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Unlocking the Healing Power of PRP: Treating Osteoarthritis & Tendonitis with Personalized Protocols

Updated: Nov 2, 2023

In recent years, platelet-rich plasma (PRP) therapy has gained widespread recognition as an effective, non-invasive treatment for a variety of musculoskeletal conditions, including osteoarthritis and tendonitis. This innovative treatment harnesses the body's natural healing abilities, providing a safe and promising alternative to invasive surgeries or potentially addictive pain medications.


In this blog, we will explore the therapeutic applications of PRP for osteoarthritis and tendonitis, delving into the science behind this regenerative medicine, discussing how it can revolutionize the management of these debilitating conditions, and examining the various protocols for optimal treatment outcomes.


Understanding Platelet-Rich Plasma (PRP)

PRP is a concentrated form of the patient's own blood, containing a high number of platelets - specialized blood cells that play a crucial role in the body's natural healing process. Platelets release growth factors and other proteins that promote tissue repair, stimulate the formation of new blood vessels, and reduce inflammation (1).


To prepare PRP, a small sample of the patient's blood is drawn and placed in a centrifuge, which separates the platelets from other blood components. The concentrated platelets are then re-suspended in a small volume of plasma, forming a solution that is injected directly into the affected area, where it can exert its regenerative effects (2). It is not necessary for patients to fast prior to the procedure. In fact, drinking fluids prior to the procedure can help!


PRP for Osteoarthritis

Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It is characterized by the gradual breakdown of cartilage - the cushioning tissue that covers the ends of bones in a joint - leading to pain, stiffness, and loss of function (3).


While there is no cure for osteoarthritis, PRP has shown promising results in alleviating pain and improving joint function. In a meta-analysis of randomized controlled trials, researchers found that PRP injections significantly reduced pain and improved physical function in patients with knee osteoarthritis compared to other treatments such as hyaluronic acid or saline injections (4).


The exact mechanism of action of PRP in osteoarthritis remains unclear. However, it is believed that the growth factors and anti-inflammatory proteins released by platelets may help to slow down cartilage degradation, promote the regeneration of damaged tissue, and reduce inflammation in the joint (5).


PRP for Tendonitis

Tendonitis is an inflammation or irritation of a tendon - the fibrous tissue that connects muscle to bone. This painful condition can occur in any tendon but is most common in the shoulders, elbows, wrists, knees, and heels. Tendonitis is typically caused by repetitive movements or sudden injuries and can lead to significant pain and disability if left untreated (6).


PRP has emerged as a promising treatment option for tendonitis, as it addresses the underlying cause of the inflammation and promotes tissue healing. In a systematic review and meta-analysis, researchers found that PRP injections were more effective than other treatments such as corticosteroid injections or physical therapy in reducing pain and improving function in patients with chronic tendinopathies (7).


The therapeutic effects of PRP in tendonitis are thought to be mediated by the release of growth factors and other bioactive molecules that stimulate the regeneration of damaged tendon tissue, enhance blood supply to the area, and modulate the local immune response to promote healing (8).


Different Protocols for PRP Treatment

The optimal protocol for PRP treatment, including the frequency of injections, the number of shots, and the concentration of platelets, can vary depending on the specific condition being treated, the severity of the symptoms, and the individual patient's response to therapy.


For osteoarthritis, PRP protocols usually involve a series of injections given several weeks apart. It's common to administer three injections with 2-4-week intervals, but some studies show benefits with just one injection (11, 12). PRP for osteoarthritis treatment typically has a platelet concentration 3 to 5 times higher than whole blood (13).


For tendonitis, the number of PRP injections depends on the specific tendon and injury severity. A usual protocol involves one to three injections with 2-4-week intervals (14). Some studies show benefits with only one injection, especially for chronic tendinopathies (15). The platelet concentration in PRP for tendonitis treatment is generally the same as in osteoarthritis, commonly 3 to 5 times higher than whole blood (16).


It is crucial to note that these protocols are not one-size-fits-all, and the optimal treatment plan should be tailored to the individual patient's needs and response to therapy. To determine the best approach for a specific patient, healthcare providers should consider factors such as the patient's overall health, the severity and duration of the symptoms, and any previous treatments or therapies.


