories will result in altered healing and efficacy. [7] [8]

We offer the highest standards and quality in PRP therapy available today. As a group we use only the most advanced scientifically proven PRP system available, which includes:

A therapeutic dose of over 1 billion platelets per mL of PRP. [9]
A high dose of growth factors released at the site of injury. [9]
A high platelet yield which recovers over 80% of platelets present in your blood [2].
The purest form of PRP available, removing red blood cells and neutrophils prior to the procedure, thereby reducing inflammation and a host of negative effects. [2]

PRP is ideal for patients who have not benefited from more conservative treatments such as physical therapy and bracing. PRP may also be an option for those interested in biological treatment options to reduce inflammation using the body’s inherent pathways for healing. It is a great alternative for those who are candidates for surgical intervention, but would like to avoid or delay invasive surgery so as to allow for a more active rehab process.

Knee

Osteoarthritis [10] [14]
Patellar tendinosis [32]
Shoulder

Osteoarthritis [15]
Ligament sprains and tears [16]
Tendonitis and tendinosis [18]
Acromioclavicular joint dysfunction and pain [16]
Foot & Ankle

Osteoarthritis [10]
Achilles tendonitis and tendinosis [19]
Plantar fasciitis [31]
Ligament sprains and tears [24]
Elbow, Hand & Wrist

Osteoarthritis [25]
Epicondylitis (tennis and golfer’s elbow) [21] [22]
Tendonitis and tendinosis [18]
Spine / Back

Degenerative Disc Disease [17]
Facet joint osteoarthritis [23]
Sacroiliac Joint Dysfunction [29]
Hip

Osteoarthritis [26] [28]
Acute Hamstring Injuries [34]
Proximal Hamstring Tendinopathy [33]
Labral tear [20]
Trochanteric bursitis [26] [27] [30]

Pre-procedural restrictions are necessary to ensure good quality PRP with high platelet integrity. Please let your provider know what medications and supplements you are currently taking so that they may advise you appropriately.

1. Stop NSAIDs 1week pre-procedure (2 weeks is most optimal
2. Ideally, stop any blood thinners 3-5 days pre-procedure. Consult with your prescribing provider to ensure that this can be done safely.
3. Stop any anti-inflammatory supplements 1 week prior to procedure (eg. Vitamin E, turmeric, curcumin, fish oil, ginseng, gingko, ginger, garlic extract, etc.)
4. Arrive early to your appointment and make sure that you are well-hydrated.

PRP therapy is usually done in-office and takes 30 minutes to an hour, from pre-procedural prep to bandaging injection sites. After identifying the tailored PRP solution needed to treat your pain, blood is drawn from your arm and run through a centrifuge which separates the blood into its components. Plasma, which contains the beneficial platelets, is collected and further refined, concentrating these vital platelets and healing molecules. Once this is done, the site of treatment will be prepared for injection. A local anesthetic may be injected into the treatment area, helping to minimize any discomfort. The final, personalized PRP solution is then injected into the affected area (joint space, disc or soft tissue such as tendons or ligaments). Ultrasound or fluoroscopic guidance is frequently used to ensure precise delivery of PRP. Our clinical team will walk you through each step of your procedure, providing you with the information and guidance you need to maximize recovery.

Most patients report an increase in pain and some swelling immediately following the injection, lasting up to several days. This is normal and results from the body’s natural inflammatory response flooding the region with healing factors. Please notify your physician if this increased pain does not resolve itself within three days.

Immediately after the procedure, it is recommended that you not soak your body in water for 24 hours (ie. baths, hot tubs) to mitigate risk of infection at the injection site. Showering is fine. It is also recommended that you abstain from anything that will inhibit the natural inflammatory response triggered by the PRP treatment (ie. nonsteroidal anti-inflammatory drug (NSAIDs). For pain relief, extra strength Tylenol is recommended. If stronger medication is requested, a short course of opioids (or non-NSAID pain relievers) may be prescribed. Ice is not recommended as it causes vasoconstriction and reduces inflammation. Heat is acceptable for pain relief.

