PRP: Hope or Hype?

Steelers wide receiver, Hines Ward, underwent a medical procedure using platelet-rich plasma- PRP- before the Super Bowl XLIII. It allowed him to play in this critical game.

But exactly what is PRP and how effective is it?

Platelet-rich plasma is prepared by drawing blood from a patient, then placing the blood in a centrifuge which spins the blood at high speed in order to separate the platelets from the red blood cells. The resulting small volume of fluid after the centrifugation process contains approximately 10 times the normal volume of platelets.

Platelets are cells that contain an enormous amount of healing and growth factors such as:

• Fibrinogen: helps with clotting and framework making

• Adhesion molecules: helps cells to bind to each other

• Platelets: initiates clotting and inflammation

• IL-1: promotes migration of macrophages

• Platelet derived growth factor: helps with healing, stimulates growth of blood vessels, attracts macrophages

• Transforming growth factor B: stimulates formation of collagen

• Epidermal growth factor: stimulates connective tissue growth

• Vascular endothelial growth factor: stimulates formation of new blood vessels, promotes healing

The platelet rich plasma is then injected under ultrasound guidance to ensure proper placement of the PRP.

Multiple studies have shown that PRP can accelerate healing of soft tissue injuries such as tendonitis, ligament tears, and related problems.

One study that demonstrated the effectiveness of PRP was performed in patients with chronic elbow tendonitis (Mishra A, Pavelko T. Am J Sports Med. 2006; 34: 1774-1778). The authors evaluated 140 patients with chronic elbow tendonitis and treated them conservatively with physical therapy. Twenty of the patients failed to respond and were randomized to receive either PRP injection (n=15) or bupivicaine (local anesthetic) injection. The bupivicaine group served as the control group.

Eight weeks after the treatment, the platelet-rich plasma patients noted 60% improvement in their visual analog pain scores versus 16% improvement in control patients. Sixty percent (3 of 5) of the control subjects withdrew or sought other treatments after the 8-week period, preventing further direct analysis. Therefore, only the patients treated with platelet-rich plasma were available for continued evaluation. At 6 months, the patients treated with platelet-rich plasma noted 81% improvement in their visual analog pain scores. At final follow-up (mean, 25.6 months; range, 12-38 months), the platelet-rich plasma patients reported 93% reduction in pain compared with before the treatment. The authors concluded that PRP significantly reduced pain and should be considered for use before attempting surgery.

While PRP has been used via a "blind" approach- just injecting it "where it hurts," it has become quite clear that precise placement of the PRP is essential for optimal results. That's why ultrasound guided placement of the PRP is crucial.

As far as Hines Ward, he had a sprain of the medial collateral ligament of the knee. While surgery could have been an option, it was decided to use PRP instead.

Dr. Nathan Wei says, "PRP can speed the rate of healing by about 50 per cent."

Another innovation has been the use of stem cells in concert with PRP. According to Dr. Wei, "We have had excellent results in treating a wide spectrum of disorders. While most cases of chronic tendonitis or bursitis will respond to PRP only, significant tendon injuries and condition such as osteoarthritis require the use of stem cells along with the PRP."

He goes on to say, "After examining the patient and evaluating MRI results, we can decide which option- PRP alone or PRP with stem cells will work better for the patient. For accelerated healing only, PRP is fine. For healing plus tissue regeneration, stem cells should be added."

Dr. Wei explains, "Stem cells are cells that haven't yet differentiated into a specific type of tissue. They can be stimulated to differentiate into any type of tissue needed provided the correct environment is arranged. In other words, if you place stem cells with heart cells, they become heart cells... if you place them with lung cells, they become lung cells. So if you place the stem cells near tendon or cartilage cells, you get tendon or cartilage."

He adds, "We use autologous stem cells. These are the patient's own cells that we harvest from the iliac crest of the hip. By using a patient's own cells, we don't run the risk of rejection reactions which you can get with stem cells from donors or unregulated growth which are theoretically possible with embryonic stem cells.

By customizing the treatment approach- using either PRP or PRP+stem cells, depending on the situation- and using ultrasound needle guidance, we have had enormous success with accelerating tissue healing and tissue re-growth.

For more information about PRP or stem cells, call the Arthritis and Osteoporosis Center of Maryland at (301) 694-5800.