Benefits and Safety of PRP

PRP therapy offers several advantages over traditional treatment options for osteoarthritis and tendonitis:

  1. Minimally invasive: PRP is a non-surgical procedure that can be performed in an outpatient setting, avoiding the risks and recovery time associated with surgery.

  2. Autologous: PRP is derived from the patient's own blood, minimizing the risk of allergic reactions or disease transmission.

  3. Targeted treatment: PRP is injected directly into the affected area, allowing for targeted delivery of growth factors and other healing substances.

  4. Fewer side effects: PRP has a favorable safety profile, with fewer side effects than corticosteroid injections or long-term use of pain medications (9).

Despite these advantages, it is essential to note that PRP therapy is not a panacea and may not be suitable for all patients. The effectiveness of PRP can vary depending on factors such as the severity of the condition, the patient's overall health, and the quality of the PRP preparation. Furthermore, while PRP has shown promising results in clinical trials, larger and more rigorous studies are needed to establish its long-term efficacy and optimal treatment protocols (10).


Conclusion

Platelet-rich plasma therapy represents a cutting-edge approach to treating osteoarthritis and tendonitis, leveraging the body's natural healing processes to alleviate pain and restore function. With personalized protocols, PRP can be tailored to the unique needs of individual patients, making it an increasingly valuable tool in the arsenal of regenerative medicine. As research continues to shed light on the mechanisms and benefits of PRP, it is poised to become an increasingly popular treatment option for those suffering from these debilitating

conditions.


Future Directions and Innovations in PRP Therapy

As PRP therapy gains wider acceptance and more clinical experience is

accumulated, researchers are continuing to explore ways to optimize its

effectiveness and expand its applications. Some areas of ongoing investigation

and innovation include:

  1. Enhanced PRP formulations: Researchers are studying ways to modify PRP formulations to increase the concentration of specific growth factors or other bioactive molecules, potentially enhancing its therapeutic effects (17).

  2. Combination therapies: Combining PRP with other treatments, such as hyaluronic acid injections, stem cell therapy, or physical therapy, may produce synergistic effects and further improve patient outcomes (18).

  3. PRP for other musculoskeletal conditions: In addition to osteoarthritis and tendonitis, PRP is being investigated for the treatment of other musculoskeletal conditions, such as muscle injuries, ligament sprains, and bone fractures (19).

  4. Personalized medicine: With advances in diagnostics and a better understanding of individual patient factors that influence treatment outcomes, it may become possible to tailor PRP therapy more precisely to each patient's unique needs, maximizing its effectiveness and minimizing potential side effects (20).

In conclusion, the landscape of PRP therapy is constantly evolving, with ongoing research paving the way for new innovations and treatment strategies. As our understanding of the science behind PRP deepens and new applications emerge, it is likely that PRP will continue to revolutionize the field of regenerative medicine, providing patients with effective, minimally invasive treatment options for a wide range of musculoskeletal conditions.


References:

1. Andia, I., & Maffulli, N. (2013). Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Nature Reviews Rheumatology, 9(12), 721-730. Link


2. Marx, R. E. (2001). Platelet-rich plasma (PRP): What is PRP and what is not PRP? Implant Dentistry, 10(4), 225-228. Link


3. Hunter, D. J., & Bierma-Zeinstra, S. (2019). Osteoarthritis. Lancet, 393(10182), 1745-1759. Link


4. Dai, W. L., Zhou, A. G., Zhang, H., & Zhang, J. (2017). Efficacy of platelet-rich plasma in the treatment of knee osteoarthritis: A meta-analysis of randomized controlled trials. Arthroscopy, 33(3), 659-670. Link


5. Sánchez M., Anitua, E., Azofra, J., Aguirre, J. J., Andia, I. (2008). Intra-articular injection of an autologous preparation rich in growth factors for the treatment of knee OA: A retrospective cohort study. Clinical and Experimental Rheumatology, 26(5), 910-913. Link


6. Sharma, P., & Maffulli, N. (2005). Tendon injury and tendinopathy: Healing and repair. J Bone Joint Surg Am, 87(1), 187-202. Link