Many patients resume their activities of daily living immediately after the procedure. Your provider will discuss specific limitations and rehabilitation protocols with you before leaving the office.

At about 2 weeks post-procedure, most patients will experience some relief from pre-injection pain levels. The greatest benefit is typically reported at 4-6 weeks post-injection and can occur up to 6-9 months after. To maximize recovery, we strongly suggest that you adhere to the guidelines recommended by your treating physician. This may include short-term non-weightbearing protocols, reduced activity, formal physical therapy, and at-home exercises.

Your treatment plan is created based upon the severity and duration of the injury or degeneration. Usually, one treatment with PRP is sufficient for returning to desired activities after 6-8 weeks of rehabilitation and at-home exercises. However, more severe conditions may need ‘booster’ shots after four weeks [1]. Your provider will evaluate your situation and advise if you need repeat treatment after your first follow-up appointment.

There are complementary treatments to PRP, such as Bone Marrow Concentrate (BMC), Extracorporeal Shock Wave Therapy (ESWT), and hyaluronic acid that may help maximize your results.

Healing that occurs from PRP therapy is usually long-term. However, if the etiology of the injury is not addressed (such as flat feet leading to knee or hip pain), then repeated wear and tear will continue to degrade the joints and/or tendons. For this reason, a comprehensive approach which incorporates PRP therapy with structured physical therapy, and other adjunctive therapies may be recommended.

It is important to note that the results of PRP vary and depend on the quality of one’s own platelets. Every patient’s level of health and chemistry are different, hence their platelets are somewhat different as well. Our team will develop a treatment and care plan personalized to your needs, ensuring the best possible outcome.

No, PRP comes from your own body and is used immediately. Therefore, there is no risk of rejection and very low risk of infection (the same risk as any other injection). In addition, the aspiration is done under sterile conditions to mitigate any contamination with pathogens and the injection is done using aseptic technique.

This depends on what type of procedure is done. Microfracture surgery is a common surgical procedure done to restore the cartilage surface in your knee. If your doctor performs this procedure on you, there are numerous scientific articles that show a far more robust patient outcome when augmented with PRP. [11]

Numerous clinical studies have confirmed that PRP provides significant healing and long-lasting pain reduction for a variety of injuries. [3]

• Several recent studies and reviews have demonstrated PRP to be more effective than corticosteroids or hyaluronic acid, the current, standard treatments for knee osteoarthritis. [4] [5]
• A study in the American Journal of Sports Medicine revealed that patients with elbow tendinosis receiving PRP reported a 46% reduction in pain by week four, and an 81% reduction in pain after six months. At the study’s conclusion, 93% of patients were completely satisfied with their PRP treatment and had avoided s [1]
• MRI imaging across numerous studies has also confirmed significant improvements in pain relief. Studies show that over 70% of patients receiving PRP for knee osteoarthritis have delayed further progression of the disease and prevented further knee degeneration. [6] PRP may, in some cases, eliminate the need for more aggressive treatments such as long-term medication or surgery.

The characteristics of PRP composition is critical to final outcomes. Commercially available PRP processing kits vary in white blood cell count, red blood cell count, platelet yield and integrity, and the total volume of product produced. Variances in these categories will result in altered healing and efficacy. [7] [8]

We offer the highest standards and quality in PRP therapy available today. As a group we use only the most advanced scientifically proven PRP system available, which includes:

1. A therapeutic dose of over 1 billion platelets per mL of PRP. [9]
2. A high dose of growth factors released at the site of injury. [9]
3. A high platelet yield which recovers over 80% of platelets present in your blood [2].
4. The purest form of PRP available, removing red blood cells and neutrophils prior to the procedure, thereby reducing inflammation and a host of negative effects. [2]

The cost of a PRP treatment varies based on the procedure performed. Our office staff can assist you with payment options and any other questions you may have.

