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The Current Role of PRP in Sports Medicine

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Recently, there has been much talk about platelet-rich plasma (PRP) therapy and its effectiveness in treating sports injuries. What may be surprising to learn is that PRP in orthopedics is really nothing “new.” Of course, with its widespread use also comes the potential for abuse of its capabilities so it is important to have a realistic understanding of what PRP is, its indications, and precisely which types of injuries and situations it is best applied to for optimal healing.

PRP’s rapid rise to fame can be credited to professional athletes, claiming their speedy return to the field or court was thanks to this advanced therapy. Over the years, famous athletes such as Kobe Bryant and Tiger Woods, who are well known for placing such high demands and stress on their bodies, have received various forms of biologics treatment and successfully found relief.

So what exactly is PRP and how does it aid in the healing process?

PRP is a biologic therapy used in sports medicine to either decrease inflammation in early arthritic joints that have become painful and to increase healing in tendon injuries and to potentially speed recovery.

Our blood is made up of red cells, white cells, and platelets, which all combine in liquid called plasma. The platelets are most well known for being responsible for clotting the blood; however, it was discovered that they also contain hundreds of proteins called growth factors which have the potential to aid significantly in the healing of injuries.

The process of obtaining PRP is performed via centrifuge, which spins whole blood down to three distinct “layers” or components.

The plasma layer includes a greater growth factor via the platelets than the other two layers, and therefore has demonstrated an increased healing potential in patients. Alone without the other layers, it has an anti-inflammatory effect, especially on sensitive or reactive joints.

The second layer is called the “buffy coat” and includes a mix of white cells and other materials, which more recent research has shown to increase the reactivity of the PRP mix and can be especially helpful in tendon healing, such as chronic tears in tendons (tennis elbow or jumper’s knee.)

The final layer is the red blood cells, which by themselves create a reactive inflammatory response that can increase healing time, inflammation and in large part can create circumstances that are not conducive to healing.

In my practice, I have found PRP most helpful in getting chronic tendinopathies to heal with follow-up MRI in which healed vs. non-healed tissue is fairly obvious. This is my most common indication for PRP as it tends to work very well for patients. However, PRP has not had the same healing effect when I have used it on patients with joint inflammation. In fact, in some cases where I have applied PRP treatment, the joint has further stiffened. Modifying PRP by adding the buffy coat to help tendons heal, while not adding the buffy coat to keep the reactivity of an inflamed joint down has helped improve outcomes.

The above information notwithstanding, PRP does not compare to Stem Cell Therapy when it comes to calming down inflamed joints or tendons. Stem cell injections involve providing many multiples the times of growth factor and other beneficial biologics than PRP treatment is able to accomplish. 

Stem cells are becoming increasingly more available and just like in most things technological, with time the pricing is drastically decreasing, and the techniques in harvesting and administration are improving.

Administration of allograft placental derived amnion only stem cell is an in-office injection technique that is simpler than that of PRP.  PRP requires a venous puncture with aspiration of whole blood – centrifuging the specimen, drawing off the PRP from the red cells and then injecting the injured area. Allograft stem cells come frozen, are thawed under the manufacturer’s guidelines, and then are injected. Both PRP and stem cell injections warrant similar short-term post-injection protection protocols.

With the increased availability and decreased costs associated with stem cells, as well as improved variants such as amnion only allografts, the days of PRP being the first-line biologic used appear to be coming to an end. This holds especially true for high profile amateur and professional athletes where stem cell therapy is most often the treatment of choice.