Regenerative Sports & Orthopedics
Platelet Rich Plasma (PRP), autologus stem cells, and Regenerative Medicine in Orthopedics and Sports Medicine
Platelet Rich Plasma (PRP) therapy is a relatively new treatment designed to aid in the healing and regeneration of soft tissues such as tendons and ligaments.
Tendons and ligaments are made up of fibers of collagen. When these fibers are stretched or torn we may refer to the injury as a “pull”, “tear”, “sprain” (ligament) or “strain” (tendon). Part of the body’s natural response to such injuries is increased blood flow to the area to aid in healing. The blood carries platelets and growth factors that allow for healing of the tissue.
Sometimes, however, the healing process does not work correctly and instead of forming healthy fibers there is significant scar tissue that develops instead. One of the risk factors for this is not getting enough blood flow to the area to provide those platelets and healing factors. The development of scar tissue even further hinders the healing process.
When these injuries don’t heal properly, patients often become frustrated. They may try anti-inflammatory and other pain medications, various pain-relieving creams and gels, braces, physical therapy, massage, acupuncture and cortisone injections but nothing seems to work. That’s because these therapies may try to treat pain and inflammation but they don’t treat the underlying problem of scar tissue, disordered fibers and poor blood flow. The result is many patients may give up and live with pain and disability or may end up with surgery.
PRP therapy (also known as PRP Prolotherapy) and autologous stem cell therapy (also called "stem cell prolotherapy") are two potentially promising solutions to these problems:
Platelet-rich Plasma (PRP)
In PRP treatment the patient’s own blood used to help facilitate healing. Using a special centrifuge machine this blood is spun down to separate out the healthy platelets and growth factors that are essential for tissue healing. This small amount of fluid with concentrated platelets and growth factors is called platelet rich plasma (PRP). Nothing else is added to the patient’s own blood products so there is very minimal risk of allergy, reaction or rejection. PRP therapy is a purely natural process using the body’s own healing factors. The trick is getting them to the right place. Fortunately, the best part of all is that this can all be done right in the physician’s office without need for a costly or time-consuming hospital stay or special surgery center.
This therapy has been used extensively in Europe for a number of years and has now become increasingly popular in the U.S. as more people become aware of its potential benefits and as more research is being done.
How is it done?
The physician uses a diagnostic ultrasound machine to identify the area within the ligament or tendon that is injured. A special needle is used to inject the PRP directly into the injured area. The PRP can even be injected directly into very small tears that are sometimes not apparent on MRI. Once these platelets and growth factors are in the area of injury they then become activated. They also recruit other healing proteins and factors to the area and healing and regeneration of the tissue can now begin. With the development of PRP, we can now actually get the specific healing factors within the blood to the injured area. This not only allows for healing of injuries which may not otherwise heal, but it also speeds up recovery of injuries which may eventually heal over a longer period of time.
Thus PRP therapy is a great option for two different patient populations:
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The patient with the chronic injury that never seems to go away.
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The patient with an acute injury which might otherwise take 8-12 weeks to heal and is looking to do something to “speed up” the recovery process.
That is why PRP has become so popular among athletes and there have been many media reports of elite athletes receiving PRP treatment for injuries that occur mid-season or even right before big events.
But PRP treatment is not just for athletes…
Medical researchers have been reporting remarkable results using PRP in the treatment of common injuries, including:
§ tendonitis
§ the regeneration of cartilage in osteoarthritis of the thumbs, knees and hips
§ non-surgical repair of rotator cuff tears
Published studies have also shown:
§ restoration and smoothing of roughened cartilage
§ improved range of motion
§ resolution of pain in osteoarthritis of hips, knees and shoulders.
