Platelet-Rich Plasma

Platelet-Rich Plasma -PRP in Amarillo - shows impressive results

Let's start by saying that claiming any treatment can prevent a specific surgery is a bold thing to say. Understand, everyone is different and that's why results differ from patient to patient. However, it is absolutely appropriate to look at the research that has been done, the effects that have been noted, and where the treatment trend is going. So let's do exactly that. 

The first thing we want to be clear on is what exactly PRP is. PRP stands for platelet-rich plasma. It is a newer treatment in which the provider draws blood from the patient, spins it down in the centrifuge to separate the parts of the blood right there in the office, then extracts the plasma that separated from the rest of the blood, and then finally, the provider injects the platelet-rich plasma back into the patient's complaint or problem spot. 

PRP has little to no adverse effects or allergic reactions because 'the cure' came from the patient themselves. So it's perfect in that aspect. Other common joint treatments include cortisone and hyaluronic acid. Cortisone only treats the inflammation and PRP has beat cortisone and hyaluronic acid in several randomized controlled research trials. 

Now, why does PRP plasma injected into a problem spot in this way make any difference? 

The plasma contains healing platelets in the blood that when concentrated and injected back into your knee, may provide you with pain relief by way of regenerating, repairing, and replacing damaged knee tissue according to Care Medical (https://www.caringmedical.com/prolotherapy-news/platelet-rich-plasma-knee-osteoarthritis/)

What is becoming more and more clear about PRP for knee pain is that it is more effective when part of a cycle. If you've heard that one shot didn't fix it, there's a reason for that. Our medical provider spent time in Dallas with colleagues and PRP professionals to find the very best way to get the very best effects from the treatment. PRP shows the best results when done as part of a cycle of PRP treatment combined with low-level laser and targetted rehabilitation. Pain almost always responds to a multi-modal approach which is exactly what we offer here at Creek Stone Integrated Medical. 

One research paper concluded, "Platelet-rich plasma injections delay the need for knee replacement” – “85.7% of the patients did not undergo total knee replacement during the five-year follow-up”

Now, many folks do go on to have knee replacement but PRP can delay it significantly and there are those avoiding it altogether. Some patients have been told that their knee is bone on bone but they are too young to have the replacement surgery. Some would do replacement but they can't be out of work or they are active in sports and just can't do the knee replacement. Some patients have had a knee replacement on one knee and don't want to have the procedure on the other knee. 

Let's be clear from the top; PRP does not work for every single patient. Sometimes, joints are just simply too far gone and cannot be salvaged through PRP. Every treatment has its limitations. For example, if a patient's knee can't be bent, the integrity of the joint is probably compromised too significantly. Sometimes, the limitation is due to the doctor or the patient giving up too soon and not staying the course. Remember, it's not just one shot and 'BAM' - you're cured. It's not instant relief. Cortisone, for example, treats inflammation and can have a fairly rapid effect on the pain level. However, they are short-lived and do nothing to rebuild or repair the joint. While cortisone can be fast-acting and effective short-term, the research is piling up about the detrimental effects of cortisone injections. They are actually showing to be bad for the joints. 

PRP can sometimes feel a little worse in the beginning or no pain relief for a bit. PRP is NOT like cortisone. While with cortisone, nothing is being healed, PRP brings healing through inflammation. When tissue is repaired, the inflammation goes away. Cortisone is short-term. PRP is long-term. For more comparisons between the different types of knee injections, visit https://www.caringmedical.com/prolotherapy-news/different-types-knee-injections-2/

For you science-y people, the exact mechanism for PRP treatment goes like this; 

February 2021 (10) study from the Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology at the University of Catania, Italy. Here is what the researchers documented:

“PRP supplies and releases cytokines (cells that send signals to other cells that a repair process needs to begin), growth factors, and α-granules (the proteins of the platelets), which can offer a recovering stimulus and promote healing and tissue repair. The PRP injection can promote the release of fibrinogen (a substance that helps in wound healing or a ligament tear for example), interleukin-1 receptor antagonist (acting as an inti-inflammatory), tissue growth factors (TGFs), platelet-derived growth factors (PDGFs), and vascular endothelial growth factors (VEGFs). These growth factors have local and systemic involvement, encouraging the inhibition of catabolic enzymes (stops an overactive inflammatory response from breaking down tissue healing tissue – this is the problems of chronic swelling)  and cytokines, modulating inflammation and local angiogenesis (development of new blood vessels, you need circulation to heal), and recruiting local stem cells and fibroblasts to sites of damage, and inducing healthy nearby cells to manufacture greater numbers of growth factors.” https://pubmed.ncbi.nlm.nih.gov/33546408/

MRI evidence that PRP regrows cartilage

A January 2020 study published in the Journal of Pain Research (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6959502/) investigated the effect of PRP on cartilage characteristics by special MRI sequencing in knee osteoarthritis patients. All the patients were women and about 58 years old.  Here is what the researchers wrote:

In this double-blind randomized clinical trial, patients with bilateral knee osteoarthritis were included in the study. Each patient’s knees were randomly placed into the control or the treatment groups. PRP was injected in two sessions with 4-week intervals in the PRP group.

