Bashir, MD; Alberto J. Panero, DO; Andrew L. Sherman, MD; “The Emerging Use of Platelet-Rich Plasma in Musculoskeletal Medicine”, The Journal of the American Osteopathic Association: JAOA; January, 2015, Vol. 115, Number 1, pg. 24-31
While teaching CME courses to DO’s and MD’s in Osteopathic Manipulative Medicine at the University of New England College of Osteopathic Medicine (UNECOM) over the years I ask how many physicians present have heard of prolotherapy? Five years ago only a few would raise their hands, now most raise their hands and only a few have never heard of prolotherapy. This injection technique used to help bolster the body’s own acute inflammatory healing response to repair partially torn or loose ligaments and tendons in my opinion is extremely effective. I have been using prolotherapy with patients for ten years and have seen its positive effects.
In more recent years a newer option in the prolotherapy concept is to use platelet rich plasma as the proliferant:
The Science Behind Using Platelet Rich Plasma:
“Initially thought to be solely the bandages of the circulatory system, the contents of platelets, specifically “a” granules, have been found to contain a number of growth factors crucial to the reparative process. Cytokines that act as homing signals to circulating mesenchymal cells, mitogens that stimulate mitosis and proliferation of fibroblasts, and transcription factors that increase the production of collagen fibrils are all abundant within densely packed “a” granules in the cytoplasm of circulating platelets.
Histopathologic changes associated with chronic painful tendon injuries or tendonopathy exhibit degeneration and disorganization of collagen, hypercellularity, and little inflammation…. These changes in tendon characteristics have been found to be, in part, related to the pathologic replacement of the resilient type I collagen by the less stable type III collagen and neovascularization, with concomitant neurogenesis.”
With PRP macrophages proliferate in the area of the injection and have a reservoir of growth factors and signaling molecules:
“Platelet-derived growth factor concentrations can reach a 5-fold increase in PRP preparations and have been shown to stimulate cell proliferation and mitosis of fibroblasts in injured animal tendons. Transforming growth factor-B concentrations can also reach highly elevated concentrations of nearly 4-fold and have been found to increase the quantity of type I and III collagen synthesized by local fibroblasts. The role of vascular endothelial growth factor in the neogenesis of blood vessels has been known for years. Therapy with PRP results in a nearly 6-fold increase in this potent molecule and is believed to help improve delivery of vital nutrition to the poorly vascularized region of tendons. This combination of increased cell recruitment, increased metabolic activity of recruited cells, increased vessel growth, and improved nutrition provides the foundation of PRP therapy’s presumed efficacy.”
See next weeks blog for a review of the clinical trials done on PRP.