PRP Treatment Therapy
Platelet-Rich Plasma Therapy Speeds Healing
of Musculoskeletal Injuries
Platelet-rich plasma therapy, a treatment for aiding the regeneration of ligament and tendon injuries, is helping to shorten rehabilitation time and often eliminates the need for surgery. Platelet-rich plasma therapy is part of a relatively new field of medicine known as orthobiologics that includes the use of stem cells and emphasizes employing the latest technologies along with the body's natural ability to heal itself. "One of our major goals is to make healing time faster for patients with soft tissue injuries," says Christopher S. Ahmad, MD, Director, Center for Pediatric and Adolescent Sports Medicine at NewYork-Presbyterian Morgan Stanley Children's Hospital. "For example, a patient undergoing elbow ligament reconstructive surgery, commonly referred to as Tommy John surgery, may take a year to recover. That's a long time. Recovery time for anterior cruciate ligament [ACL] surgery is approximately six months. So while we are very good at performing surgery to correct these injuries, we're now accelerating the healing by biologic manipulation. That's where platelet-rich plasma comes in."
What is Platelet-Rich Plasma?
Blood is made of red blood cells, white blood cells, plasma, and platelets. Platelet-rich plasma (PRP) is the name given to blood plasma with a high concentration of platelets that contains huge doses of bioactive proteins, such as growth factors, that are critical in the repair and regeneration of tissues.
"In order to extract these platelets, a small amount of blood is drawn from the patient and it immediately undergoes centrifugation, a process in which mixtures are separated using centripetal force," explains Dr. Ahmad. "This process separates out red blood cells, which carry oxygen, and the platelet and the plasma. The platelets with the plasma have all of the healing agents. Once we've done the separation, we extract the platelet-rich plasma that can then be injected back into the patient's injured area. It is their own platelet-rich plasma -- it isn't taken from another person or derived in a laboratory."
Growth factors can dramatically enhance tissue recovery and the special proteins also initiate new blood vessel formation, bone regeneration and healing, connective tissue repair, and wound healing. There is little chance for rejection because the components used for treatment are extracted from a person's own body. This makes the procedure entirely safe. The PRP injection also carries less chance for infection than an incision, with a considerably shorter recovery time than after surgery.
When to Use Platelet-Rich Plasma Therapy
There is no minimum or maximum age for patients receiving PRP, which can be used to promote surgical healing, for an injury that does not require surgery, and for chronic tendon injuries, as well. "We can inject it after an ACL or rotator cuff surgery or any shoulder or knee operation," says Dr. Ahmad, who specializes in shoulder instability and labral tears, ACL injuries, Tommy John surgery, and advanced arthroscopic surgical techniques for sports related injuries of the knee, shoulder, and elbow. "Not only does it make the injury heal faster, it also makes recovery more predictable." Dr. Ahmad describes a high school pitcher who injured his ligament and normally would require Tommy John surgery. "Because of his young age and his desire to avoid a year-long rehab, we gave him the injection to help his ligament heal. Usually it goes hand in hand with an aggressive rehab program and other modalities that stimulate healing such as ice and heat contrast and sometimes ultrasound."
Dr. Ahmad cannot say definitively how much faster PRP accelerates healing, but points to examples where it has reduced the process considerably. "We've had patients with hamstring strains from playing sports such as baseball, and what typically has been a six-week injury has gone down to a three-week injury," he says. "We don't have enough numbers to actually quantify it, but we have seen healing time reduced quite a bit in patients treated with PRP."
Benefits for Younger Athletes
Dr. Ahmad, who is also head team physician for the New York Yankees, began using PRP therapy as an option for professional athletes. Once established that this approach was beneficial for the professional, he began offering it to young athletes and older "weekend warriors" with sports injuries. "We have an even greater motivation to use a healing agent for younger patients. The younger a patient is, the less we want to do an operation that potentially could be career ending if it doesn't work or could possibly change the normal anatomy," says Dr. Ahmad. "We try to preserve a patient's own anatomy and tissues and avoid surgery as much as possible."
Dr. Ahmad has researched the effects of injury in younger children and adolescents as compared to adults. Preliminary data shows that a sports injury in an adolescent has a much greater impact on his or her emotional status and perception of quality of life. "That makes sense because adults work and have other responsibilities," says Dr. Ahmad. "With students, their focus and energy are on school, socializing, and often, athletics. If you take away their ability to be involved in athletics, it affects their school and social environment. Young athletes have so much future and potential, and if we don't provide the maximum benefit to them, they have a long life to feel the repercussions."
Future of PRP and Other Growth Factors
As Director of Biomechanics Research at the Center for Orthopaedic Research, Dr. Ahmad continues to explore the uses and benefits of PRP. "We know that the platelet-rich plasma is working, but what we aren't sure about yet is what the exact dosing should be. Is one injection enough? Are two injections better? Are three injections too many? So I'm involved in basic science research to determine what the exact dose should be."
Dr. Ahmad is also pursuing research to identify and reproduce the exact healing factor that is most effective to accelerate healing. "If there are multiple factors, then we must identify those factors and which infinite combination to design, and then how to deliver them," he says. "What's very advantageous about the platelet-rich plasma therapy is that of all the healing agents, it's already in its natural combination of quantities. We just concentrate it and deliver it to the area where the body needs it most. It's an extremely inexpensive approach compared to trying to isolate the healing factor, reproduce that healing factor in a laboratory, and then design the technique to deliver it. Platelet-rich plasma therapy is readily available to people right now."