Pain questionnaires were utilized and MRI was performed for all patients, before, and 8 months after treatment.

Results

• In the PRP group, all of the radiologic variables (patellofemoral cartilage volume, synovitis, and medial and lateral meniscal disintegrity), with the exception of subarticular bone marrow abnormality, had significant improvement. In a comparison between the two groups, patellofemoral cartilage volume and synovitis had significantly changed in the PRP group.

Conclusion

• “In this study, in addition to the effect of PRP on pain, there was a significant effect on radiologic characteristics (patellofemoral cartilage volume and synovitis). 

WOW. That's impressive.

What we are coming to understand as well is that if an office practices a single-shot injection technique, sometimes it is going to help but long-term and overall, it likely will not. Single PRP shots, rather than a cycle of them, may only be a temporary 'fix' because the single shot didn't address the cause of the damage, the knee instability. Knee instability is noticed when it feels loose or 'wobbles' a bit. Maybe it feels like it could 'give out' at times. Common sense tells us and patients that one shot of PRP can patch problems with the cartilage but cannot stabilize the entire knee. 

PRP will not work if it is considered a one-shot treatment and offered in a similar manner to cortisone. One-shot and done. Once again, PRP therapy should be considered to be a process and performed in a cycle. For some patients, we may see them in our office periodically for 3-6 total visits per area treated. 

Here at Creek Stone, our Family Nurse Practitioner is our medical professional, is trained in PRP therapy, and performs PRP treatment right here in our Amarillo clinic.

Make sure you call us at 806-355-3000 to set up your PRP therapy today 

One of the most exciting things about PRP treatment is that it's not just for the knee. Here at Creek Stone, we can use PRP to help treat shoulders, knees, hips, ankles, plantar fasciitis, carpal tunnel, hair loss, elbows, and much much more. The possibilities for PRP, at this time, appear to be almost endless. And exciting. 

