Platelet Therapy

Click for Additional Information from American Academy of Orthopaedic Surgeons 

Platelet rich plasma injections offer an alternative for people with joint or tendon pain who may be considering elective surgery or joint replacement due to injury or arthritis.

There is also evidence that it is a safer alternative that steroid injections and, when successful, provides longer lasting relief.

Commonly treated conditions

ShoulderPRP IMage 1
Rotator Cuff tendon wear and tears
AC & Glenohumeral Joint Arthritis
Bicep Tendinosis
Labral tear

Elbow
Lateral/Medial Epicondylitis (Tennis/Golfers Elbow)
Ulnar Collateral Ligament Injuries
Elbow Arthritis

Hand & Wrist
Tendonitis
TFCC, scapholunate ligament tear
Thumb, digit and wrist Arthritis (not end stage)

Knee 
Patellar Tendinosis (Jumper’s knee)
Quadricep tendinosis
Knee arthritis (not end stage)
ITB Friction Syndrome
Quadricep/Hamstring Strains
Kneecap Pain (Patellofemoral Syndrome or Runner’s knee)

Foot & Ankle
Achilles Tendon Injuries
Peroneal/Posterior Tibialis Tendon Injuries
Plantar Fasciitis
Foot and Ankle Arthritis (not end stage)
Chronic Ligament Injuries

Hip/Pelvis
Trochanteric Bursitis/tendinopathy
Hamstring Injuries
Hip Arthritis (not end stage)
Hip labral tear

 

Platelet Therapy – Also known as Platelet Rich Plasma (PRP).PRP Illustration

Blood is composed of red blood cells, white blood cells, plasma, and platelets. Platelets are responsible for blood clotting and healing. When activated at a site of injury in the body, platelets release healing proteins called growth factors and attract cells that contribute to regrowth (stem cells).

This procedure is done in the office setting with local anesthesia. The blood is drawn the same day of treatment and approximately 45 minutes is required for the visit. Once the platelet portion of the blood is concentrated and separated, it is injected under ultrasound guidance to the problem area. The patient may experience between 2-5 days of soreness after the treatment and use of anti-inflammatory medications is not advised during treatment. Depending on the problem, multiple treatments may be required.

Studies have shown that PRP may be effective in treating many conditions such as mild-moderate joint arthritis and tendon and ligament injuries. Studies are being published regularly describing the appropriate use and effectiveness of this treatment.

Platelet Therapy FAQs:

Does PRP really work? – Yes. Much research has gone into the development of PRP based procedures.

How do I know if I am a candidate for PRP therapy?   PRP therapy is advised for patients with moderate osteoarthritis in the hip, knee or shoulder or chronic tendonitis in the elbow or ankle, and others. Typically the patient has failed conservative treatment options such as rest, medication, and physical therapy.

Who is NOT a candidate for PRP therapy?

  • Any one with a cancer (such as prostate cancer or breast cancer), not in remission for at least 5 years
  • Certain other malignancies or blood borne diseases that you are being treated for
  • Any current infection
  • Patients using a high dosage of Coumadin
  • General procedural contraindication
  • Patients with multiple medical issues may not be good candidates 

What is the cost of PRP therapy?

The cost of PRP treatment may vary depending on the area being treated.  Insurance companies, for the most part, will not pay for PRP. This is generally paid for out of pocket.

How long do I have to wait to return to my normal activities?

How quickly you can return to your normal activities depends on the condition and body part being treated.

  • Injections in the elbow or shoulder may be placed in a sling for 48 hours to 1 week or more and then as needed for comfort.
  • For the ankle (Achilles tendon, peroneal tendon, plantar fascia), you will be required to wear a walking boot for up to two weeks or more. (If the injection is on the right side, you will not be able to drive with the boot on.)
  • If you have an injection in your knee for osteoarthritis, you only need to rest for 24 hours and then you can return to your normal activities. If the injection is in your patellar tendon or quadriceps tendon, your knee may be placed in a knee immobilizer for 1-2 days.
  • Most procedures, will begin therapy 1 week after the injection.

 

How long does it take the PRP to “work”?

PRP does not offer quick pain relief. Pain gradually subsides as the injured tissue repairs and pain relieving factors activate. This can take weeks or months, but when successful, the effect is lasting. If relief is not sufficient at 3 months, a second injection may be performed. Maximum effects are usually seen at 6-9 months. Some knee joints may require 2 injections in closer succession.

How soon can I return to normal and athletic activities?

Most patients are able to return to work the day following the procedure unless they are 1 in 10 that has a post-injection flare. In that situation, the patient may need an extra day off work. Return to athletic activity depends on the type and site of injury. Most chronic tendon injuries that have failed to respond to any other type of treatment will generally take quite a number of weeks to heal. Injections into joints and acute muscle injuries respond a bit sooner.

Are there any side effects or complications of PRP?

No serious complications have been reported related to PRP. Like any injection, there is a risk of infection, or damage to a nerve or blood vessel. However, there is not a risk of adverse reaction to the platelets the way there is to a medication (ex. corticosteroids)

What are the side effects of commonly used cortisone injections (alternative treatment)?

Cortisone injections have been widely used over many years to treat sports injuries and arthritis. Unlike PRP injections, cortisone injections allow only inflammation and pain to settle down and they do not induce healing. Hence, in many conditions the pain will recur due to lack of healing. Also steroid injections have potential complications such as skin atrophy, discoloration, weakening and rupture of the tendon where injection is given, joint deterioration and infection, among others.

Can I drive home after the PRP injection?

If the injection is in your right knee or ankle tendons, you should bring a driver. If the injection is located in any other body part, you may drive yourself home after the injection.

Do I need to schedule a follow up appointment?

Yes, Dr. Lehman will want to see you back in clinic to check your progress. You will be asked to make a follow up appointment 6 weeks following the injection.

Can I take my normal medication(s) before and after the injection?

Do not take anti-inflammatory medication such as Advil, Aleve, Motrin, Ibuprofen, Mobic, Naproxen, Nabumetone, or Diclofenac for 7 days prior to the injection and several weeks after the last injection. Pain medication will be prescribed the day of the procedure to be taken as needed. A regular aspirin regimen (81mg/day) is ok.  Tylenol/Acetaminophen is allowed.

What is the “typical” response to PRP treatment?

Research and clinical experience suggest that PRP can successfully treat pain from chronic degeneration and tears of tissue tendons, and pain from mild-moderate joint articular cartilage degeneration. It is important to understand that PRP isn’t a miracle cure. The Hospital for Special Surgery in NYC estimates that their success rate for the platelet-rich plasma treatment, or PRP, is between 60 and 75 percent. (success is >50% relief of pain)

The Mayo clinic claims an 80% success rate. For a minimally invasive procedure for injuries/conditions that are notoriously hard to heal, that’s pretty impressive.

Technique and Ultrasound guidance is essential to accuracy of placement and enhancing efficacy of the injection.

What if I don’t get a good enough response with PRP treatment?

Then bone marrow stem cell therapy or surgical treatment might be the next step.