WHAT IS PRP?
PRP is an abbreviation for Platelet Rich Plasma. Plasma is what’s left when blood cells are separated from the liquid component of human whole blood. The plasma portion contains numerous biologic factors that have been shown to enhance healing. Some of this work dates back to the early 90’s in dentistry to aid in bone grafting techniques. It is often used by professional athletes to speed recovery from injuries.
WHY USE PRP?
Advantages in using PRP injection therapy for the treatment of tendonitis are numerous including the following: it contains entirely natural products from a patient’s own blood; traditional treatments for tendonitis are unreliable, repeated cortisone injections into tissue can destroy and weaken it. Cortisone injections into tendons of the lower extremity can lead to rupture of those tendons and acceleration of arthritis in joints.
Long term anti-inflammatory pills only mask symptoms and do not heal tissue and often cause gastrointestinal problems. The success rate for surgical management of tendonitis can vary and is unpredictable for any individual. There is little if any risk for injecting one’s own blood product back into their body.
WHAT IS REGERNATIVE MEDICINE?
The future of medicine and orthopedics is increasingly looking to gene therapy and utilizing “biologic” solutions to common problems such as bone, ligament, cartilage and tendon healing.
The Food and Drug Administration has approved the use of PRP in other applications within the field of orthopedic surgery. Studies proving the efficacy of PRP injection for the treatment of tendonitis are currently underway. Early results are promising. At the current time FDA approval is pending and these injections are considered “off label use”. However, this is not an artificial or manufactured product that requires long term safety evaluation. It is not a chemical that was produced in a lab to treat a condition with its inherent short and long term risks. As mentioned it is merely injection of one’s own blood after it has been separated into its different components by spinning it in a centrifuge.
AM I A CANDIDATE FOR PRP?
Patients who have acute or long standing problems with tendonitis of the foot or ankle, achilles tendon problems, plantar fasciitis or osteoarthritis of foot or ankle joints are the most typical patient. Also those who have failed previous treatment, including surgery, or have the inability to tolerate oral anti-inflammatory medications due to medical problems or allergies.
If you are on blood thinners for medical problems such as history of blood clots or atrial fibrillation, or have allergy to local anesthetics you ARE NOT a candidate.
WHAT TO EXPECT DURING THE PROCEDURE
The injection of PRP is an office based procedure. It is scheduled differently from a standard office consultation. 10-15 cc’s of blood is drawn from the patient’s arm. It is prepared and placed in a sterile single use container where it is spun in a high-speed centrifuge for 5 minutes. We use the Arthrex ACP system. The portion of the blood that contains the platelet rich plasma is drawn off into a syringe. The area to be injected is prepared using standard sterile technique. The area is anesthetized and then anywhere from 3-5 cc’s of the material is injected into the affected tendon. We use an Ultrasound image to identify the target tissue to see the injury. After we identify this location we will guided the needle to place the PRP cells directly into the target which will ensure the healing cells get into the injury. This is a vital component in having a good result. Doing this procedure without the aid of an Ultrasound is like throwing a dart with your eyes closed hoping to hit the target. Stretching and light resistance training instructions will be given. Formal physical therapy may follow. Follow up appointment will be at 6 weeks for an assessment and to see if a 2nd injection is needed.
Insurance companies at this time do not cover PRP treatments as it is considered “experimental” to them and not billable to the insurance plan. There are some plans which offer a benefits card to cover medical items not paid for by their insurance company which can be used to pay for PRP treatments.
We will provide all documentation needed to help you obtain reimbursement through your insurance company if desired. This may or may not be successful. All patients considering this procedure must be seen in the office for examination, proper medical and medication history taking and diagnostic studies as needed. An informed consent for the procedure must be signed.
There can be no guarantees of success with PRP injections. Currently this is most often a single injection and not a series. If one does not work, there is no current information that further procedures are helpful. Neither can there be any guarantee with cortisone injections, braces, physical therapy or surgery. All of these other modes of treatment have costs involved as well and financial obligations due to co-pays and deductibles required by insurance contract. In studies going on right now in the United States and elsewhere around the world, the success rate for PRP injections is much better than cortisone and often more successful with less risk than surgery.
PREPARATION FOR INJECTION
- Patients who have scheduled an injection should stop all anti- inflammatory medications for 7-10 days prior to injection. This includes; aspirin (regular and mini-doses 81 mg), Advil, Aleve, Motrin (anything that contains ibuprofen), arthritis pills such as Celebrex, Naprosyn, Arthrotec, Mobic, etc.
- Patients should be prepared to take it easy for about 2 days after the injection. Often patients will be placed in a boot or a brace for the first 2-3 weeks.
AFTERCARE FOLLOWING PRP INJECTION
- Following the procedure the patient will be asked to remain for 15 minutes to insure that the procedure was tolerated well.
- It is suggested to go home and not go back to work or do errands.
- Ice should be applied to the area of injection only if there is pain. This can be used for about 15 minutes, 3 times per day as needed.
- DO NOT TAKE anti-inflammatory medications for the next two weeks.
- Use of a brace is helpful and not for comfort only. It is to be used at all times except when showering.
- After 2-3 days, normal activities are allowed with the brace. This would include going to work, driving, errands, school, etc.
- A follow up post procedure exam will be scheduled for about 6 weeks.