Although PRP in musculoskeletal applications is well-supported by clinical studies, the broader use of PRP therapy in treating pain is still considered relatively new at this time, PRP is not typically covered by commercial insurance companies and Medicare, and is provided as a cash-pay procedure.

[1] Mishra, A., & Pavelko, T. (2006). Treatment of Chronic Elbow Tendinosis with Buffered Platelet-Rich Plasma. The American Journal of Sports Medicine, 34(11), 1774–1778. https://doi.org/10.1177/0363546506288850

[2] Mandle, R. (2016). Research Study: Comparison of EmCyte GS30-PurePRP II, EmCyte GS60-PurePRP II, Arteriocyte MAGELLAN, Stryker REGENKIT THT, and ECLIPSE PRP [White Paper]. Biosciences Research Associates. https://drive.google.com/file/d/15CsBI91_23glkmMfecv0HwsgTUBWYA13/view

[3] Wu, P. I., Diaz, R., & Borg-Stein, J. (2016). Platelet-Rich Plasma. Physical medicine and rehabilitation clinics of North America, 27(4), 825–853. https://doi.org/10.1016/j.pmr.2016.06.002

[4] Riboh, J. C., Saltzman, B. M., Yanke, A. B., Fortier, L., & Cole, B. J. (2016). Effect of Leukocyte Concentration on the Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis. The American journal of sports medicine, 44(3), 792–800. https://doi.org/10.1177/0363546515580787

[5] Chang, K. V., Hung, C. Y., Aliwarga, F., Wang, T. G., Han, D. S., & Chen, W. S. (2014). Comparative effectiveness of platelet-rich plasma injections for treating knee joint cartilage degenerative pathology: a systematic review and meta-analysis. Archives of physical medicine and rehabilitation, 95(3), 562–575. https://doi.org/10.1016/j.apmr.2013.11.006

[6] Halpern, B., Chaudhury, S., Rodeo, S. A., Hayter, C., Bogner, E., Potter, H. G., & Nguyen, J. (2013). Clinical and MRI outcomes after platelet-rich plasma treatment for knee osteoarthritis. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 23(3), 238–239. https://doi.org/10.1097/JSM.0b013e31827c3846

[7] Mautner, K., Malanga, G. A., Smith, J., Shiple, B., Ibrahim, V., Sampson, S., & Bowen, J. E. (2015). A call for a standard classification system for future biologic research: the rationale for new PRP nomenclature. PM & R : the journal of injury, function, and rehabilitation, 7(4 Suppl), S53–S59. https://doi.org/10.1016/j.pmrj.2015.02.005

[8] Dohan Ehrenfest, D. M., Pinto, N. R., Pereda, A., Jiménez, P., Corso, M. D., Kang, B. S., Nally, M., Lanata, N., Wang, H. L., & Quirynen, M. (2018). The impact of the centrifuge characteristics and centrifugation protocols on the cells, growth factors, and fibrin architecture of a leukocyte- and platelet-rich fibrin (L-PRF) clot and membrane. Platelets, 29(2), 171–184. https://doi.org/10.1080/09537104.2017.1293812

[9] Louis, M. L., Magalon, J., Jouve, E., Bornet, C. E., Mattei, J. C., Chagnaud, C., Rochwerger, A., Veran, J., & Sabatier, F. (2018). Growth Factors Levels Determine Efficacy of Platelets Rich Plasma Injection in Knee Osteoarthritis: A Randomized Double Blind Noninferiority Trial Compared With Viscosupplementation. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 34(5), 1530 1540.e2. https://doi.org/10.1016/j.arthro.2017.11.035

[10] Görmeli, G., Görmeli, C. A., Ataoglu, B., Çolak, C., Aslantürk, O., & Ertem, K. (2015). Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: A randomized, double-blind, placebo-controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy, 25(3), 958-965. doi:10.1007/s00167-015-3705-6

