A new form of orthopedic therapy called platelet-rich plasma (PRP) is the epitome of “natural healing” in that it uses the healing power of your own blood, in concentrated form, to help ligaments and tendons recover faster and more completely from injury. It is a technique that has been used since the 1990s in oral surgery… has been tapped by Tiger Woods and other elite athletes to recover quickly and get back in the game… and is now available to the rest of us as well. I asked Brian Halpern, MD, sports medicine physician and PRP expert at New York City’s Hospital for Special Surgery, to explain how it works.
Of course, we’re going to have to start with a basic biology lesson. The four main components of blood are red cells, which primarily transport oxygen… white cells, which fight infection… platelets, which help with clotting and transport growth factors that help with cell division and migration… and plasma, which is the protein-rich solution that transports all the other cells. In general (and put very simply), when an injury occurs, a clot forms… the platelets involved release their growth factors… and new cell growth is stimulated to help bring about healing.
Making PRP is very simple and it can take the healing power of platelets to new levels. Blood is drawn from the patient and spun in a centrifuge to separate the various components. The platelet/plasma mix is drawn off the top, and then injected back into the patient at the injury site, in a procedure that takes about 20 minutes. Because the PRP comes from the patient, there’s no risk of rejection or allergic reaction — the only risks are the slight chance of infection or swelling that come with any injection.
Dr. Halpern told me that PRP doubles, even triples “the attack force” of platelets. This is especially helpful in areas that aren’t well vascularized (such as ligaments and tendons), because it brings a concentrated dose of healing platelets to an area where they normally wouldn’t go. It’s like turning on a switch, says Dr. Halpern. “It tells the body, ‘Let’s heal this area that hasn’t healed.’ ” It takes about 10 days for the platelets to slowly break down and release their various growth factors. While some movement helps with healing, patients are usually asked to cut back on activity to what is tolerable with minimal discomfort in the days after the injection. The healing process itself will continue for weeks afterward.
Though there’s little research supporting the efficacy of PRP, there is plenty of anecdotal evidence that the treatment works: Dr. Halpern says that his hospital’s success rate is “at least 90%” for the tendon injuries they’ve treated with PRP — and, he added, “that’s without surgery.” Even so, there are some unanswered questions — including one very important one: How long do its effects last? Because here’s the thing: While PRP has led to complete healing of torn tendons in some cases, in other cases the symptoms may abate even when imaging tests show that healing is incomplete (i.e., abnormalities may still be present). Dr. Halpern said that results show that most patients heal well and that few have recurring problems. More studies will need to be done to know for sure.
The lack of evidence-based research leads to an insurance conundrum. Though PRP is less expensive and less invasive than surgery (a quick Internet search finds that PRP costs about $2,000, compared with $10,000 to $15,000 for surgery), insurance providers generally don’t cover the treatment. Dr. Halpern believes that this will change as the treatment becomes more popular and insurers finally see it as a way to avoid surgery costs, but that will take time — and proof that it works. Questions still need to be answered about which patients and injuries respond best, how concentrated the platelets should be, how many injections are needed, how frequently those injections should be administered and more.
Clearly this is a treatment with great promise — it is an extremely low-risk and low-cost option to treat injuries, and one which most patients would welcome as an alternative to drugs or surgery, with all their attendant undesirable side effects and complications. To find a practitioner who works with PRP in your area, ask your doctor for a recommendation.
