Emerging Insights On Platelet-Rich Plasma

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How To Acquire And Activate PRP

To acquire autologous PRP, a technician collects blood from the cubital vein. The amount of blood acquired depends on the clinical application (treatment area) and desired concentration. A centrifuge or filtration then separates the platelets from the plasma. Many different systems are available on the market today to obtain the PRP.

   When using a simple centrifugation process, the collected blood spins down between five and 20 minutes. This is determined by the speed of the centrifuge and the concentration desired. A technician then collects the PRP from the tube using a syringe and 18-gauge needle, being careful not to collect any platelet poor or red cells.

   A similar method of collection uses an automated centrifugation process that separates the platelets from the whole blood and then automatically sends the product to a separate syringe, using an infrared micro-processing sensor to differentiate between red blood cells and platelet-rich plasma. This type of system seems to lead to more accuracy and allows for more reproducible concentrations.

   One such device is the Magellan Autologous Platelet Separator System (Arteriocyte Medical Systems). With either method, the tube that initially collected the blood must have an anticoagulant. The kits that come with the products usually have tubes that already have anticoagulant or come with a separate anticoagulant.

   The literature seems to be mixed on the idea of activating the platelets before use. De Vos and colleagues presented a study on the effects of PRP on Achilles tendinopathy without mentioning activation.10 In their review article, Foster and co-workers suggest activation with bovine thrombin.11 Thomas and colleagues mention use of a combination of calcium and thrombin (bovine, human or recombinant).12 Fufa and co-workers used type I collagen to activate PRP and create a collagen-PRP gel.13 The brochure for the Magellan system calls for the activation of PRP by using adenosine diphosphate. The proper way to activate the platelets depends on the intended use of the PRP.

   Thrombin and calcium can activate the PRP into a platelet gel. This creates a product that can distribute growth factors to stimulate wound healing while constricting blood vessels to reduce bleeding. In addition, the PRP activation will increase the function of the platelets. The gel can improve tissue adhesion as a scaffold and protect from infection with its concentration of leukocytes. The gel has also reduced pain postoperatively. The platelet gel material is in use mostly for intraoperative situations to promote bone healing as well as being a wound sealant.2,5,6

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David J. Soomekh, DPM, FACFAS

Platelet-rich plasma has become more popular over the last several years as an orthobiologic option for foot and ankle injuries. Incorporating a mix of research findings with his own clinical experience, this author takes a closer look at how PRP may be beneficial for plantar fasciitis, Achilles tendinopathy, bone augmentation and wound healing.

   The use of orthobiologics in the treatment of foot and ankle injuries, both in the clinical and surgical venues, is significantly increasing. Clinicians and surgeons continue to seek better ways to accelerate and mediate the healing of bone and soft tissue while incorporating less invasive techniques.

   Over the last few years, the use of autologous platelet-rich plasma (PRP) has emerged in the forefront of biologic tools for foot and ankle specialists. Researchers have investigated the use of PRP in the treatment of tendon injuries, chronic wounds, ligamentous injuries, cartilage injuries, muscle injuries and for bone augmentation (intraoperative fusions and fracture repair).1

   Platelet-rich plasma has been in use over the last four decades. Theoretically, PRP offers increased concentrations of autologous platelets, which yield high concentrations of growth factors and other proteins that will subsequently lead to enhanced healing of bone and soft tissue on a cellular level.

   Platelet-rich plasma is a concentration of platelets derived from the plasma portion of centrifuged or filtered autologous blood. This platelet-rich solution can be an adjunct to healing as with a fresh surgical fusion or it can reinstate healing as with chronic tendon injuries. Platelet-rich plasma and related products have different labels throughout the literature including platelet-rich concentrate, platelet gel, preparation rich in growth factors (PRGF), platelet releasate and platelet-leukocyte-rich gel (PLRG).

   Platelet-rich plasma may or may not become activated by another product. The PRP without activation is usually reserved for the treatment of tendon, muscle and other soft tissue. When PRP is available in a gel or fibrin sealant, one can use this both clinically and intraoperatively for wound healing and bone augmentation. There have been several studies investigating the efficacy of PRP and its applications including wound healing and podiatric surgery.1

   There have been several basic science reviews and studies as well as clinical studies on PRP. There are both in vitro and in vivo studies. Animal and human studies have examined the benefits and safety of PRP. Many of these studies have adequately shown the safety and efficacy of PRP in the clinical and surgical setting.2-7

   However, the human studies are limited by their inconsistencies, small sample size and lack of controls.8 Other limitations include a lack of standardization in technique, concentration of platelets, applications of clinical use, the volume injected, separation from whole blood and post-injection care. There also seems to be as many studies that confirm the benefits of PRP as there are studies that are inconclusive. An important distinction is whether the use of PRP is as beneficial in the acute phases of tissue healing as it may be in chronic pathology.

   Foot and ankle applications for PRP fall into several categories. These categories include: acute and chronic ligamentous injuries, chronic tendinopathy (tendinosis), bone pathology, chronic wounds and cartilage injury. With this in mind, let us take a closer look at the use of PRP in the foot and ankle.

What You Should Know About Using PRP For Plantar Fasciitis

Barrett and Erredge investigated the use of PRP for plantar fasciitis in a small study.9 They obtained an ultrasound of the fascia before and after treatment, and utilized a patient pain scale to help determine efficacy. The patients were weightbearing in a walking boot for two days after the procedure and were subsequently in regular shoe gear with limited activity. They were restricted from using anti-inflammatories or other modalities.

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Anonymoussays: May 6, 2010 at 11:07 am How do you bill for this? Reply to this comment »
Anonymoussays: May 6, 2010 at 1:58 pm I would also like to know what coding is being used for this and do most insurance companies recognize PRP treatment for plantar fasciitis? Reply to this comment »
Anonymoussays: August 5, 2010 at 5:11 pm

There is a new code for this. 0232T Came out in January 2010 but only became valid July, 2010.

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