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Platelet Rich Plasma Injections
What exactly are PRP (platelet rich plasma) Injections?
Platelet Rich Plasma (PRP) injections for muscle, ligament tendon, cartilage injuries
Platelet Rich Plasma (PRP) injections for muscle, ligament tendon, cartilage injuries
Platelet Rich Plasma (PRP) injections for muscle, ligament tendon, cartilage injuries
Blood draw
Platelet Rich Plasma (PRP) injections for muscle, ligament tendon, cartilage injuries
Platelet Rich Plasma (PRP) injections for muscle, ligament tendon, cartilage injuries
Performed under sterile technique
Blood delivery into Centrifuge system
Platelet Rich Plasma (PRP) injections for muscle, ligament tendon, cartilage injuries
Blood delivery into Centrifuge system
Centrifuge system will separate the platelet rich plasma from red blood cells and white blood cells
(Flow Cytometry)
Programming the centrifuge
Separation of blood components by light
Blood delivery into Centrifuge system
Can generate white blood cells rich or poor plasma depending on the clinical indication (articular vs. soft tissue injections)
Separation of blood components by light
Separation of blood components by light
Separation of blood components by light
Final PRP product
Separation of blood components by light
Separation of blood components by light
PRP automatically withdrawn into sterile syringe by the centrifuge.
Closed loop system to minimize contamination
Sterile blood draw
15 cc whole blood required (ACP) / 60 cc (Angel)
Knee PRP injection technique
Autologous Conditoned Plasma (ACP) PRP Injections
Technique
Prime double syringe
21G Butterfly needle - draw 15 cc blood. No need for citrate if injected w/in 30 mins
Place syringe red cap into centrifuge w/ counterbalance (saline filled syringe)
Spin @ 1500 rpm x 5 mins
Place index fingers under clear wings of outer syringe & use thumbs to depress red wings of inner syringe to draw the plasma into inner syringe.
Insert 22g needle & inject
Select literature Study
Intra-articular Autologous Conditioned Plasma Injections Provide Safe and Efficacious Treatment for Knee Osteoarthritis: An FDA-Sanctioned, Randomized, Double-blind, Placebo-controlled Clinical Trial
Patrick A Smith. Am J Sports Med. 2016 April
Conclusion: ACP is safe & provides quantifiable benefits for pain relief & functional improvement w/ regard to knee OA. No adverse events were reported for ACP administration. After 1 year, WOMAC scores for ACP subjects had improved by 78% from baseline score compared to only 7% for placebo control group had improved.
Autologous Conditoned Plasma (ACP) Injections : Platelets + Growth Factors
Elbow PRP injection Technique
literature review - prp injections for muscle tears PRP may decrease swelling & speed up healing which in turn may decrease time for return to play
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Ultrasound guidance - A dynamic diagnostic visualization
Ultrasound guided PRP (platelet rich plasma) injections
Correlation of the site of pathology on MRI
Ultrasound guided PRP Injection
Elbow lateral epicondylitis (tennis elbow)
Meta-analysis of 18 studies
Primary outcome = change in pain intensity. Leukocyte rich prp better than leukocyte poor prp
Indications: tennis elbow, patella tendonitis, rotator cuff tendinopathy, achilles tendinopathy.
Recommendations: ultrasound guided single prp injection into tendon with 2 mm local anesthetic superficial to tendon using 6 pass peppering dry needling
Shoulder PRP Injection - partial thickness rotator cuff tear
Select article
Randomized Controlled Trial
Platelet rich plasma (PRP) in patients with partial thickness rotator cuff tears or tendinopathy leads to significantly improved short term pain relief & function compared with corticosteroid injection: a double blind randomized controlled trial.
Cory A Kwong et al. Arthroscopy. 2021 Feb.
Conclusions: Patients with PTRCTs or tendinopathy experienced clinical improvement in pain & patient-reported outcome scores after both ultrasound-guided cortisone & PRP injections. Patients who received PRP obtained superior improvement in pain & function at short-term follow-up (3 months). There was no sustained benefit of PRP over cortisone at longer-term follow-up (12 months).
PRP injection for shoulder rotator cuff tendinopathy
PRP injection for shoulder rotator cuff tendinopathy
Evidence based sports medicine
Subacromial Platelet-Rich Plasma Injections Decrease Pain and Improve Functional Outcomes in Patients With Refractory Rotator Cuff Tendinopathy
Luciano A Rossi et al. Arthroscopy. 2021 Sep.
Methods: Between March & October 2019, 50 patients w/ #rotatorcufftendinopathy refractory to conservative treatment were treated w/ one subacromial PRP injection.
MRI was performed in all patients to confirm diagnosis. Visual analog scale (VAS) used to evaluate pain.
#Rangeofmotion, the #AmericanShoulderandElbowSurgeons #ASESscore, & the #Constantscore were used to assess functional outcomes
80% of patients (40 of 50 patients) & 86% the patients (43 of 50 patients) achieved a clinically significant improvement that exceeded the substantial clinical benefit for the ASES & Constant scores, respectively. Mean (SD) age was 37.3 (9.3) years.
Results: All mobility parameters evaluated improved significantly after treatment. The VAS, ASES, & Constant scores showed statistical improvement after the injection (P < .001). Sleep disturbances (Pittsburgh Sleep Quality Index) were resolved in 86% of patients.
Of the 32 patients who practiced #sports before the injury, 84% returned to sports & 78% returned to the same level.
There were no complications associated with the procedure.
Conclusions: In most patients with refractory rotator cuff tendinopathy, subacromial injections of leukocyte-rich PRP significantly decreased pain, improved functional outcomes, and resolved sleep disturbances. Moreover, most of the athletes returned to sports at the same level they had before the injury.
Combined PRP + Hyaluronic Gel Injection for Knee Arthritis
PRP (Platelet Rich Plasma) Infused Hyaluronic Acid Gel Injection for shoulder rotator cuff tear
