Platelet rich plasma injections

California Sports and Orthopaedic Institute provides office based Platelet Rich Plasma (PRP) injections for the treatment of chronic tendonitis, tendonosis, chronic muscle strain, muscle fibrosis, and ligamentous injuries. PRP is effective where steroid injections may have had minimal effectiveness or failure and as a first line alternative to cortisone injection.

PRP uses a patient’s own blood obtained in the office at time of procedure. It is prepared in the office by centrifuge, concentrating the platelets rich in growth factors necessary for tissue healing. Studies show improved healing response by introducing growth factors to tissue with limited direct blood supply.

The entire procedure takes less than 30 minutes and with no more discomfort than a standard cortisone injection.

No serious side effects have been documented by multiple studies. The patient’s own blood is used so risk of allergy or rejection is eliminated. Dr. Roghair has performed the procedure on patients from ages 17 to 75 without complications and high rate of success. Many Division I athletes have returned to pain free competition within 3 weeks of injection after not responding to cortisone injections.

Please contact our office in Berkeley or Orinda for questions or if you have a patient who may be interested.

What is Platelet-Rich Plasma (PRP)?

Platelet-rich plasma or PRP is an "autologous blood therapy" that uses a patient's own blood components to stimulate a healing response in damaged tissues. In response to an injury or tissue damage, your body naturally recruits platelets and white blood cells from the blood to initiate a healing response. Under normal conditions, platelets store numerous growth factors which are released in response to signals from the injured tissue. Modern technology allows us to concentrate platelets and white blood cells from your blood, and induce this growth factor release as we inject the solution directly into injured tissue, simulating this same healing response in a more powerful form. By enhancing the body's natural healing capacity, the treatment may lead to a more rapid, more efficient, and more thorough restoration of the tissue to a healthy state.

What conditions can be treated with PRP?

Platelet-rich plasma or PRP is an "autologous blood therapy" that uses a patient's own blood components to stimulate a healing response in damaged tissues. In response to an injury or tissue damage, your body naturally recruits platelets and white blood cells from the blood to initiate a healing response. Under normal conditions, platelets store numerous growth factors which are released in response to signals from the injured tissue. Modern technology allows us to concentrate platelets and white blood cells from your blood, and induce this growth factor release as we inject the solution directly into injured tissue, simulating this same healing response in a more powerful form. By enhancing the body's natural healing capacity, the treatment may lead to a more rapid, more efficient, and more thorough restoration of the tissue to a healthy state.

What conditions can be treated with PRP?

Knee Pain

Patellar tendonitis/tendinosis
Quadriceps muscle injuries
Ligament sprains or tears
Bursitis

Hip Pain

Hip girdle muscle pain or injury
Pyriformis syndrome
Greater trochanteric Bursitis
Ischial bursitis
Pubic symphysis pain
Sacroiliac joint pain
Hamstring tendonitis or tears

Shoulder and Arm Pain

Rotator Cuff tendonitis, tendonopathy or partial tears
Acromio-clavicular joint pain or arthritis
Bicipital tendonitis
Medial and Lateral epicondylitis (golfers & tennis elbow)
Ulnar Collateral Ligament sprain or tear

Back Pain

Spinal nerve inflammation
Facet Joint arthritis
Disc herniation or tear
Interspinous ligament sprain

Lower Leg and Foot

Plantar Fasciitis
Shin Splints
Peroneal tendonitis
Ankle sprains
Achilles tendonitis or partial tears

Treatment Process:
Following a formal evaluation and diagnostic workup, an individualized treatment plan will be discussed with you. A full explanation of the procedure including risks and benefits will be reviewed. Once written consent is obtained, blood is drawn from your arm and placed in a special processing unit, which separates platelets, white blood cells and serum from red blood cells. The platelets and white blood cells are then concentrated and collected into a sterile syringe. Some of the blood is used to create an "activator" of the PRP. The skin and soft tissue is anesthetized with local anesthetic, followed by injection of both the PRP and activator into the tissue targeted for treatment. Depending on the size of the injured tissue, one or several needles are inserted to optimize placement of the PRP.

Treatment plan:
Depending on the severity and duration of your injury, one to three PRP injections are suggested. Following the initial treatment with PRP, a follow up visit occurs 2-3 weeks later. At this visit an evaluation of your response to the initial therapy is performed and a decision is made regarding the need for additional PRP treatments. In general, chronic injuries require more than one injection. In both acute and chronic injuries, injections may be combined with an exercise or physical therapy program to enhance the success of the treatment.

Are PRP injections safe?
Research and clinical data show that PRP injections are extremely safe, with minimal risk for any adverse reaction or complication. Because PRP is produced from your own blood, there is no concern for rejection or disease transmission. There is a small risk of infection from any injection into the body, but this is rare. Of note, recent research suggests that PRP may have an anti-bacterial property which protects against possible infection (4).

What to expect after your treatment:
Often, following the initial injection, an "achy" soreness is felt at the site of injury. This "soreness" is a positive sign that a healing response has been set in motion. This effect can last for several days and gradually decreases as healing and tissue repair occurs. It is important that anti-inflammatory medications such as Ibuprofen, Naproxen and Aspirin be avoided following PRP treatments. These medicines may block the effects of the intended healing response facilitated by the injection itself. It is acceptable to use over the counter pain medication, such as Tylenol and in some cases a prescribed analgesic, which does not have anti-inflammatory properties, to control discomfort as needed. Pain management options will be discussed with you by the physician managing your treatment plan. You will be permitted to resume normal day to day activities and light exercise following injection. We suggest that you avoid strenuous lifting or high level exercise for at least several days after injection.

How do I find out if PRP is right for me?
Questions regarding PRP or your candidacy for the treatments can be addressed to Dr. Roghair at our Orinda office. Contact person for the PRP treatment program is Laura Bellard at 925-258-9571. We would be happy to review a brief history of your problem via telephone in order to determine if a formal evaluation is warranted.

Selected References

1. Anitua E, S. M., Nurden A, Nurden P, Orive G, Andia I. (2006). "New insights into and novel applications for platelet-rich fibrin therapies." Trends in Biotechnology 24(5): 227-234.

2. Becker C, H. S., Drewlo S, Rodriguez SZ, Kramer J, Willburger RE. (2007). "Efficacy of epidural perineural injections with autologous conditioned serum for lumbar radicular compression." Spine 32(17): 1803-1808.

3. Mishra A, A. J., Anitua E, Andia I, Padilla S, Mujika I. (2007). "Treatment of chronic elbow tendinosis with buffered platelet-rich plasma." Am J of Sports Med 34(11): 1774-1778.

4. Moojen D, E. P., Schure R, et al. (2007). "Antimicrobial activity of platelet-leukocyte gel against Staphylococcus anreus." Journal of Orthopaedic Research DOI: 10.1002/jor.20519.

5. Sanchez M, A. E., Azofra J, Andia I, Padilla S, Mujika I. (2007). "Comparison of Surgically Repaired Achilles Tendon Tears Using Platelet-Rich Fibrin Matrices." Am J of Sports Med 10(10): 1-7.