Musculoskeletal Medicine

Platelet rich plasma injections (PRP injections) can be used in the treatment of many musculoskeletal injuries including that of tendons, muscles and joints. Typically 2 or more injections are required, separated by 4-6 weeks apart. This may vary depending on your injury.

Platelet Rich Plasma (PRP) Injections for Tendons

What is the structure of tendons?

Tendons are made of special cells called tenocytes, water and fibrous collagen protein. These proteins weave together to make a strong durable structure that naturally anchor to bone (2).

Why are tendons injured?

Tendons can transfer great force and thus can be injured if they are overused or overwhelmed. If this occurs, micro tears start to form in the collagen (1).

How do tendons heal after injury?

Injured tendons heal by scarring — this affects their strength and hence increases the risk of re-injury. Also, because tendons do not have a good blood supply, they tend to heal slower than other soft tissues (2-4).

Why is my tendon injury not improving?

As tendons have a poor blood supply, there is only a minimal inflammatory response. Without inflammation, the tendon repair system is limited and an abnormal pathological response occurs called angiofibroblastic degeneration (5-7). This degenerative response to the micro tears in collagen is the essence of tendinopathy or tendinosis. Often pain, localised tenderness, swelling and impaired performance occurs (8).

How have tendons been treated traditionally?

Traditional therapies do not address the inherently poor healing properties of tendons. Corticosteoid is sometimes injected but adverse effects such as atrophy and permanent structural damage to tendons can occur (6). Non steroidal anti-inflammatory medications (NSAIDs) can cause gastrointestinal or kidney damage (1).

How is PRP different?

PRP injections aim to embrace and stimulate the inflammatory process which in turn will encourage the healing process. PRP focuses on restoring normal tissue composition while avoiding further degeneration.

Ask your doctor about whether your tendon injury can be treated with PRP.

Platelet Rich Plasma (PRP) Injections for Muscle Strains / Tears

PRP can potentially accelerate muscle healing and reduce injury time. The early blood clot can be substituted by PRP with its supraphysiological concentration of growth factors which stimulates the healing process (8).

Ask your doctor about whether your muscle injury can be treated with PRP.

Platelet Rich Plasma (PRP) Injections for Other Injuries

There is ongoing medical research into the use of PRP regarding its potential to heal other musculoskeletal injuries including: Trochanteric bursitis, Knee MCL tears, Knee osteoarthritis (9,10, 12-14) and Hip Osteoarthritis (11)

Ask your doctor about whether your injury can be treated with PRP.

References

1. Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 2008 Dec;1(3-4):165-74.
   
2. Antitua E, Andia I, Sanchez M, Azofra J, Del Mar Zalduendo M, De La Fuente M, et al. Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF productions by human tendon cells in culture. J Orthop Res. 2005;23:281–6.
   
3. Fenwick SA, Hazlelman BL, Riley GP. The vasulature and its role in the damaged and healing tendon. Arthritis Res. 2002;4: 252–60.
   
4. Hayem G. Tenology: a new frontier. Joint, Bone, Spine. Rev Rhum. 2001;68:19–25.
   
5. Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006;10(10):1–5.
   
6. Jobe F, Ciccotti M. Lateral and medial epicondylitis of the elbow. J Am Acad Orthop Surg. 1994;2:1–8.
   
7. Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. Am J Hand Surg. 2003;28(2): 272–8.
   
8. Sánchez M, Anitua E, Orive G, Mujika I, Andia I. Platelet-rich therapies in the treatment of orthopaedic sport injuries. Sports Med. 2009;39(5):345-54.
   
9. Filardo G, Kon E, Pereira Ruiz MT, Vaccaro F, Guitaldi R, Di Martino A, Cenacchi A, Fornasari PM, Marcacci M. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach. Knee Surg Sports Traumatol Arthrosc. 2011 Dec 28.
   
10. Kon E, Mandelbaum B, Buda R, Filardo G, Delcogliano M, Timoncini A, Fornasari PM, Giannini S, Marcacci M. Arthroscopy. Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. 2011 Nov;27(11):1490-501.
    
11. Sánchez M, Guadilla J, Fiz N, Andia I. Ultrasound-guided platelet-rich plasma injections for the treatment of osteoarthritis of the hip. Rheumatology (Oxford). 2012 Jan;51(1):144-50.
    
12. Filardo G, Kon E, Buda R, Timoncini A, Di Martino A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2011 Apr;19(4):528-35.
    
13. Wang-Saegusa A, Cugat R, Ares O, Seijas R, Cuscó X, Garcia-Balletbó M. Infiltration of plasma rich in growth factors for osteoarthritis of the knee short-term effects on function and quality of life. Arch Orthop Trauma Surg. 2011 Mar;131(3):311-7.
    
14. Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010 Apr;18(4):472-9.