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References

1 Sánchez M, Jorquera C, Sánchez P, Beitia M, García-Cano B, Guadilla J, Delgado D. Platelet-rich plasma injections delay the need for knee arthroplasty: a retrospective study and survival analysis. Int Orthop. 2020 Jul 3. doi: 10.1007/s00264-020-04669-9. Epub ahead of print. PMID: 32621139. [Google Scholar]
2 Guermazi A, Neogi T, Katz JN, Kwoh CK, Conaghan PG, Felson DT, Roemer FW. Intra-articular Corticosteroid Injections for the Treatment of Hip and Knee Osteoarthritis-related Pain: Considerations and Controversies with a Focus on Imaging—Radiology Scientific Expert Panel. Radiology. 2020 Dec;297(3):503-12. [Google Scholar]
3 Forogh B, Mianehsaz E, Shoaee S, Ahadi T, Raissi GR, Sajadi S. Effect of single injection of Platelet-Rich Plasma in comparison with corticosteroid on knee osteoarthritis: a double-blind randomized clinical trial. J Sports Med Phys Fitness. 2015 Jul 14.  [Google Scholar]
4 Freire MR, da Silva PM, Azevedo AR, Silva DS, da Silva RB, Cardoso JC. Comparative effect between infiltration of platelet-rich plasma and the use of corticosteroids in the treatment of knee osteoarthritis: a prospective and randomized clinical trial. Revista Brasileira de Ortopedia. 2020 Oct;55(5):551-6. [Google Scholar]
5 Cole BJ, Karas V, Hussey K, Merkow DB, Pilz K, Fortier LA. Hyaluronic acid versus platelet-rich plasma: a prospective, double-blind randomized controlled trial comparing clinical outcomes and effects on intra-articular biology for the treatment of knee osteoarthritis. Am J Sports Med. 2017 Feb;45(2):339-46. [Google Scholar]
6 Pavone V, Vescio A, Turchetta M, Giardina SM, Culmone A, Testa G. Injection-Based Management of Osteoarthritis of the Knee: A Systematic Review of Guidelines. Frontiers in Pharmacology. 2021 Apr 20;12:741.
7 Ren H, Zhang S, Wang X, Li Z, Guo W. Role of platelet-rich plasma in the treatment of osteoarthritis: a meta-analysis. Journal of International Medical Research. 2020 Oct;48(10):0300060520964661. [Google Scholar]
8 Dong Y, Zhang B, Yang Q, Zhu J, Sun X. The effects of platelet-rich plasma injection in knee and hip osteoarthritis: a meta-analysis of randomized controlled trials [published online ahead of print, 2020 Jun 12]. Clin Rheumatol. 2020;10.1007/s10067-020-05185-2. doi:10.1007/s10067-020-05185-2 [Not listed yet in Google Scholar]
9 Dai WL, Zhou AG, Zhang H, Zhang J. Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Meta-analysis of Randomized Controlled Trials. Arthroscopy. 2016 Dec 22. pii: S0749-8063(16)30780-0. [Google Scholar]
10 Testa G, Giardina SM, Culmone A, Vescio A, Turchetta M, Cannavò S, Pavone V. Intra-Articular Injections in Knee Osteoarthritis: A Review of Literature. Journal of functional morphology and kinesiology. 2021 Feb 3;6(1):15. [Google Scholar]
11 Martini LI, Via AG, Fossati C, Randelli F, Randelli P, Cucchi D, Barbour KE, Helmick CG, Theis KA, Al-Arfaj A, Al-Boukai AA. Single Platelet-Rich Plasma Injection for Early Stage of Osteoarthritis of the Knee. Joints. 2017 Mar;5(01):002-6. [Google Scholar]
12. Hauser RA, Orlofsky A. Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series. Clin Med Insights Arthritis Musculoskelet Disord. 2013 Sep 4;6:65-72. Google Scholar
13 Raeissadat SA, Ghorbani E, Taheri MS, Soleimani R, Rayegani SM, Babaee M, Payami S. MRI Changes After Platelet Rich Plasma Injection in Knee Osteoarthritis (Randomized Clinical Trial). Journal of Pain Research. 2020;13:65. [Google Scholar]
14 Southworth TM, Naveen NB, Tauro TM, Leong NL, Cole BJ. The Use of Platelet-Rich Plasma in Symptomatic Knee Osteoarthritis. The Journal of Knee Surgery. 2018 Nov 13. [Google Scholar]
15 Cook CS, Smith PA. Clinical Update: Why PRP Should Be Your First Choice for Injection Therapy in Treating Osteoarthritis of the Knee. Current reviews in musculoskeletal medicine. 2018 Dec 1;11(4):583-92. [Google Scholar]
16  Rajan PV, Ng MK, Klika A, et al. The Cost-Effectiveness of Platelet-Rich Plasma Injections for Knee Osteoarthritis: A Markov Decision Analysis [published online ahead of print, 2020 May 22]. J Bone Joint Surg Am. 2020;10.2106/JBJS.19.01446. doi:10.2106/JBJS.19.01446. [Google Scholar]
17 Cengiz IF, Pereira H, Espregueira-Mendes J, Reis RL, Oliveira JM. The Clinical Use of Biologics in the Knee Lesions: Does the Patient Benefit?. Current reviews in musculoskeletal medicine. 2019 Jun 28:1-9. [Google Scholar]
18 Sakata R, Reddi AH. Platelet-Rich Plasma Modulates Actions on Articular Cartilage Lubrication and Regeneration. Tissue Eng Part B Rev. 2016 Apr 25. [Google Scholar]
19 Campbell KA, Saltzman BM, Mascarenhas R, Khair MM, Verma NN, Bach BR Jr, Cole BJ. A Systematic Review of Overlapping Meta-analyses. Arthroscopy. 2015 Nov;31(11):2213-21. doi: 10.1016/j.arthro.2015.03.041. [Google Scholar]
