Soft tissue injury has become one of the major reasons for clinic visits in the United States. It has been estimated that more than a million clinic consultations per year are because of soft tissue injury. (1) In the 33 million musculoskeletal injuries per year, 50% often include tendon and ligament injuries (2), while anterior cruciate ligament (ACL) rupture counts to 100,000 to 200,000 per year. (3)
In the 1970s, when a lot of medical discovery was happening, was also the time when platelet-rich plasma therapy was discovered and applied in regenerative medicine (4).
So, what is platelet-rich plasma and why is it for you? In this article, we will be discussing comprehensively on what it really is and why this could be the golden treatment of the century.
Platelet- Rich Plasma, a Brief History
Platelet-rich plasma has been around for quite some time. It has been experimented and studied in thousands of clinical trials and with publications in hundreds of medically renowned journals. It has been used in different areas of medicine such as dentistry, plastic and cosmetic surgery, trauma, maxillofacial surgery, and even veterinary medicine.
In the 1970s, hematologists first started the concept of platelet-rich plasma. They created the term to describe plasma with platelet count that surpassed the number of that from peripheral blood, which was used for patients with thrombocytopenia or low platelet count. (5)
It was first used in maxillofacial surgery to help stimulate cells, and eventually, it has gained a lot of attention because of its use in sports injury such as ligament injuries, muscle strains, cartilage injury, and even on early osteoarthritis.
Apart from the interest of platelet-rich plasma, it is currently gaining a lot of noise because of its application in dermatology. It is also being used to help rejuvenate the skin, treat alopecia or hair loss, and even in wound healing and scar revision.
What is Plasma?
Now that you have read a little on platelet-rich plasma, let’s deconstruct them one by one. So what is plasma? You’ve heard it before but what is it really and why is it relevant as a treatment to a lot of injuries? Plasma or blood plasma is the light- yellow to straw yellow liquid found in our blood. When we say “whole blood” this includes the red blood cells, the white blood cells, and the platelets.
Plasma is about 91 to 92% water and only 8 to 9% solid material. It contains fibrinogen, an important factor in clotting blood. It also has proteins like albumin and globulin that help maintain the balance in the blood. Sodium, potassium, bicarbonate, chloride, and calcium are also present in the plasma to help maintain the normal value of blood pH. Lastly, it also contains immunoglobulins that protect our body from both viral and bacterial infections. (6)
Plasma can be extracted and separated by centrifugation which we will tackle later on. 55% of our blood is plasma and it is formed from the water and salt that has been absorbed by our stomach and intestines. The bone marrow, dead blood cells, and the other tissues of the body also help in the formation of plasma. Our plasma can also be used as a laboratory test. It can help diagnose diseases like diabetes and can help detect levels of albumin in the body.
Plasma is amazing because it is used in a lot of ways. Fresh frozen plasma helps in the treatment of people who have massive bleeding that results in shock— like seen in burns or those with trauma. It can also help in clotting especially in those suffering from massive internal bleeding or for people with clotting abnormalities.
What are Platelets?
To understand platelet-rich plasma therapies, we must know the star of the show first, the platelet! You have heard it before in 3rd grade but have you ever wondered why platelets are such important factors and why it has become one of the most studied cells of the body?
Platelets are very small but despite the size, they have a lot of purpose in our bodies. The normal platelet count is from 150,000 to 400,000 platelets per microliter. They are formed from very large cells that break off to eventually become platelets. The lifespan of platelets is at 7-10 days on average and then they are removed from the bloodstream. (7)
They have a lot of functions in the body. They help you clot by sticking together and starting the coagulation cascade where a mesh-like structure is made to prevent the leaking of more blood products when there is a break in the skin or even when there is injury in our internal organs.
Platelets are the first cells to arrive when there is injury and are active in the early part of the inflammation stage of the body. In simple words, they are important in maintaining balance to our body when problems arise. They also store antibacterial and even fungicidal proteins which help in activating other processes in the body that deals with inflammation. This is where the healing property of platelets lies — they help deal with the pain because they help with the inflammation and they facilitate the recovery of the body through the growth factors that are associated with healing.
