Platelet Rich Plasma (PRP)

The use of Platelet rich plasma started around the 1970s with Haematologists using it to treat patients with Thrombocytopenia. Ten years after this, it began to be used in Maxillofacial surgery. Spain was one of the countries using it the most. Subsequently, its use became popular for musculoskeletal injuries

What is PRP?

Plasma is the liquid portion of whole blood, which is composed of water, proteins, red blood cells, white blood cells and platelets. PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets (and the concentration of growth factors inside of them) can be 5 to 10 times greater than usual.

The first step for PRP preparation is to withdraw blood from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugation. These platelets are then injected into the injured site. Platelets activate in the patient and help in the body's natural healing process.

How does PRP work?

Platelets, also called thrombocytes, develop from the bone marrow. The physiological count of platelets circulating in the blood stream ranges from 150,000 to 400,000 platelets per μL. Platelets contain several secretory granules which are crucial to platelet function. In each platelet there are approximately 50-80 granules. There are 3 types of granules: dense granules, o-granules, and lysosomes.

Platelets were thought to have only haemostatic activity, although in recent years, scientific research and technology has provided a new perspective on platelets and their functions. Studies suggest that platelets contain an abundance of growing factors and cytokines that can affect inflammation, angiogenesis, stem cell migration, and cell proliferation. Some of the most important growing factors (GF) released by platelets in PRP include vascular endothelial GF, fibroblast GF, platelet-derived GF, epidermal GF, hepatocyte GF, insulin-like GF 1, 2 (IGF-1, IGF-2), matrix metalloproteinases 2, 9, and interleukin 8.

During the lytic process, platelets release these growing factors which help the diseased tissue to heal. Since platelets lifespan is roughly 10 days, we expect a constant and slow release of GFs during that period of time after an injection. PRP is usually injected up to 3 times depending on the initial response.

What is the use of PRP in Orthopaedics?

PRP can be used in different scenarios, some of the options are:

• Early joint degeneration
• Chronic tendinopathy, such as Achilles tendinosis or chronic lateral epicondylitis
• Plantar fasciitis
• Muscular tear
• Chronic skin ulcers
• Fracture healing
• Acceleration of ligament or tendon healing after surgical treatment

Who can benefit from PRP?

PRP has gained a bad name in the recent years as there is an over indication. Generally speaking, anyone can receive a PRP injection. However, each case has to be properly analysed, as PRP cannot be widely recommended. Case by case analysis determines who is the right candidate for a PRP injection.

Any enquiries, please feel free to contact me at info@dinalloorthopaedics.com.au or though my practice at 02 4801 0474.

References

Dr Martin Di Nallo
Orthopaedic Surgeon
21 St Jude Street
Bowral NSW 2576
02 4801 0474
02 4861 2083