Platelet rich plasma injections are among the most promising treatments for orthopedic conditions. Every year, more research supports the use of platelet rich plasma injections.
What is platelet rich plasma?
Platelets have many functions in the body. One of their main functions is to respond to tissue injury. Take for example an injured blood vessel. Platelets help stop bleeding by forming a blood clot. This blood clot remodels over time to become normal healthy tissue. Platelets are important for starting the healing and repair process.
This is the foundation for platelet rich plasma therapy. Platelets contain an enormous amount of growth factors and bioactive molecules. These are called cytokines. Cytokines are important for cell migration, cell proliferation, and cell differentiation.
One of the most important cytokines in platelet rich plasma is platelet derived growth factor. Platelets contain an enormous amount of this growth factor. Platelet derived growth factor activates mesenchymal stem cells which help with tissue healing and pain relief.
What happens during a platelet rich plasma injection?
The entire process can be done in a physician’s office and takes about 40 minutes. First, your blood is drawn into a special container. This is placed in a centrifuge. The centrifuge separates the layers of blood. The top layer contains concentrated platelets. This is isolated and prepared for injection.
The way we administer platelet rich plasma injections affect outcomes. Ultrasound has changed how physicians perform injections. This study compared the accuracy of ultrasound guided injections and landmark based injections. Ultrasound guided injections won by a landslide:
Outcome data show similar results. This study looked at patients with knee osteoarthritis. One group got ultrasound guided injections. The other group got landmark based injections. The group that got ultrasound guided injections did much better.
What are some evidence based indications for platelet rich plasma injections?
-- Knee osteoarthritis --
These researchers compared platelet rich plasma injections to cortisone injections for the treatment of knee osteoarthritis. They found that platelet rich plasma injections outperformed steroid injections at 4 months through 1 year.
These researchers compared platelet rich plasma injections to hyaluronic acid injections for the treatment of knee osteoarthritis. Patients who got platelet rich plasma injections had greater improvements in pain and function.
-- Elbow tendinopathy --
Elbow tendinopathies include tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis). These are overuse and repetitive stress injuries. Click here to learn more about tendon problems.
These researchers compared platelet rich plasma injections to cortisone injections for elbow tendinopathies. They found that platelet rich plasma injections provided meaningful long term improvement in pain scores. Cortisone injections provided only short term reduction in pain scores. There were no long term benefits with cortisone.
-- Plantar fasciitis --
Plantar fasciitis is a very common cause of heel pain. It usually causes pain at the bottom of the heel while walking or running.
These researchers compared platelet rich plasma injections to cortisone injections for the treatment of plantar fasciitis. They found that platelet rich plasma injections outperformed cortisone injections at 12 months follow up. Pain and function favored the platelet rich plasma injection groups.
-- Gluteal tendinopathy --
Gluteal tendinopathy is commonly referred to as trochanteric bursitis or greater trochanteric pain syndrome. It is one of the most common causes of lateral hip pain and is often associated with knee pain and low back pain.
These researchers compared platelet rich plasma injections to cortisone injections for the treatment of gluteal tendinopathy. They found that the platelet rich plasma injection group had significantly better pain and function at 3 months, 6 months, 1 year, and 2 years follow up. Cortisone injections only provided relief up to 6 weeks.
Things to know before a platelet rich plasma injection
Non steroidal anti-inflammatory drugs inactivate platelets and must be stopped two weeks before and two weeks after the injection. This includes aspirin, ibuprofen, naproxen, celecoxib, meloxicam, indomethacin, diclofenac, etc. This study showed daily use of low dose aspirin significantly decreased the expression of growth factors in platelet rich plasma.
Platelets can also be mechanically damaged. It is important to minimize strenuous physical activity involving the injection site for one week.
Heat can help reduce pain and facilitate platelet rich plasma signaling. Apply heat to the injection site after the procedure. Continue to do so for the first week.
What to expect after a platelet rich plasma injection
The goal of a platelet rich plasma injection is to change the biology of the tissues and joints. Recovery takes time. Joints can expect to see improvements in 6-8 weeks. Tendons take longer. Tendons can take up to 3 months to see improvements. Studies show pain relief with platelet rich plasma injections at long term follow up.
Some patients may get worse before symptoms get better. A small number of patients will have a heightened inflammatory reaction after getting a platelet rich plasma injection. This is a normal process. It is due to the body responding to the release of growth factors. This resolves on its own after a few days.
Fevers, significant redness, purulent drainage, or persistent swelling or pain at the site of the injection are NOT normal. Let your physician know immediately as these could be signs of an infection.
A rehabilitation program is just as important as the platelet rich plasma injection. Progressive loading of muscles, tendons, and joints will augment the healing effects of platelet rich plasma. A post platelet rich plasma injection protocol can be found here.
How many platelet rich plasma injections do you need? Do you need booster injections?
Researchers continue to investigate this question. Preliminary studies suggest 2 or 3 platelet rich plasma injections provide greater benefit than one injection. This much is clear. One platelet rich plasma injection provides greater long term pain relief compared to one cortisone injection.
Booster injections are recommended if you have osteoarthritis. This is because no injection treatment will give you a new joint. The only way to get rid of osteoarthritis is to replace the joint. Unfortunately, this involves a major surgery.
While a joint replacement can last about 20 years, no injection treatment will last that long. At best, an injection can provide a few years of relief. This is because the joint still has underlying osteoarthritis.
Osteoarthritis results in the release of toxic enzymes and inflammatory proteins. These degrade and further damage the joint. Platelet rich plasma injections alter the biochemical signaling within a joint. It decreases the concentration of toxic proteins and initiates anti-inflammatory signaling pathways. But once the effects wear off, the toxic proteins reaccumulate. Periodic platelet rich plasma injections can prevent the build up of these toxic proteins.
Platelet rich plasma injections are an exciting new treatment option for musculoskeletal conditions. Data from clinical trials continue to support its use. Discuss with a sports medicine physician if this is a good treatment option for you.