What is Platelet- Rich Plasma?
Now, the part that I am excited to talk about— what is platelet-rich plasma and why all the fuss?
Platelet-rich plasma is an efficient and minimally invasive (meaning there’s almost no pain and it is a very fast procedure!) method that is done by getting your own blood and separating the red blood cells from the plasma through the process, centrifuging. I promised to discuss centrifuging earlier and here it is: Centrifuging is done using a machine that slowly swirls the blood around to separate the plasma, which contains platelets. This process is very fast and can take up to 10 minutes only.
The attraction of using platelet-rich plasma is in its ability to deliver growth factors and other cytokines that contain functions that can optimize healing in sites of injury like those commonly seen in sports. Growth factors are important because they can give the body the boost needed to heal at a faster than usual rate. It is also very appealing because it has a very low cost, minimally invasive, safe, and easy to do.
Getting into the technicality of PRP, there are a lot of commercially available devices that can produce PRP and various techniques have been developed but the end goal remains the same: faster recovery, improvement of pain, and getting the body back to normal after an injury.
Platelet-rich plasma is just as the name suggests— millions of platelets in the plasma, extracted from the patient himself or through commercially-prepared PRPs, thus making it 100% safe from any allergic reaction or infection, given to areas in the body with injuries or problems.
What is it used for?
Since it has been around for more than 50 years, platelet-rich plasma has been used in medicine countless of ways:
Treatment of tendon injuries
The use of platelet-rich plasma in tendinopathies has been done in several well-known studies. The cytokines and growth factors found in PRP are involved in helping regrow tissues, faster healing, and decreasing inflammation. PRP may also help in increasing the blood supply of the damaged tendons, by giving abundant nutrients to the area to help cells regenerate faster and bringing new cells that can remove the damaged tissues.
Treatment of Orthopedic Injuries or Illness
PRP has been a known method of treatment for several orthopedic injuries like lateral epicondylitis, patellar tendinopathy, Achilles tendinopathy, rotator cuff tendinopathy, and plantar fasciitis. It helps as a treatment for patients who do not respond to physical therapy. In one study done by Mishra et al., they evaluated 230 patients who did not respond to conservative treatment and used PRP and it showed that there was a significant improvement to their pain compared to that of the control group. (8)
There are even more studies that have noted improvement for patients undergoing PRP especially those who have received leukocyte rich PRP because of its pro-inflammatory effects. Patients who belonged in studies that had PRP treatment reported better activity, improved pain and function compared to those who belonged in the placebo group. This is important especially if you are a patient looking for a way to improve your pain and at the same time gain back your function.
Augmentation for Surgery
Platelet-rich plasma has now been incorporated in some surgeries especially those involving the bones and the tendons. A lot of the studies are looking into incorporating PRP into the preparation that will help improve the strength and functional outcomes of patients. PRP has been used in surgeries for rotator cuff repair, Achilles tendon repair, and anterior cruciate ligament surgery. Promising results are now being reported by new clinical trials involving PRP and its uses in surgery. (9)
The use of platelet-rich plasma for osteoarthritis has long been studied. Osteoarthritis is the most common form of arthritis and presents with joint pain and loss of function. It is very variable and can present in several ways but it is a devastating disease that can leave the patient to become disabled.
Platelet-rich plasma is used in osteoarthritis involving the knee and hip. If you have had osteoarthritis, you would know how upsetting it is to realize that your bones will never be the same and the constant pain that it can give. Researchers have found out that intra-articular PRP has become very effective in osteoarthritis and helps decrease pain and inflammation of the areas involved. (9)
This is explained by the different anti-inflammatory mediators found in platelets (such as TNF-α, IL-6, and IL-1β) which all help in blocking the activities of factors that may cause inflammation within the bones and cartilages.
Apart from bones and tendons, PRP is believed to have shown improvement in muscle healing also because of the inflammatory response and improvement in cell movement and growth.
