Platelet-Rich Plasma Therapy (PRP Therapy) What is it and why do we care? Inservice presented by Elly Tucker, NAU

What is it? PRP consists of the application of autologous plasma containing a high concentration of platelets Preparation process includes centrifugation of patient’s own blood to allow for separation of blood components Can be used as primary treatment or in conjunction with either conservative or surgical treatment Application via direct injection or stitching If used as primary treatment, typically will receive a series of injections (2+) each 4-6 weeks apart Actual parameters depend on physician, injury site, and nature of injury

Why is it used? Platelets contain high concentration of growth factors Thought to increase… healing fiber reorganization cell proliferation vascularity tensile strength May help to decrease pain Expert opinion supports these claims, more research still needed…

Research A review of studies utilizing PRP therapy found the previous results to be supported No one benefit occurred in the majority of studies (variable results) No standardized procedures PRP therapy parameters often not included Support for use on lateral epicondylitis Preliminary results are “promising” for other chronic tendon conditions Ongoing research into other tissues Muscles (strains) Joints (arthritis) Ligaments (tears, strains) Bone (fractures)

Why do we care? Physical therapy protocol Medication restrictions Tend to be more conservative Want to guide healing with mechanical stress See included protocol Medication restrictions No NSAIDs one week prior to application and for one to four weeks post-application (varies with physician) If having multiple injections, no NSAIDs between treatments Reasoning: don’t want to inhibit the natural inflammatory process stimulated by the application

Other Information Currently legal under the World Anti-Doping Code Contraindications: Cancer or metastatic disease Active infection Low platelet count Pregnancy or currently breastfeeding Insurance coverage varies due to lack of supporting research Medicare will only cover under very specific circumstances

What’s the bottom line? May provide numerous benefits during the healing process, however there is little research supporting these claims for injuries other than lateral epicondylitis Autologous procedure, so no harm other than cost ($750+) Conservative PT protocol Adhere to NSAID restrictions to allow for greatest healing potential (Tylenol is okay)

References (2014). In Platelet Rich Plasma Injections. Retrieved June 13, 2014, from http://www.prpinjection.com.au/ Baksh, N., Hannon, C., Murawski, C., Smyth, N., & Kennedy, J. (2013, March). Platelet-rich plasma in tendon models: a systematic review of basic science literature. Arthroscopy: The Journal Of Arthroscopic & Related Surgery, 29(3), 596-607. Retrieved June 12, 2014 Griffin, L. Y. (2010, September). Treating tendinopathy with PRP. In American Academy of Orthopaedic Surgeons. Retrieved June 12, 2014, from http://www.aaos.org/news/aaosnow/sep10/clinical2.asp Hannafin, J. A. (2010, September). Platelet-rich plasma: Clarifying the issues. In American Academy of Orthopaedic Surgeons. Retrieved June 12, 2014, from http://www.aaos.org/news/aaosnow/sep10/clinical1.asp Platelet-Rich Plasma. (2011, September). In American Academy of Orthopaedic Surgeons. Retrieved June 12, 2014, from http://orthoinfo.aaos.org/topic.cfm?topic=A00648 van Ark, M., van den Akker-Scheek, I., Meijer, L., & Zwerver, J. (2012, May). An exercise-based physical therapy program for patients with patellar tendinopathy after platelet-rich plasma injection. Physical Therapy in Sport, 14, 124-130. Retrieved June 12, 2014