[11] Guney, A., Yurdakul, E., Karaman, I., Bilal, O., Kafadar, I. H., & Oner, M. (2015). Medium-term outcomes of mosaicplasty versus arthroscopic microfracture with or without platelet-rich plasma in the treatment of osteochondral lesions of the talus. Knee Surgery, Sports Traumatology, Arthroscopy, 24(4), 1293-1298. doi:10.1007/s00167-015-3834-y

[12] Belk, J. W., Kraeutler, M. J., Houck, D. A., Goodrich, J. A., Dragoo, J. L., & Mccarty, E. C. (2020). Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. The American Journal of Sports Medicine, 036354652090939. doi:10.1177/0363546520909397

[13] Kaminski, R., Maksymowicz-Wleklik, M., Kulinski, K., Kozar-Kaminska, K., Dabrowska-Thing, A., & Pomianowski, S. (2019). Short-Term Outcomes of Percutaneous Trephination with a Platelet Rich Plasma Intrameniscal Injection for the Repair of Degenerative Meniscal Lesions. A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study. International Journal of Molecular Sciences, 20(4), 856. doi:10.3390/ijms20040856

[14] Huang, G., Hua, Yang, Ma, Yu, & Chen. (2018). Platelet‐rich plasma shows beneficial effects for patients with knee osteoarthritis by suppressing inflammatory factors. Experimental and Therapeutic Medicine, 15, 3096–3102. 

[15] Cai, Y., Sun, Z., Liao, B., Song, Z., Xiao, T., & Zhu, P. (2019). Sodium Hyaluronate and Platelet-Rich Plasma for Partial-Thickness Rotator Cuff Tears. Medicine & Science in Sports & Exercise, 51(2), 227-233.  doi:10.1249/mss.0000000000001781

[16] PASİN, T., ATAOĞLU, S., PASİN, Ö., & Ankarali, H. (2019). Comparison of the Effectiveness of Platelet-Rich Plasma, Corticosteroid, and Physical Therapy in Subacromial Impingement Syndrome. Arch Rheumatol, 34(3), 308–316. 

[17] Tuakli-Wosornu, Y., MD, MPH, Terry, A., MD, Boachie-Adjei, K., BS, CPH, Harrison, J., BS, Gribbin, C., BA, LaSalle, E., BS, . . . Lutz, G., MD. (2016). Lumbar Intradiskal Platelet-Rich (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study. PM&R, 8.

[18] Chen, X., Jones, I., Park, C., & Vangsness, C. (2018). The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-Analysis with Bias Assessment. Am J Sports Med, 46(8).

[19] Alsousou, J., Handley, R., Thompson, M., McNally, E., Harrison, P., & Willett, K. (2018). PLATELET RICH PLASMA IN ACCELERATED ACHILLES TENDON REGENERATION: A RANDOMIZED CONTROLLED TRIAL. Orthopaedic Proceedings, 94. 

[20] DeLuigi, A. J., Blatz, D., Karam, C., Gustin, Z., & Gordon, A. H. (2019). Use of Platelet-Rich Plasma for the Treatment of Acetabular Labral Tear of the Hip: A Pilot Study. Am J Phys Med Rehabil, 98(11), 1010–1017. 

[21] Behera, P., Dhillon, M., Aggarwal, S., Marwaha, N., & Prakash, M. (2015). Leukocyte-poor platelet-rich plasma versus bupivacaine for recalcitrant lateral epicondylar tendinopathy. J Orthop Surg (Hong Kong), 1, 6–10. 

[22] Yadav, R., Kothari, S. Y., & Borah, D. (2015). Comparison of Local Injection of Platelet Rich Plasma and Corticosteroids in the Treatment of Lateral Epicondylitis of Humerus. Journal of Clinical and Diagnostic Research, 9(7), RC05–RC07. 

[23] Wu, J., Zhou, J., Liu, C., Zhang, J., Xiong, W., Lv, Y., … Liu, Q. (2017). A Prospective Study Comparing Platelet-Rich Plasma and Local Anesthetic (LA)/Corticosteroid in Intra-articular Injection for the Treatment of Lumbar Facet Joint Syndrome. Pain Practice, 17(7), 914–924. 

