There has been a lot written about platelet-rich plasma (PRP) recently. It's been in the news and has been on television. Hines Ward, a wide receiver for the Pittsburgh Steelers, and Dara Torres, the Olympic swimmer, both received PRP for chronic tendon injuries. This treatment allowed both of these superb athletes to compete way ahead of schedule.
PRP has become a very popular item to talk about when the discussion focuses on the best way to treat chronic... or even acute injuries in both world-class athletes as well as in weekend warriors. You, yourself, may be a person who has had a chronic tendon or ligament injury. You may have gone through the usual gamut of therapies including physical therapy, non-steroidal-anti-inflammatory drugs, physical therapy, steroid injections, and so on.
This article is written for you- the person who may be contemplating PRP, some direction.
I've prepared a question and answer guide to help you- the patient- find out about when, who, and how you should get your PRP.
1. Is PRP good for every injury? The answer is no. For severe injuries where the tendon is completely torn or the ligament is completely disrupted, surgery is the answer. PRP is good for tendon and ligament injuries that are less severe. Strains and sprains.
2. Is the physician board-certified? Board eligibility is not enough. All that means is that the doctor has gone through a training program. It doesn't mean that he or she has actually taken the board certification exam and passed it. Sometimes the physician doesn't take the exam because of fear... and sometimes they don't pass the exam. How comfortable would you feel getting a procedure done by a person who isn't board-certified.?
3. What should their specialty be? It should be in this order: rheumatology; physical medicine and rehabilitation (physiatry); orthopedics; pain management. The best is a rheumatologist. They know joint and soft tissue disease and are usually much gentler than the other specialists.
4. What type of training should they have had? First of all, all procedures should be done using ultrasound guidance. If they don't use ultrasound to guide their injections, run away as fast as you can. Ultrasound allows precise targeting of the affected area. Who wants a blind injection? The chance of a blind injection working is very low. Second they should have more than a weekend course under their belt. Ask them what type of certification they have. Who has trained them? At the risk of embarrassing this person, Dr. Tom Clark is the absolute best trainer in the world. If a person is Clark-trained, they are good. You should be blunt and grill the physician about their training credentials when it comes to PRP.
5. How many cases should they have done? Good results come with experience. Unless they've done at least 100 cases, you're a guinea pig.
6. What do they use to create the PRP? They should use machines from either Arteriocyte or Harvest. These are the two best machines available.
7.Who prepares the PRP? If they aren't RN's watch out. Preparation of the PRP is very very important to the success of the procedure.
8. How much time is there between drawing blood for the PRP and the actual procedure. This will vary, depending on whether a stem cell procedure is also being done at the same time. If it's only a PRP procedure and you have to wait more than 30 minutes, you won't get the best result.
9. Does the doctor fenestrate before injecting the PRP? What this means is this... the proper way to administer PRP is to "irritate' the area with a needle in preparation for the PRP. This fenestration should be done at least 50 times. If the PRP is just injected without fenestration, it won't work.
10. Will PRP work for arthritis? In cases where a patient is not a good candidate for lubricant therapy (viscosupplementation) or they have failed steroid injections, PRP might be helpful for pain relief. For unknown reasons, PRP is useful for pain relief in many patients with arthritis for who other more conservative therapies have failed. PRP should not be done in patients who have stage 4 joints (bone on bone) unless the patient absolutely refuses to, or is not a candidate for joint replacement.
11. When will PRP not work in tendon problems? When there is a complete tear, PRP, by itself, will not be effective. A stem cell treatment might be more effective. For instance, we've had patients with full thickness rotator cuff tears in the shoulder or gluteus minimus and gluteus medius tears in the hip not respond to PRP but who did respond to stem cell procedures.
12. How long before you know whether the PRP has worked? PRP is not an overnight miracle cure. It takes time. However, if a patient isn't noticeably better within 4-6 weeks, it's time to consider the following options: another PRP procedure; a stem cell procedure; surgery. It may take 2-3 PRP procedures for healing to occur. While expensive, it is less expensive than surgery and the time off required for surgical recovery.
13. What kind of anesthetic is used? Local only.
14. What types of post-procedural activities should be avoided? Here is where the staff of the place where you get your PRP procedure should be most useful. You should receive comprehensive, easy-to-understand instructions with a follow up with the doctor within one to two weeks.
15. What's the cost? The cost will vary, depending on the skill and experience of the practitioner. Beware of bargain basement prices. It's not like getting a steal in Filene's basement!
Hope this article has been helpful.
