HC Chang Orthopaedic Surgery | Singapore

Platelet-Rich Plasma (PRP) Therapy

Platelet-Rich Plasma (PRP) therapy is an innovative treatment that uses the body’s own cells to relieve pain and promote accelerated, long-lasting healing of certain musculoskeletal conditions.
Type of Injuries where PRP Can Help

Although PRP therapy has been used safely in dentistry for over twenty years, recent
advancements have revolutionized the field of orthopedic sports medicine throughout
North America and Europe. By using the body’s own blood cells, PRP therapy naturally
stimulates and accelerates soft tissue healing and regeneration in certain soft tissue
injuries and conditions, including:

1. Osteoarthritis of the knee, shoulder, hip and spine
2. Rotator cuff tears
3. Anterior cruciate ligament (ACL) injuries
4. Tennis elbow
5. Ankle sprains
6. Tendonitis
7. Ligament sprains
8. Chronic plantar fasciitis

The body’s first response to any soft tissue injury is to deliver platelets, which play an
instrumental role in the normal healing process by secreting growth factors and
attracting stem cells–critical components of the healing cascade.

PRP therapy magnifies the body’s own healing and reparative efforts by delivering a much higher concentration of platelets through a single injection than the body would otherwise produce. This higher concentration of platelets helps accelerate the healing of tendons and ligaments, which translates to a quicker recovery for the occasional athlete as well as for the professional one.
Persons who develop tendonitis from everyday activities have also benefited from this technique.
Preliminary studies have demonstrated that PRP therapy is associated with a reduction in pain and faster healing, and has decreased risks and costs as compared to surgical alternatives. In addition, because a patient’s own blood is used, there is no risk of a transmissible infection and a very low risk of allergic reaction.
How PRP works
PRP injections are brief outpatient procedures that involve obtaining a small sample of
your blood, which is drawn similar to a lab test sample.

We use the REGENLab’s system.

The blood is then spun at high speeds in a centrifuge, which separates the desired platelets from the other blood
components.

The concentrated platelet-rich plasma is then injected into and around the site of injury, which appears to jumpstart the body’s instincts to repair muscle, bone and other tissue.

The entire procedure, including preparation and recovery time, takes approximately 30 minutes. Most patients can expect to return to their jobs or usual activities right after the procedure, although some patients do report increased pain in the treatment area over the following week due to the accelerated healing process.

Panadol can be taken to minimize or eliminate this discomfort. We discourage the use of nonsteroidal anti-inflammatory medications (NSAIDs), such as aspirin, ibuprofen-containing products, as they may adversely affect the treatment outcome.

Up to three injections may be administered within a 6-month period, and the injections
are typically performed two to three weeks apart. However, significant or even complete relief may be achieved after the first or second injection.

Currently, many insurance companies do not cover PRP Therapy, as it is still
considered by most to be “experimental”; however, researchers are optimistic that larger
studies of its use in the treatment of joints, spine, bones and tendons will convince
insurance companies to pay for this treatment.

In fact, many physicians and researchers believe that PRP Therapy may become part of the standard treatment protocol for many musculoskeletal conditions before surgical treatment is warranted.

What Are the Evidences?

Treatment of chronic elbow tendinosis with buffered platelet-rich plasma.
Mishra A, Pavelko T.  Am J Sports Med. 2006 Nov;34(11):1774-8.

This is the first study supporting the use of PRP for chronic tendon problems.  93% reduction in pain at average 2 year follow up.

Treatment of tendon and muscle using platelet-rich plasma.  Mishra A, Woodall J Jr, Vieira A.Treatment of Tendon and Muscle  Clin Sports Med. 2009 Jan;28(1):113-25.

This is a review article that includes basic science, animal and human data including a reference to Dr. Gosens’ work showing PRP improves patient pain and function when compared to cortisone in a 100 patient double-blind prospective randomized trial.

Platelet-rich plasma enhances the initial mobilization of circulation-derived cells for tendon healing.
Kajikawa Y, Morihara T, Sakamoto H, Matsuda K, Oshima Y, Yoshida A, Nagae M, Arai Y, Kawata M, Kubo T.   J Cell Physiol. 2008 Jun;215(3):837-45.

This study confirms PRP can help attract cells that contribute to a healing process in a tendon.

Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices.
Sánchez M, Anitua E, Azofra J, Andía I, Padilla S, Mujika I. Am J Sports Med. 2007 Feb;35(2):245-51.

This study showed PRP may accelerate healing from Achilles Tendon repair surgery.

Can platelet-rich plasma enhance tendon repair? A cell culture study.
de Mos M, van der Windt AE, Jahr H, van Schie HT, Weinans H, Verhaar JA, van Osch GJ. Am J Sports Med. 2008 Jun;36(6):1171-8.

This study confirms PRP enhances tenocyte proliferation and collagen production.

Cellular effects of platelet rich plasma: a study on HL-60 macrophage-like cells.  Woodall J Jr, Tucci M, Mishra A, Benghuzzi H.  Biomed Sci Instrum. 2007;43:266-71

This study found PRP initially inhibits the inflammatory Macrophage cell.  This helps explain why PRP may be useful for tissue healing.

Any Level I Evidence? (Level I evidence is the most reliable evidence in Scientific studies)

Level One Two Year Follow Up Paper Supports Use of Platelet Rich Plasma for Tennis Elbow

Dr. Taco Gosens and his team from the Netherlands have just published in the American Journal of Sports Medicine the best paper to date on the use of PRP for tennis elbow.  Using the Biomet GPS device to create platelet rich plasma (Type 1A PRP in Mishra’s classification system of PRP), they found PRP patients were successfully treated more often than patients treated with corticosteroid injections at two year follow up.  This was highly statistically significant at a p value of < 0.0001.

This paper confirms that a specific type of PRP is better than the often used cortisone injection for chronic lateral epicondylar tendinopathy.  This team of researchers also needs to be congratulated on finishing this important work.

For more information on PRP therapy, please contact us at 683 666 36 or email hcchang@ortho.com.sg

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