7. Fitzpatrick, J., Bulsara, M., & Zheng, M. H. (2017). The effectiveness of platelet-rich plasma in the treatment of tendinopathy: A meta-analysis of randomized controlled clinical trials. The American Journal of Sports Medicine, 45(1), 226-233. Link


8. Foster, T. E., Puskas, B. L., Mandelbaum, B. R., Gerhardt, M. B., & Rodeo, S. A. (2009). Platelet-rich plasma: From basic science to clinical applications. The American Journal of Sports Medicine, 37(11), 2259-2272. Link


9. Lana, J. F., Purita, J., Paulus, C., Huber, S. C., Rodrigues, B. L., Rodrigues, A. A., Santana, M. H., Madureira, J. L., & Malheiros Luzo, A. C. (2016). Contributions for classification of platelet rich plasma - Proposal of a new classification: MARSPILL. Regenerative Medicine, 11(2), 181-194. Link


10. Bennell, K. L., Hunter, D. J., & Paterson, K. L. (2017). Platelet-rich plasma for the management of hip and knee osteoarthritis. Current Rheumatology Reports, 19(5), 24. Link


11. Filardo, G., Di Matteo, B., Di Martino, A., Merli, M. L., Cenacchi, A., Fornasari, P., Marcacci, M., & Kon, E. (2015). Platelet-rich plasma intra-articular knee injections show no superiority versus viscosupplementation: A randomized controlled trial. The American Journal of Sports Medicine, 43(7), 1575-1582. Link


12. Gobbi, R. A., Karnatzikos, G., & Sankineani, S. R. (2012). One-step surgery with multipotent stem cells for the treatment of large full-thickness chondral defects of the knee. The American Journal of Sports Medicine, 40(3), 534-547. Link


13. Filardo, G., Kon, E., Di Martino, A., Di Matteo, B., Merli, M. L., Cenacchi, A., Fornasari, P. M., & Marcacci, M. (2012). Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: Study design and preliminary results of a randomized controlled trial. BMC Musculoskeletal Disorders, 13, 229. Link


14. de Jonge, S., de Vos, R. J., Weir, A., van Schie, H. T., Bierma-Zeinstra, S. M., Verhaar, J. A., & Tol, J. L. (2011). One-year follow-up of platelet-rich plasma treatment in chronic Achilles tendinopathy: A double-blind randomized placebo-controlled trial. The American Journal of Sports Medicine, 39(8), 1623-1629. Link


15. de Vos, R. J., Weir, A., van Schie, H. T., Bierma-Zeinstra, S. M., Verhaar, J. A., Weinans, H., & Tol, J. L. (2010). Platelet-rich plasma injection for chronic Achilles tendinopathy: A randomized controlled trial. JAMA, 303(2), 144-149. Link


16. Monto, R. R. (2014). Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot & Ankle International, 35(4), 313-318. Link


17. Anitua, E., Zalduendo, M. M., Prado, R., Alkhraisat, M. H., & Orive, G. (2015). Morphogen and proinflammatory cytokine release kinetics from PRGF-Endoret fibrin scaffolds: Evaluation of the effect of leukocyte inclusion. Journal of Biomedical Materials Research Part A, 103(3), 1011-1020. Link


18. Filardo, G., Kon, E., Pereira, R. B., Vaccaro, F., Guitaldi, R., Di Martino, A., Cenacchi, A., Fornasari, P. M., & Marcacci, M. (2012). Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: Singleversus double-spinning approach. Knee Surgery, Sports Traumatology, Arthroscopy, 20(10), 2082-2091. Link


19. Wright-Carpenter, T., Klein, P., Schäferhoff, P., Appell, H. J., Mir, L. M., & Wehling, P. (2004). Treatment of muscle injuries by local administration of autologous conditioned serum: A pilot study on sportsmen with muscle strains. International Journal of Sports Medicine, 25(8), 588-593. Link


20. Anitua, E., Sánchez, M., Nurden, A. T., Zalduendo, M. M., de la Fuente, M., Azofra, J., & Andía, I. (2006). Autologous fibrin matrices: A potential source of biological mediators that modulate tendon cell activities. Journal of Biomedical Materials Research Part A, 77(2), 285-293. Link

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