What Can Platelet Rich Plasma Treat

What Can Platelet Rich Plasma Treat?

By: Edward G. Loniewski, DO, FACOS, FAOAO

Platelet rich plasma is not just platelets - it is a combination of growth factors and important proteins which not only prep the area for repair, but also deliver important growth factors into areas where they cannot reach.

This healing cascade can be used for:

• Arthritis of the knee, hip, ankle and wrist
• Tennis Elbow
• Golfer’s Elbow
• Tendonitis of hip, knee and shoulder
• Bursitis of the hip, knee and shoulder
• Ligament injuries
• Carpal Tunnel Syndrome

Platelet Rich Plasma for Arthritis

The growth factors and proteins found in platelet rich plasma may help with the pain and loss of function commonly associated with arthritis.

Earlier studies performed in Italy on the use of platelet rich plasma for arthritis of the knee revealed some promising results for arthritis of the knee.[1] Dr. Elise Kon from the Rizolli Orthopedic Clinic in Bologna, Italy followed over 100 patients for over one year, and found that all parameters of knee function and pain improved but these injections would lose their effect over time.

Researchers from many other respected institutions such as Rush University, Cornell, and the Hospital for Special Surgery also found some benefits of using platelet rich plasma in basic science studies as well as animal studies and suggested that the positive findings were not just due to the platelets, but the other bioactive components.[2] Some further studies were developed to compare PRP to common treatments and determine which treatment was superior; one study compared an injection of a steroid to platelet rich plasma and found that the PRP patients had superior reduction in pain and improvement in function for longer periods of time.[3]

Italian researchers compared PRP to the very commonly administered hyaluronic acid injections sometimes known as rooster comb or chicken fat injections with the trade names Supartz™ or Synvisc™. Over 120 patients were given either the hyaluronic injection or PRP, and followed for six months. The PRP patients had superior outcome scores, and PRP even worked very well in severe forms of arthritis.[4] This finding was repeated over and over in other studies; a review of these studies lead researchers to conclude that “PRP is a viable treatment for knee OA, and has the potential to lead to symptomatic relief for up to 12 months.”[5]

This finding was confirmed with another meta-analysis of over 551 studies, concluding, “This study suggests that PRP injection is more efficacious than HA injection and placebo in reducing symptoms and improving function and quality of life. It has the potential to be the treatment of choice in patients with mild-to-moderate OA of the knee who have not responded to conventional treatment.”[6]

Not only does PRP reduce the pain of arthritic joints, but one study demonstrated that PRP increased the muscle strength of the treated knee, as compared to a placebo treatment in the other knee. Researchers found that the PRP treated knee had significantly more strength than the knee which received an injection of normal saline.[7]

Given all of this evidence, keep the following in mind: no matter what other people tell you, PRP has significant evidence of being proven useful in the treatment of osteoarthritis when compared to commonly accepted treatments! Even when we compare the results to alternative methods of treating arthritis such as prolotherapy, PRP appeared to have a longer lasting positive effect.[8]

How Does Platelet Rich Plasma Work?

The platelets and the surrounding fluid called plasma work together to reduce harmful chemicals and simultaneously increase beneficial biochemical reactions. The net result is a healing environment.

Platelet Rich Plasma works in two ways:

1. Reduces harmful chemical reactions in the injured area
2. Stimulates the healing response

Taiwan researchers found that platelet rich plasma injections lead to continual reduction of harmful biochemical products in the knee, as well as an increase in the biochemical markers which promote healing and anti-aging.[9] This same decrease in harmful chemicals was found in a trail in the United States and appeared to be linked to a greater positive response. This means that when PRP reduced these harmful chemicals, there was a better reduction of pain and increase in activities.[10]

This finding was further confirmed by German researchers who found the same anti-inflammatory effect of platelet derived growth factors in an experimental model of rheumatoid arthritis.[11]

Unlike other conventional treatments for arthritis, PRP seems to have a double-edged sword approach by both reducing the harmful substances from your joint while also increasing the beneficial substances over a period of time. This could potentially slow down the progression of the arthritis and protect the joint.

This mechanism was looked at in a study evaluating serial MRIs of knees given a PRP injection over a year’s time. In it, 73% of the participants revealed no further degenerative changes.[12]

What other conditions can be treated with Platelet Rich Plasma?

I, Dr. Loniewski, have had been utilizing platelet rich plasma since 2005, and have applied this treatment on thousands of patients over the past 13 years or more. Most (but not all) of these patients responded positively.

I will only recommend PRP and the special customized type of PRP if I have some evidence that this would be beneficial for the patient in question. Every person is not a candidate; we must look at each prospective patient as unique, with special needs and conditions which require a customized approach.

When we look at the current body of peer reviewed published studies and articles, we find a growing list of orthopedic conditions where PRP may provide at least short or mid- term benefit. The following is a very brief review of some of the studies evaluating PRP.

This is not an exhaustive review, and many more articles are available. These studies are intended to provide you with a body of scientific knowledge, since this is not generally accepted standard of treatment by most board certified orthopedic surgeons.