PRP is well-known nowadays in the world of dermatology. This is because of its ability to improve skin structure by rejuvenating the skin and making the cells newer while basically “throwing away” the old or dead cells. It can also significantly reduce scars especially newer ones. Surprisingly, one well-known use of PRP is for hair loss. Because of the growth factors released by PRP, it is believed to help in the proliferation of the cell, which is essential in new hair regrowth. (10)
How is the Procedure Done?
As mentioned earlier, platelet-rich plasma is done in the office. A few tubes of your blood is extracted, and run on a centrifuge machine for 10 minutes. Once the platelet-rich plasma has been separated from the red blood cells, it will be extracted. We will then slowly inject the platelet-rich plasma that we have taken using very thin needles into the areas where you feel pain. Once these are injected, you may feel improvements in your pain already!
The procedure itself will take less than an hour if done in a single area like the knee or elbow. You will feel little to no pain during the procedure and it will be done by our expert physicians in PremierMed.
You may need repetitive injections of PRP if you have been having chronic pain or when the damage has been present for a long time. Platelet-rich plasma therapy may take weeks or months but the effect and healing that it can provide are long-lasting and life-changing.
As discussed, PRP has become one of the emerging treatments for pain, especially of the tendons and bones. This is important especially when your injury is not only giving you pain but limiting you from doing all the things you love!
To recap our discussion of platelet-rich plasma therapy here is what we covered:
- Platelet- Rich Plasma, A Brief History
- What is plasma?
- What are platelets?
- What is Platelet- Rich Plasma
- What is it used for?
- Treatment of tendon injuries
- Treatment of orthopedic injuries or illnesses
- Augmentation for surgery
- Muscle injuries
- Dermatologic application
- How is the procedure done?
Pain and injury should not be part of your daily life. We now live in a world where anything and everything can be improved. If you think PRP is for you, you can visit us for more details or book an appointment to live the life that you have been missing out on!
- Cole, B. J., Seroyer, S. T., Filardo, G., Bajaj, S., & Fortier, L. A. (2010). Platelet-rich plasma: where are we now and where are we going?. Sports health, 2(3), 203–210. https://doi.org/10.1177/1941738110366385
- James, R., Kesturu, G., Balian, G., & Chhabra, A. B. (2008). Tendon: biology, biomechanics, repair, growth factors, and evolving treatment options. The Journal of hand surgery, 33(1), 102–112. https://doi.org/10.1016/j.jhsa.2007.09.007
- Musahl, V., & Karlsson, J. (2019). Anterior Cruciate Ligament Tear. The New England journal of medicine, 380(24), 2341–2348. https://doi.org/10.1056/NEJMcp1805931
- Jain, A., Bedi, R. K., & Mittal, K. (2015). Platelet-rich plasma therapy: A novel application in regenerative medicine. Asian journal of transfusion science, 9(2), 113–114. https://doi.org/10.4103/0973-6247.162679
- Alves, R., & Grimalt, R. (2018). A Review of Platelet-Rich Plasma: History, Biology, Mechanism of Action, and Classification. Skin appendage disorders, 4(1), 18–24. https://doi.org/10.1159/000477353
- Mathew J, Sankar P, Varacallo M. Physiology, Blood Plasma. [Updated 2020 Apr 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK531504/
- Fountain JH, Lappin SL. Physiology, Platelet. [Updated 2019 Apr 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470328/
- Mishra, A. K., Skrepnik, N. V., Edwards, S. G., Jones, G. L., Sampson, S., Vermillion, D. A., Ramsey, M. L., Karli, D. C., & Rettig, A. C. (2014). Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. The American journal of sports medicine, 42(2), 463–471. https://doi.org/10.1177/0363546513494359
- Le, A., Enweze, L., DeBaun, M. R., & Dragoo, J. L. (2018). Current Clinical Recommendations for Use of Platelet-Rich Plasma. Current reviews in musculoskeletal medicine, 11(4), 624–634. https://doi.org/10.1007/s12178-018-9527-7
- Stevens, J., & Khetarpal, S. (2018). Platelet-rich plasma for androgenetic alopecia: A review of the literature and proposed treatment protocol. International journal of women’s dermatology, 5(1), 46–51. https://doi.org/10.1016/j.ijwd.2018.08.004