Regenerative Medicine – Platelet-Rich Plasma (PRP)
There have been exciting developments made in the field of Regenerative Medicine. This includes the use of PRP (platelet-rich plasma), amniotic fluid, and stem cells to help build healthy discs, tendons, cartilage, ligaments, and bone. PRP, for example, is being used to treat injured or degenerative discs, joints, or soft tissues such as tendons.
PRP is obtained by drawing blood, and then spinning it in a centrifuge to separate a concentrated layer of platelets from the red blood cells. This layer of PRP from the patient’s own blood is then injected into or around the injured site. The injection is carried out under ultrasound (US) guidance to ensure accuracy.
PRP contains growth factors and cells that enhance and strengthen the body’s ability to regenerate healthy tissue.
PRP has been used successfully to treat tendon problems at the elbow (lateral epicondylitis)[2, 3], knee (patellar tendonitis), Achilles tendinosis[1, 5], shoulder (rotator cuff) when combined with dry needling (tenotomy), and other areas, although the studies that look at the use of PRP to repair abnormal tendons do not all show positive results.
Joint Arthritis (Osteoarthritis) and Cartilage Defects
There is a growing body of evidence that supports the use of PRP in the knee and hip, and other joints to treat cartilage defects or degeneration[7-13]. This is a reasonable option to consider after physical therapy, analgesics, and possibly viscosupplementation injection with the cartilage building block / lubricant, hyaluronic acid.
There is exciting, early information from a study by Terry, Lutz, et al.  that shows positive results when PRP is injected into painful discs. The growth factors found in PRP may serve to stimulate regeneration of disc material. Other regenerative options that are being studied include amniotic fluid, and there is good emerging evidence for the use of mesenchymal stem cells[17-19]
Muscle, Ligaments, Plantar Fascia
1. Nguyen, R.T., J. Borg-Stein, and K. McInnis, Applications of platelet-rich plasma in musculoskeletal and sports medicine: an evidence-based approach. PM R, 2011. 3(3): p. 226-50.
2. Mishra, A. and T. Pavelko, Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med, 2006. 34(11): p. 1774-8.
3. Peerbooms, J.C., et al., Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med, 2010. 38(2): p. 255-62.
4. Filardo, G., et al., Use of platelet-rich plasma for the treatment of refractory jumper’s knee. Int Orthop, 2010. 34(6): p. 909-15.
5. Monto, R.R., Platelet rich plasma treatment for chronic Achilles tendinosis. Foot Ankle Int, 2012. 33(5): p. 379-85.
6. Rha, D.W., et al., Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial. Clin Rehabil, 2013. 27(2): p. 113-22.
7. Filardo, G., et al., Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc, 2011. 19(4): p. 528-35.
8. Kon, E., et al., Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc, 2010. 18(4): p. 472-9.
9. Kon, E., et al., Platelet-rich plasma (PRP) to treat sports injuries: evidence to support its use. Knee Surg Sports Traumatol Arthrosc, 2011. 19(4): p. 516-27.
10. Zhu, Y., et al., Basic science and clinical application of platelet-rich plasma for cartilage defects and osteoarthritis: a review. Osteoarthritis Cartilage, 2013. 21(11): p. 1627-37.
11. Andia, I., M. Sanchez, and N. Maffulli, Joint pathology and platelet-rich plasma therapies. Expert Opin Biol Ther, 2012. 12(1): p. 7-22.
12. Guadilla, J., et al., Arthroscopic management and platelet-rich plasma therapy for avascular necrosis of the hip. Knee Surg Sports Traumatol Arthrosc, 2012. 20(2): p. 393-8.
13. Sanchez, M., et al., Ultrasound-guided platelet-rich plasma injections for the treatment of osteoarthritis of the hip. Rheumatology (Oxford), 2012. 51(1): p. 144-50.
14. Terry, A., Lutz, G, et al., Lumbar Intradiscal Platelet Rich Plasma Injections: A Prospective, Double-Blind, Randomized Controlled Trial. (2013), International Spine Intervention Society – 2013 21st Annual Scientific Meeting Research Abstracts. Pain Medicine, 14: 1269–1276. doi: 10.1111/pme.12219, 2013. 14: p. 1269-1276.
15. Wang, S.Z., et al., Enhancing intervertebral disc repair and regeneration through biology: platelet-rich plasma as an alternative strategy. Arthritis Res Ther, 2013. 15(5): p. 220.
16. Leckie, S.K., et al., Injection of human umbilical tissue-derived cells into the nucleus pulposus alters the course of intervertebral disc degeneration in vivo. Spine J, 2013. 13(3): p. 263-72.
17. Chou, S.H., et al., Mesenchymal stem cell insights: prospects in hematological transplantation. Cell Transplant, 2013. 22(4): p. 711-21.
18. Huang, Y.C., et al., The effects of microenvironment in mesenchymal stem cell-based regeneration of intervertebral disc. Spine J, 2013. 13(3): p. 352-62.
19. Werner, B.C., X. Li, and F.H. Shen, Stem cells in preclinical spine studies. Spine J, 2013.
20. Wilson, J.J., et al., Platelet-rich plasma for the treatment of chronic plantar fasciopathy in adults: a case series. Foot Ankle Spec, 2014. 7(1): p. 61-7.