Patients must consider that we are providing them with a one-sided review of these results. In addition, new supporting and conflicting studies may appear daily; we are only presenting from the body of literature available at the time of the development of this web site.

Shoulder

• Rotator cuff repairs ( Randelli P1, Arrigoni P, Ragone V, Aliprandi A, Cabitza P J Shoulder Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up. Elbow Surg. 2011 Jun;20(4):518-28. doi: 10.1016/j.jse.2011.02.008.)
• Partial rotator cuff tears (Shams A1, El-Sayed M2, Gamal O1, Ewes W3. Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears. Eur J Orthop Surg Traumatol. 2016 Dec;26(8):837-842. Epub 2016 Aug 20.)
• Biceps tendonitis (Sanli I1, Morgan B2, van Tilborg F3, Funk L2, Gosens T4. Single injection of platelet-rich plasma (PRP) for the treatment of refractory distal biceps tendonitis: long-term results of a prospective multicenter cohort study. Knee Surg Sports Traumatol Arthrosc. 2016 Jul;24(7):2308-12. doi: 10.1007/s00167-014-3465-8. Epub 2014 Dec 11.
• Ulnar collateral ligament injury of the elbow (Podesta L1, Crow SA, Volkmer D, Bert T, Yocum LA. Treatment of partial ulnar collateral ligament tears in the elbow with platelet-rich plasma. Am J Sports Med. 2013 Jul;41(7):1689-94. doi: 10.1177/0363546513487979. Epub 2013 May 10.)
• Lateral epicondylitis (tennis elbow) (Gautam VK1, Verma S1, Batra S1, Bhatnagar N2, Arora S1. Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation. J Orthop Surg (Hong Kong). 2015 Apr;23(1):1-5.)
• Lumbar Disc Disease (Levi D1, Horn S2, Tyszko S2, Levin J3, Hecht-Leavitt C4, Walko E2. Intradiscal Platelet-Rich Plasma Injection for Chronic Discogenic Low Back Pain: Preliminary Results from a Prospective Trial. Pain Med. 2016 Jun;17(6):1010-22. doi: 10.1093/pm/pnv053. Epub 2015 Dec 26.)
• Sacroiliac joint pain (low back pain) (Singla V1, Batra YK2, Bharti N3, Goni VG4, Marwaha N5. Steroid vs. Platelet-Rich Plasma in Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back Pain. Pain Pract. 2017 Jul;17(6):782-791. doi: 10.1111/papr.12526. Epub 2016 Dec 1.)
• Bursitis and tendonitis of the hip (Fitzpatrick J1,2,3, Bulsara MK4, O'Donnell J5, McCrory PR6, Zheng MH1,7. The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection. Am J Sports Med. 2018 Mar;46(4):933-939. doi: 10.1177/0363546517745525. Epub 2018 Jan 2.)
• Osteoarthritis of the hip (Dallari D1, Stagni C2, Rani N2, Sabbioni G2, Pelotti P3, Torricelli P4, Tschon M4, Giavaresi G4. Ultrasound-Guided Injection of Platelet-Rich Plasma and Hyaluronic Acid, Separately and in Combination, for Hip Osteoarthritis: A Randomized Controlled Study. Am J Sports Med. 2016 Mar;44(3):664-71. doi: 10.1177/0363546515620383. Epub 2016 Jan 21. )
• Arthroscopic hip surgery (Rafols C1, Monckeberg JE2, Numair J1, Botello J1, Rosales J1. Platelet-Rich Plasma Augmentation of Arthroscopic Hip Surgery for Femoroacetabular Impingement: A Prospective Study With 24-Month Follow-up. Arthroscopy. 2015 Oct;31(10):1886-92. doi: 10.1016/j.arthro.2015.03.025. Epub 2015 May 15.)
• Anterior cruciate ligament reconstruction (Radice F1, Yánez R, Gutiérrez V, Rosales J, Pinedo M, Coda S. Comparison of magnetic resonance imaging findings in anterior cruciate ligament grafts with and without autologous platelet-derived growth factors. Arthroscopy. 2010 Jan;26(1):50-7. doi: 10.1016/j.arthro.2009.06.030.
• Patellar tendonitis (jumper’s knee) (Dragoo JL1, Wasterlain AS, Braun HJ, Nead KT. Platelet-rich plasma as a treatment for patellar tendinopathy: a double-blind, randomized controlled trial. Am J Sports Med. 2014 Mar;42(3):610-8. doi: 10.1177/0363546513518416. Epub 2014 Jan 30.)
• Bursitis of the knee (Rowicki K1, Płomiński J1, Bachta A2. Evaluation of the effectiveness of platelet rich plasma in treatment of chronic pes anserinus pain syndrome. Ortop Traumatol Rehabil. 2014 May-Jun;16(3):307-18. doi: 10.5604/15093492.1112532.)
• Plantar fasciitis (Monto RR1. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot Ankle Int. 2014 Apr;35(4):313-8. doi: 10.1177/1071100713519778. Epub 2014 Jan 13. )
• Ankle arthritis (Fukawa T1, Yamaguchi S1, Akatsu Y1, Yamamoto Y1, Akagi R1, Sasho T1. Safety and Efficacy of Intra-articular Injection of Platelet-Rich Plasma in Patients With Ankle Osteoarthritis. Foot Ankle Int. 2017 Jun;38(6):596-604. doi: 10.1177/1071100717700377. Epub 2017 Apr 11. )

