Explaining PRP To Your Patients

Jeffrey Bowman DPM MS

When you suggest adding platelet-rich plasma to the treatment plan of your patients, keep in mind that they might not be familiar with this type of treatment. Expect some questions.

What Is Platelet-Rich Plasma (PRP)?

Platelets are a cellular component of the blood that play a key role in the formation of a blood clot. Platelets contain and release proteins, cytokines and other bioactive factors (growth factors, clotting factors, etc.) that initiate and regulate wound healing.

Platelet-rich plasma contains the following growth factors:
* PD-EGF (platelet derived epidermal growth factor)
* PDGF-A,B (platelet derived growth factor
* TGF-β1 (transforming growth factor)
* IGF-1,2 (insulin-like growth factor)
* VEGF, ECGF (vascular endothelial growth factor, endothelial cell growth factor)
* bFGF (basic fibroblast growth factor)1

These growth factors will initiate cell growth, blood vessel growth and collagen synthesis necessary for healing. When released, these factors send out a signal to other cells in the body to help activate the healing sequence.

The normal platelet count is anywhere between 150,000 µL – 350,000 µL. A batch of platelet-rich plasma may contain at least 1 million µL and three to five times greater concentration of growth factors.2 This increase is what gives PRP its punch.

To make PRP, one takes a sample of blood, adds an anti-clotting agent and places it in a centrifuge until the platelets are separated from the other components of blood.

How Does PRP Work?

1. Platelet-rich plasma stimulates revascularization, which helps signal the necessary cells that are involved in the healing process.
2. It increases growth factors, which are responsible for blood vessel and tissue formation.
3. Platelet-rich plasma can turn a chronic condition into an acute condition. Platelet-rich plasma changes the environment by bringing the necessary healing cells.

What Types Of Conditions Can Clinicians Treat With PRP?

* Tendon pathology (especially of the Achilles)
* Plantar fasciitis
* Ligamentous injury
* Bone augmentation (fracture repair)
* Wound healing

Some literature has shown that PRP is effective in promoting tissue healing while other studies have shown no effect at all.3,4 Other than infection and possible injury to nerves or blood vessels, PRP injections have no adverse effects.

References

1. Monto RR. Platelet rich plasma treatment for chronic Achilles tendinosis. Foot Ankle Int. 2012;33(5):379-85.
2. Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent. 2001;10(4):225-8.
3. Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet rich plasma from basic science to clinical applications. Am J Sports Med. 2009;37(11):2259-72.
4. Owens RF Jr, Ginnetti J, Conti SF, Latona C. Clinical and magnetic resonance imaging outcomes following platelet rich plasma injection for chronic midsubstance Achilles tendinopathy. Foot Ankle Int. 2011;32(11):1032-9.
5. Lyras DN, Kazakos K, Verettas D, Polychronidis A, Tryfonidis M, Botaitis S, et al. The influence of platelet-rich plasma on angiogenesis during the early phase of tendon healing. Foot Ankle Int. 2009;30(11):1101-6.
6. de Vos RJ, Robert J de Vos MD, et al. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010;303(2):144-9.
7. Soomekh DJ. Emerging insights on platelet-rich plasma. Podiatry Today. 2010;23(5):34-43.

For any questions regarding this blog, please contact Dr. Bowman at www.houstonfootspecialists.com

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