Many other conditions respond to prolotherapy with PRP, including injuries to the shoulders, knees, back, neck, jaw, elbows, hands, hips, ankles and feet. Dr. Vaidya commonly uses platelet injections on tendons and ligaments through the body, including:
§ Sports injuries, including tennis elbow and golfer’s elbow
§ Tendonitis
§ Ligament and meniscal tears
§ Spine conditions
§ Arthritic joints
§ Rotator cuff tear of the shoulder
§ Labral tears of the shoulder
§ Osteoarthritis of the hip, knee, and shoulder
§ Overuse syndromes
...and many other conditions associated with scarred or non-healing tissue.
The latest exciting news is that PRP has recently also been shown to be effective in treating osteoarthritis (OA). In fact, several new studies have shown that PRP is more effective than typical conservative treatments and has even performed better than viscosupplementation (hyaluronic acid injections) in head-to-head studies.
Thus PRP may be an excellent non-invasive alternative to joint replacement surgery in treating the symptoms of arthritis. PRP can also be used to treat the symptoms of arthritis of the shoulder, hip, knee, ankle and foot.
Autologous stem cell therapy
For some stubborn or severe orthopedic injuries and conditions, the PRP by itself is not enough to ensure adequate healing. In those cases, physicians are increasingly utilizing an alternative in-office treatment known as Autologous adipose-derived stem cell therapy, combining the standard PRP injections with stem cells from the patient’s own fat tissue. Currently, Dr. Vaidya is one of the growing numbers of physicians in the United States who are performing in-office “mini-liposuction,” if you will – usually in either the central abdomen or love-handle area – to extract stem cells from fat. This “fat graft” is an excellent source of stem cells. These stem cells are isolated and then combined with the patient’s PRP to create an “enhanced PRP” injection.
What's the role of stem cells?
Stem cells have the ability to develop — through a process called differentiation — into many different types of cells, such as skin cells, brain cells, lung cells, and so on. Stem cells are a key component of regenerative medicine, as they open the door to new clinical applications that can heal the body from within. The best part is, your body already contains millions of stem cells! They’re available in just about every tissue, lying dormant and waiting for activation to be active where needed.
What is stem cell transfer?
The future of regenerative medicine today is taking those stem cells from one part of your body that’s not using them -- for example, your fat (adipose cell) tissue – and place them in an area where they are needed for regeneration (a deteriorating knee joint, for example). Stem cell transfer is a procedure done in the office setting where blood from bone marrow or fat tissue is extracted, filtered, and the stem cells are utilized to grow cartilage in -- for example -- an arthritic joint. These stem cells grow and develop into cartilage and are called autologous mesenchymal stem cells.
Stem cells are being utilized to treat arthritis and other conditions such as tendon and ligament tears as well as meniscal tears. Here is a great video clip from Reuters Healh News describing the stem cell prolotherapy procedure:
Are PRP and Stem Cell Transfer Safe?
Yes!
Autologous (patient derived) PRP has been used for over 30 years as an aid in recovery following certain surgical, orthopedic and dental procedures. There are thousands of research articles published on the safety of PRP, and an ever-increasing amount of research on stem cells. Because your own blood and fat tissue are used, there is no risk of a transmissible infection and a very minimal risk of allergic reaction.
How many treatments are required?
The response to treatment varies. Most patients require two treatments, but some patients require more. Patients are usually evaluated to see how they will respond to the injection. For more severe problems, additional injections may be necessary. Some people respond immediately, but most of the time, it takes approximately six weeks to respond to the treatment, and about 2-3 months before complete healing resolution and return to desired activity level. For more severe problems, some people may require more than two treatments.
Is PRP or stem cell transfer right for me?
If you suffer from arthritis, an injured ligament, or tendon injury, and traditional methods have not provided relief, then PRP and/or stem cell transfer therapy may be the solution. The procedure is less aggressive and less expensive than surgery. It can heal tissue with minimal or no scarring
and alleviate further degeneration of the tissues. There will be an initial evaluation with Dr. Vaidya to see if PRP and/or stem cell transfer therapy is right for you. Contact us today to find out more information or to make an appointment!