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PRP and the ultimate weekend warrior.

June 10, 2009

Robert Campbell, MD



FINANCIAL DISCLOSURE: At present, Dr. Campbell receives no kickbacks related to PRP therapy.

If you refer to the February 19, 2009 article in the NY Times labeled "A Promising Treatment for Athletes, in Blood", you will come across a feature explaining how athletes use their own blood to treat various muscular/tendon injuries. This article in specific talks about how the Super Bowl winning Pittsburgh Steelers Hines Ward and Troy Polamalu, along with other professional athletes, used this treatment to prepare themselves physically before their sporting events. This phenomenon of using the bodies own blood and cells to heal is referred to as platelet rich plasma (PRP) therapy.

First off, let's dissect the function of platelets. Platelets, of course, play a large role in hemostasis, or the halting of bleeding. Platelets also are a rich source of platelet derived growth factors, transforming growth factors and endothelial growth factors. In layman's terms, all these growth factors aid in the cellular growth and formation of many different smooth muscle cells and blood cells. Platelets also play a key role in the binding of stem cells. What this boils down to is a linear relationship in that the more platelets you have, the more growth factors you have.

During the PRP procedure, a physician extracts around 30-50cc of a patient's own blood into a small tubule. This blood is then put into a centrifuge and "spun down" until where there are 3 separate layers forming in the tube. The platelet rich plasma forms a layer between the platelet poor plasma and packed red blood cells respectively. The platelet rich plasma layer is then extracted with a syringe and injected into the injured area of tissue either by physical palpation or under ultrasound guidance.

This method is mostly used, but not limited to injuries such as tennis elbow and knee tendonitis. If this procedure fulfills its expectations, it could help regenerate ligament and tendon fibers thus shortening the rehabilitation process and possibly eliminating surgery. This is attractive to patients in that it is non-surgical and financially cost effective.

In a 6 week study known as the Berghoff study, hospitalized patients who received PRP for total knee replacement had increased range of motion, had a shorter hospital stay and required less narcotics for pain control compared to those who did not receive PRP. A similar podiatry study called the "Dr. Barrett study" also proved positive outcomes in patients suffering from plantar fasciitis. Platelet rich plasma is a fascinating new addition to the medical world. From college, high school and professional athletes, all the way down to the weekend warriors, this intervention can benefit a large spectrum of patients. It has the potential to heal sports related injuries faster and cut down on rehab time and medical cost by using your body's natural products and possibly avoiding the cost and agony of surgery.

References:
1. Growth Factors for Chronic Plantar Fasciitis. Stephen L Barett, DPN, CWS. Susan E. Erredge DPN, CWS. Podiatry today, 2004, Volume 17-Issue 11-November 2004, pages 36-42.
2. Platelet Rich Plasma Application During Closure Following Total Knee Arthroplasty: A Retrospective Study. William J. Berghoff M.D.,William S. Pietrzak PhD, Richard D. Rhodes M.D. The Cutting Edge, Orthopedics, July 2006, Volume 29 number 7, pages 590-598.
3. Harrison's Principles of Internal Medicine, 16th Edition.
4. The New York Times "A Promising Treatment for Athletes, in Blood", February 16, 2009.
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