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Doctor... Tell Me About Platelet Rich-Plasma For Tendonitis And Arthritis...

Mar 30, 2008
The holy grail will be to one day institute treatments that help regenerate normal tissue in areas where normal tissue has been damaged or worn. Research into the use of stem cells for this purpose looks promising.

To date, one area where accelerated tissue healing has been demonstrated is wound healing with the use of platelet rich plasma. As it turns out, this substance is now being used to help accelerate the healing of conditions such as tendonitis, ligament strains, muscle strains, arthritis, synovitis (inflammation inside the joint), and cartilage defects.

Platelet rich plasma is employed as a matrix graft, often referred to as an autologous tissue graft. This platelet-rich plasma (PRP) matrix is defined as a "tissue graft incorporating autologous growth factors and/or autologous undifferentiated cells in a cellular matrix where design depends on the receptor site and tissue of regeneration." (Crane D, Everts PAM. Practical Pain Management. 2008; January/February: 12- 26) 2008)

The reason this substance is so useful is that platelets, which are a constituent of normal blood, contain multiple growth factors that stimulate tissue growth. This is particularly true for collagen which is the main component of connective tissue such as tendons and cartilage. These factors include transforming growth factor-Β (TGF-B), fibroblast growth factor, platelet-derived growth factor, epidermal growth factor, connective tissue growth factor, and vascular endothelial growth factor.

These growth factors recruit undifferentiated cells to the site of injury and stimulate their growth. Another constituent of platelets, stromal cell derived factor I alpha causes newly recruited cells to adhere to the area.

PRP needs to be prepared in a way to ensure a maximal amount of platelets along with a high concentration of growth factors. Obviously, the more growth factors that can be delivered to the site of injury, the more likely tissue healing takes place.

This type of autologous tissue graft (ATG) is currently being used in musculoskeletal medicine for patients with pain and injury in joints, tendons, and ligaments.

Contrast this approach with the traditional approach which has been to use non-steroidal-anti-inflammatory drugs as well as steroid injections, which, while reducing inflammation, also impede the healing process.

ATG is often used in conjunction with percutaneous tenotomy where a patient undergoes a procedure where there is purposeful needle irritation of the affected area using ultrasound guidance after which PRP is then slowly injected into the site.

The use of diagnostic ultrasound has revolutionized the field of musculoskeletal medicine in allowing tissue healing procedures like tenotomy which often prevent the need for open surgical procedures with their attendant morbidity and mortality.

The average number of treatments required is two to three separated by four to eight week intervals.

The PRP is prepared by drawing 20 cc's of whole blood from the patient and then spinning the blood in a special centrifuge that layers out the platelets. This 20 cc's of whole blood generally yields about 2-10 cc's of platelet rich plasma.

Contraindications to the administration of PRP include platelet dysfunction, low platelet count, infection, anemia.

Prior to a PRP procedure, a patient needs to hold their non-steroidal anti-inflammatory drugs for at least 3-4 days. They may resume them one week after. Also, patients with rheumatoid arthritis should hold their methotrexate for at least one week before and one week after the procedure. Patients on biologic medicines may need to hold their medicines longer, particularly when it comes to adalimumab (Humira), and infliximab (Remicade) because of the long half life of these drugs.

Following the procedure, patients must rest the affected area to prevent leakage of the PRP from the site.

Pain at the injection site is common for a 1-2 day period following the procedure.

For more information on tenotomy and platelet rich plasma, call the Arthritis and Osteoporosis Center of Maryland at (301) 694-5800
About the Author
Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment
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