Elbow

Wrist

• Carpal Tunnel Syndrome (Malahias MA1, Nikolaou VS1, Johnson EO2, Kaseta MK1, Kazas ST1, Babis GC1. Platelet-rich plasma ultrasound-guided injection in the treatment of carpal tunnel syndrome: A placebo-controlled clinical study. J Tissue Eng Regen Med. 2018 Mar;12(3):e1480-e1488. doi: 10.1002/term.2566. Epub 2017 Dec 17.)

Lower Back

Hip

Knee

Foot and Ankle

If you would prefer to have a face to face consultation with Dr. Loniewski, please feel free to contact us at 810-299-8552 for an appointment today.

[1] Kon E1, Buda R, Filardo G, Di Martino A, Timoncini A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010 Apr;18(4):472-9. doi: 10.1007/s00167-009-0940-8. Epub 2009 Oct 17.

[2] Boswell SG1, Cole BJ, Sundman EA, Karas V, Fortier LA. Platelet-rich plasma: a milieu of bioactive factors. Arthroscopy. 2012 Mar;28(3):429-39. doi: 10.1016/j.arthro.2011.10.018. Epub 2012 Jan 28.

[3] Forogh B1, Mianehsaz E, Shoaee S, Ahadi T, Raissi GR, Sajadi S. Effect of single injection of platelet-rich plasma in comparison with corticosteroid on kneeosteoarthritis: a double-blind randomized clinical trial. J Sports Med Phys Fitness. 2016 Jul-Aug;56(7-8):901-8. Epub 2015 Jul 14.

[4] Cerza F1, Carnì S, Carcangiu A, Di Vavo I, Schiavilla V, Pecora A, De Biasi G, Ciuffreda M. Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis. Am J Sports Med. 2012 Dec;40(12):2822-7. doi: 10.1177/0363546512461902. Epub 2012 Oct 25.

[5] Campbell KA1, Saltzman BM2, Mascarenhas R3, Khair MM2, Verma NN2, Bach BR Jr2, Cole BJ2. Does Intra-articular Platelet-Rich Plasma Injection Provide Clinically Superior Outcomes Compared With Other Therapies in the Treatment of Knee Osteoarthritis? A Systematic Review of Overlapping Meta-analyses. Arthroscopy. 2015 Nov;31(11):2213-21. doi: 10.1016/j.arthro.2015.03.041. Epub 2015 May 29. ¹⁰

[6] Kanchanatawan W1, Arirachakaran A2, Chaijenkij K3, Prasathaporn N4, Boonard M5, Piyapittayanun P2, Kongtharvonskul J6. 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. doi: 10.1007/s00167-015-3784-4. Epub 2015 Sep 19.

[7] Wu YT1, Hsu KC, Li TY, Chang CK, Chen LC. Wu YT1, Hsu KC, Li TY, Chang CK, Chen LC. Effects of Platelet-Rich Plasma on Pain and Muscle Strength in Patients With Knee Osteoarthritis. Am J Phys Med Rehabil. 2018 Apr;97(4):248-254. doi: 10.1097/PHM.0000000000000874.

[8] Rahimzadeh P, Imani F, Faiz SHR, Entezary SR, Zamanabadi MN, Alebouyeh MR. The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis. Clinical Interventions in Aging. 2018;13:73-79. doi:10.2147/CIA.S147757.

[9] Chen CPC1, Cheng CH2, Hsu CC3, Lin HC1, Tsai YR1, Chen JL4. The influence of platelet rich plasma on synovial fluid volumes, protein concentrations, and severity of pain in patients with knee osteoarthritis. Exp Gerontol. 2017 Jul;93:68-72. doi: 10.1016/j.exger.2017.04.004. Epub 2017 Apr 20.

[10] Cole BJ1,2,3,4,5, Karas V6, Hussey K1, Pilz K1,5, Fortier LA7. 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):339-346. doi: 10.1177/0363546516665809. Epub 2016 Oct 21.

[11] Tohidnezhad M1, Bayer A2, Rasuo B1, Hock JVP1, Kweider N1, Fragoulis A1, Sönmez TT1,3,4, Jahr H5, Pufe T1, Lippross S6. Platelet-Released Growth Factors Modulate the Secretion of Cytokines in Synoviocytes under Inflammatory Joint Disease. Mediators Inflamm. 2017;2017:1046438. doi: 10.1155/2017/1046438. Epub 2017 Nov 19.

[12] Halpern B1, 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. 2013 May;23(3):238-9. doi: 10.1097/JSM.0b013e31827c3846.