12 Mar Before and After Treatment with Platelet Rich Plasma (PRP)
Before treatment
- If taking NSAID’s( anti-inflammatory medication i.e.: Motrin, Naprosyn, Advil, Aleve) please discontinue 5-7 days prior to treatment. If taking an 81mg Aspirin, continue.
- Follow you normal daily routine on procedure day; make sure to drink plenty of water.
- The procedure takes approximately 1 hr to perform.
- Upon arriving at the clinic your peripheral blood will be drawn and you will be prep’d for your procedure. Your blood will be spun in a special centrifuge which takes about 15 minutes.
After treatment with PRP
- You will be numb in the areas treated for 2-4 hrs after the procedure.
- Due to the numbness we ask that you refrain from any strenuous activities but to stay mobile. Continue to move affected area to decrease soreness and stiffness.
- After the anesthesia wears off you may resume activities to tolerance of pain.
- You will experience some pain and soreness for 2-5 days after your treatment. The initial inflammatory phase last 7 days and secondary phase can last up to 14 days.
- No anti-inflammatory medication (Ibuprofen, Motrin, Aleve, or Naprosyn) should be used for 4-6 wks after treatment.
- Tylenol for pain, Ice as needed for pain and or swelling (10-20 minutes to cool the skin, repeat every 2-3 hours)
- Follow a program for flexibility and core strength to rehabilitate and correct any imbalances in the kinetic chain.
- You may experience the “roller coaster” syndrome where you feel great one day and for no apparent reason the area treated starts to hurt again, this is normal in the healing process.
- The platelets are active for several weeks and it can take up to 12 months for normal collagen to form and heal completely.
- Our goal is 60% improvement in pain with one injection, so you may or may not need more than 1 treatment to reach that goal. Sometime a series of 2-3 treatments are needed to achieve complete healing. If subsequent treatments are needed they are usually performed 8-10 weeks apart.
“Cortisone versus PRP”
Data was released from Krakow Poland at the International Meeting on the use of Autologous Growth Factors in Orthopedics and Sports Medicine: “State of the Art” – Krakow, Poland – 24 April 2009. The study found that patients receiving cortisone showed a 40% improvement compared to PRP 75% at 12 months. This is the first head to head study. Cortisone is well known to carry a risk of weakening & rupturing a tendon & is often discouraged.
Positive Effect of an Autologous Platelet Concentrate in Lateral Epicondylitis A double-blind randomized controlled trial: PRP versus corticosteroid injection with a 1 year follow-up.
Joost C. Peerbooms, Jordi Sluimer, Daniël J. Bruijn, Taco Gosens
Context: Platelet Rich Plasma (PRP) has shown to be a general stimulation for repair.
Objectives: To determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic lateral epicondylitis.
Design: A double blind randomized controlled trial with a one-year follow-up between May 2006 and January 2008.
Setting: The trial was conducted in two teaching hospitals in The Netherlands.
Patients: 106 patients with chronic lateral epicondylitis were randomly assigned in the PRP group or in the corticosteroid group. Randomization and allocation to the trial group were carried out by a central computer system.
Intervention: Patients were randomized to receive either a corticosteroid injection or an autologous platelet concentrate injection through a peppering needling technique.
Main Outcome Measures: The primary analysis included VAS and DASH scores.
Results: Successful treatment was defined as more than a 25% reduction in VAS or DASH score without a reintervention after 1 year. The results showed that 21 of the 55 patients (40 %) in the corticosteroid group and 38 of the 51 patients (75 %) in the PRP group were defined as successful with the VAS score, which was significant different (P < 0.001). 23 of the 55 patients (42 %) in the corticosteroid group and 36 of the 51 patients (71 %) patients in the PRP group were defined as successful with the DASH, which was also significantly different (P < 0.003).
Conclusions: Treatment of patients with chronic lateral epicondylitis with PRP reduces pain and increases function significantly, exceeding the effect of corticosteroid injection. Future decisions for application of the PRP for lateralepicondylitis should be confirmed by further follow-up from this trial and should take into account possible costs and harms as well as benefits.
Trial registration: ClinicalTrials.gov. Identifier: 2007-004947-31.http://www.clinicaltrials.gov
Comments: This is probably the most convincing evidence so far for the benefit of PRP for persistent tennis elbow and demonstrates similar success rates to surgery with a 75% success rate in significant pain improvement.
References: International Meeting on the use of Autologous Growth Factors in Orthopaedics and Sports Medicine: “State of the Art” – Krakow, Poland – 24 April 2009.