PRP Injections

Dr Greg van Osch of Maritzburg Orthopaedic Centre explains how PRP injections work and how they can help speed up healing.

1. WHAT ARE PRPS?

PRP stands for Platelet Rich Plasma. A person’s own blood is drawn up into a syringe, in volumes between 15 and 50ml. This is spun in a centrifuge to separate the red blood cells from white cells, platelets and plasma. The plasma and platelets are then injected back into the area being treated.

2. HOW DOES IT WORK?

The platelets have alpha granules that contain various cytokines and cell mediators. These substances are important to stimulate the healing process in the body’s tissues. They activate the inflammatory process and activate cells to form collagen and blood vessels, and to regenerate the underlying tissue. PRPs provide supra-physiological amounts of these substances directly to the area of injury in order to speed up healing.

3. WHAT DOES IT WORK FOR?

There are a number of orthopaedic conditions that it can be used for (see below), and this is supported by studies in scientific literature. It is also used by other specialities such as plastic surgery and cosmetics, and even to treat male pattern balding.

Currently, scientific results can be summarised as:

• Abundant high-quality evidence: lateral epicondylitis (tennis elbow), OA knee (moderate severity).
• Moderate high-quality evidence: patella tendinopathy, plantar fasciitis.Insufficient evidence for routine: rotator cuff, OA hip, high ankle sprains.
• Lack of evidence currently: Achilles chronic tendinopathy, muscle injury, uon-union of fractures, ACL reconstruction.

When scientific literature refers to high-quality evidence, it means a Randomised Controlled Trial (RCT). In these trials you require large numbers of patients who are randomly assigned to either the experimental group or a control group and then the data is statistically analysed. Prospective and retrospective trials are then the next order of evidence, and finally case studies (which are often in smaller numbers.) Currently there are significant numbers of RCTs which support use of PRPs.

Studies are ongoing and will provide more clarity on effectiveness in these areas in the future.

4. IS IT SAFE?

It uses a patient’s own blood and it is an aseptic technique, to avoid reactions or infection. It works on cell receptors, not the nucleus, so there is no risk of neoplasia (cancer).

5. CONTRAINDICATIONS:

• Low platelet count (<105)
• Dysfunctional platelets
• NSAID (anti-inflammatories) within 48 hours
• Corticosteroid injection at site within two weeks
• IVI or oral steroid.
• Pseudomonas, enterococcus or klebsiella infections
• Haemopoietic cancer.

SUMMARY

PRP is a promising treatment for some musculoskeletal diseases; however, evidence of its efficacy has been highly variable depending on the specific indication. Additional high-quality clinical trials with longer follow-up will be critical in shaping our perspective of this treatment option.

Dr Greg Van Osch studied at the University of Cape Town for an undergraduate medical degree. He worked in the United Kingdom and Australia, then returned to South Africa and completed post-graduate training at the University of Cape Town and qualified as an orthopaedic surgeon. He did a fellowship in hip/knee and trauma surgery at Cape Hip and Knee. His interests are sports medicine, arthroscopic and lower limb surgery. Dr Greg Van Osch is married with two children, and is a keen mountain biker and river-and-surfski paddler.

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