20 Lubowitz JH. Editorial Commentary: Platelet-Rich Plasma Improves Knee Pain and Function in Patients With Knee Osteoarthritis. Arthroscopy. 2015 Nov;31(11):2222-3. doi: 10.1016/j.arthro.2015.08.022. [Google Scholar]
21 Belk JW, Kraeutler MJ, Houck DA, Goodrich JA, Dragoo JL, McCarty EC. Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials [published online ahead of print, 2020 Apr 17]. Am J Sports Med. 2020;363546520909397. doi:10.1177/0363546520909397 [Google Scholar]
22 Sakata R, McNary SM, Miyatake K, Lee CA, Van den Bogaerde JM, Marder RA, Reddi AH. Stimulation of the Superficial Zone Protein and Lubrication in the Articular Cartilage by Human Platelet-Rich Plasma. Am J Sports Med. 2015 Mar 26. pii: 0363546515575023. [Google Scholar]
23 Shen L, Yuan T, Chen S, Xie X, Zhang C. The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res. 2017 Jan 23;12(1):16. [Google Scholar]
24 Kanchanatawan W, Arirachakaran A, Chaijenkij K, Prasathaporn N, Boonard M, Piyapittayanun P, Kongtharvonskul J. Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 2016 May;24(5):1665-77. [Google Scholar]
25 Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD. Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review. Arthroscopy. 2015 Sep 29. pii: S0749-8063(15)00659-3. doi: 10.1016/j.arthro.2015.08.005. [Google Scholar]
26 Tavassoli M, Janmohammadi N, Hosseini A, Khafri S, Esmaeilnejad-Ganji SM. Single-and double-dose of platelet-rich plasma versus hyaluronic acid for treatment of knee osteoarthritis: A randomized controlled trial. World Journal of Orthopedics. 2019 Sep 18;10(9):310. [Google Scholar]
27 Hohmann E, Tetsworth K, Glatt V. Is platelet-rich plasma effective for the treatment of knee osteoarthritis? A systematic review and meta-analysis of level 1 and 2 randomized controlled trials. European Journal of Orthopaedic Surgery & Traumatology. 2020 Feb 14:1-3. [Google Scholar]
28 Karasavvidis T, Totlis T, Gilat R, Cole BJ. Platelet-rich plasma combined with hyaluronic acid improves pain and function compared with hyaluronic acid alone in knee osteoarthritis: A systematic review and meta-analysis. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020 Dec 3. [Google Scholar]
29 Dwyer T, Jaskarndip C. “Editorial Commentary: Injections for Knee Osteoarthritis: Doc, You Gotta Help Me!.” (2021): 1288-1289. [Google Scholar]
30 Duymus TM, Mutlu S, Dernek B, Komur B, Aydogmus S, Kesiktas FN. Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options. Knee Surg Sports Traumatol Arthrosc. 2017 Feb;25(2):485-492. [Google Scholar]
31 Angoorani H, Mazaherinezhad A, Marjomaki O, Younespour S. Treatment of knee osteoarthritis with platelet-rich plasma in comparison with transcutaneous electrical nerve stimulation plus exercise: a randomized clinical trial. Med J Islam Repub Iran. 2015 Jun 27;29:223. eCollection 2015. [Google Scholar]
32 Simental-Mendía MA, Vílchez-Cavazos JF, Martínez-Rodríguez H. [Platelet-rich plasma in knee osteoarthritis treatment].Cir Cir. 2015 Jun 23. pii: S0009-7411(15)00100-0. doi: 10.1016/j.circir.2014.06.001. [Google Scholar]
33 Szwedowski D, Szczepanek J, Paczesny Ł, Zabrzyński J, Gagat M, Mobasheri A, Jeka S. The Effect of Platelet-Rich Plasma on the Intra-Articular Microenvironment in Knee Osteoarthritis. International Journal of Molecular Sciences. 2021 Jan;22(11):5492. [Google Scholar]
34 Şen Eİ, Yıldırım MA, Yeşilyurt T, Kesiktaş FN, Dıraçoğlu D. Effects of platelet-rich plasma on the clinical outcomes and cartilage thickness in patients with knee osteoarthritis. Journal of Back and Musculoskeletal Rehabilitation. 2019 Sep 25(Preprint):1-9.
35 Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment With Platelet-Rich Plasma Is More Effective Than Placebo for Knee Osteoarthritis: A Prospective, Double-Blind, Randomized Trial. Am J Sports Med. 2013 Jan 8. [Google Scholar]
36 Halpern B, Chaudhury S, Rodeo SA, Hayter C, Bogner E, Potter HG, Nguyen J. Clinical and MRI Outcomes After Platelet-Rich Plasma Treatment for Knee Osteoarthritis. Clin J Sport Med. 2012 Dec 12.  [Google Scholar]
37 Kavadar G, Demircioglu DT, Celik MY, Emre TY. Effectiveness of platelet-rich plasma in the treatment of moderate knee osteoarthritis: a randomized prospective study. J Phys Ther Sci. 2015 Dec;27(12):3863-7. doi: 10.1589/jpts.27.3863. Epub 2015 Dec 28. [Google Scholar]
38 Alessio-Mazzola M, Lovisolo S, Sonzogni B, Capello AG, Repetto I, Formica M, Felli L. Clinical outcome and risk factor predictive for failure of autologous PRP injections for low-to-moderate knee osteoarthritis. Journal of Orthopaedic Surgery. 2021 Jun 24;29(2):23094990211021922. [Google Scholar]