Platelet rich plasma: Difference between revisions
No edit summary |
No edit summary |
||
| Line 4: | Line 4: | ||
{{EJ}} | {{EJ}} | ||
| Line 34: | Line 29: | ||
Both [[Prolotherapy]] and PRP are often used as an alternative to invasive [[arthroscopic surgery]]. They are also important alternatives when arthroscopy has failed or is not indicated. In many cases contraindications exist for joint replacement (obesity, age,medical co morbidity). PRP and prolotherapy can frequently provide a beneficial alternative in these cases as well. | Both [[Prolotherapy]] and PRP are often used as an alternative to invasive [[arthroscopic surgery]]. They are also important alternatives when arthroscopy has failed or is not indicated. In many cases contraindications exist for joint replacement (obesity, age,medical co morbidity). PRP and prolotherapy can frequently provide a beneficial alternative in these cases as well. | ||
{{SIB}} | |||
{{WH}} | |||
{{WS}} | |||
Revision as of 18:58, 9 August 2009
Editor-in-Chief: Robert G. Schwartz, M.D. [1], Piedmont Physical Medicine and Rehabilitation, P.A.
Please Join in Editing This Page and Apply to be an Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
=Overview
PRP is an autologous blood therapy that stimulates your body’s natural healing process through the injection of its own growth factors into injured areas. Research and clinical data show that PRP injections are extremely safe, with minimal risk for any adverse reaction or complication. Because PRP is produced from your own blood, there is no concern for rejection or disease transmission. There is a small risk of infection from any injection into the body, but this is rare. Some research suggests that PRP may have an anti-bacterial property which protects against possible infection.
Your body naturally recruits platelets and white blood cells from the blood to initiate a healing response. Under normal conditions, platelets store numerous growth factors which are released in response to signals from the injured tissue. Special PRP devices concentrate platelets from whole blood. When the PRP is injected into the damaged tissue growth factor release is enhanced so that natural healing is accelerated. Desired results include by enhancing the body's natural healing capacity, and a more rapid, more efficient, more thorough restoration of tissue to a healthy state [3].
History
PRP was initially developed in the 1970s. It enjoyed increasing use in hospital and outpatient surgical settings in the 1980's and began to be utilized in physician offices for musculoskeletal procedures in the 1990's. Technological advances have enabled the administration of PRP to become more popular among musculoskeletal physicians (physiatrists and orthopedists) since 2000. Much of the original PRP use centered around orhtopedic surgical procedures, such as spinal fusions and joint replacements,however PRP has also enjoyed extensive use among maxillofacial and plastic surgeons and dermatologists.
Pathophysiology
After an injury, the repair response of musculoskeletal tissues starts with the formation of a blood clot and degranulation of platelets, which releases growth factors and cytokines at the site. This microenvironment results activation of inflammatory cells and proliferation of local progenitor cells. In most cases, fibroblastic scar tissue is formed. In some settings, however, such as in a fracture callus, these conditions can also facilitate the formation of new bone tissue.
Transforming growth factor beta (TGF-b), platelet-derived growth factor (PDGF), insulin-like growth factor (IGF), vascular endothelial growth factors (VEGF), epidermal growth factor (EGF) and fibroblast growth factor-2 (FGF-2) are growth factors that can be found at injury sites during wound healing. In addition to soft tissue repair (muscle, tendon, ligament and supporting joint structures), PRP has been shown to enhance one or more phases of osteogenesis, early angiogenesis and revascularization. 1
Studies also recognize the possibility that the effect of the clot microenvironment or concentrates of PDFGs on fracture repair might be either positive or negative. The nature of this effect, like that of many graft materials, depends on the clinical setting, particularly the graft site’s local environment of cells in which PRP or associated factors are placed.
In summary, available data suggest that PRP is valuable in enhancing soft-tissue repair and in wound healing.15 The clinical role of PRP in bone repair remains controversial however. PRP is not uniformly successful as an adjuvant to bone grafting procedures. PRP may promote or inhibit bone formation, depending on the setting in which it is used and the quality of the PRP.
Treatment
Prolotherapy ("Proliferative Injection Therapy") involves injecting an otherwise non-pharmacological and non-active proliferant or irritant solution into the body, generally in the region of tendons or ligaments for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain. Most musculoskeletal physicians will use Prolotherapy prior to PRP when considering regenerative intervention, however individual considerations exist. Examples where PRP might be utilized first include professional athletes that have to reduce wound healing time, more severe cases, in instances where multiple problems exist.
Both Prolotherapy and PRP are often used as an alternative to invasive arthroscopic surgery. They are also important alternatives when arthroscopy has failed or is not indicated. In many cases contraindications exist for joint replacement (obesity, age,medical co morbidity). PRP and prolotherapy can frequently provide a beneficial alternative in these cases as well.