[24] Boesen, A. P., Hansen, R., Boesen, M. I., Malliaras, P., & Langberg, H. (2017). Effect of High-Volume Injection, Platelet-Rich Plasma, and Sham Treatment in Chronic Midportion Achilles Tendinopathy. The American Journal of Sports Medicine, 45(9). 

[25] Malahias, M. A., Roumeliotis, L., Nikolaou, V. S., Chronopoulos, E., Sourlas, I., & Babis, G. C. (2018). Platelet-Rich Plasma versus Corticosteroid Intra-articular Injections for the Treatment of Trapeziometacarpal Arthritis: A Prospective Randomized Controlled Clinical Trial. Cartilage. 

[26] Ali, M., Mohamed, A., Ahmed, H. E., Malviya, A., & Atchia, I. (2018). The use of ultrasound-guided platelet-rich plasma injections in the treatment of hip osteoarthritis: a systematic review of the literature. J Ultrason, 18, 332–337. 

[27] Begkas, D., Chatzopoulos, S.-T., Touzopoulos, P., Balanika, A., & Pastroudis, A. (2020). Ultrasound-Guided Platelet-rich Plasma Application Versus Corticosteroid Injections for the Treatment of Greater Trochanteric Pain Syndrome: A Prospective Controlled Randomized Comparative Clinical Study. Cureus. 

[28] Dallari, D., MD, Stagni, C., MD, Rani, N., MD, Sabbioni, G., MD, Pelotti, P., MD, Torricelli, P., BSc, . . . Giavaresi, G., MD. (2016). Ultrasound-Guided Injection of Platelet-Rich Plasma and Hyaluronic Acid, Separately and in Combination, for Hip Osteoarthritis. The American Journal of Sports Medicine, 44(3).

[29] Singla, V., Batra, Y., Bharti, N., Goni, V., & Marwaha, N. (2016). Steroid vs. Platelet-Rich Plasma in Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back Pain. Pain Practice, 17(6), 782-791.

[30] Fitzpatrick, J., PhD, MBBS, FACSEP, Bulsara, M., PhD, O’ Donnell, J., FRACS, MBBS, & Zheng, M., PhD, DM, FRCPath, FRCPA. (2019). Leucocyte-Rich Platelet-Rich Plasma Treatment of Gluteus Medius and Minimus Tendinopathy. The American Journal of Sports Medicine, 47(5), 1130-1137.

[31] Vahdatpour, B., Kianimehr, L., Moradi, A., & Haghighat, S. (2016). Beneficial Effects of Platelet-Rich Plasma on improvement of Pain Severity and physical disability in patients with plantar fasciitis: A randomized trial. Advanced Biomedical Research, 5. doi:10.4103/2277-9175.192731:

[32] Dupley, L., & Charalambous, C. P. (2017). Platelet-Rich Plasma Injections as a Treatment for Refractory Patellar Tendinosis: A Meta-Analysis of Randomised Trials. Knee Surgery & Related Research, 29(3), 165-171. doi:10.5792/ksrr.16.055

[33] Davenport, K. L., Campos, J. S., Nguyen, J., Saboeiro, G., Adler, R. S., & Moley, P. J. (2015). Ultrasound-Guided Intratendinous Injections With Platelet-Rich Plasma or Autologous Whole Blood for Treatment of Proximal Hamstring Tendinopathy. Journal of Ultrasound in Medicine, 34(8), 1455-1463. doi:10.7863/ultra.34.8.1455

[34] Bradley, J., MD, Lawyer, T., MD, Ruef, S., MA, Towers, J., MD, & Arner, J., MD. (2020). Platelet-Rich Plasma Shortens Return to Play in National Football League Players with Acute Hamstring Injuries. The Orthopaedic Journal of Sports Medicine, 8(4). doi:10.1177/2325967120911731

PRP can be highly effective in substantially reducing pain in patients with even advanced arthritis. [10] Often, patients are able to delay total knee replacement for years with PRP therapy.