PRP and Me


                    After months of suffering from chronic knee pain despite regular therapy sessions, I decided to address the issue head on by undergoing an X-Ray and MRI as per the advise of my doctor so that we could better analyze the root of my knee problem. The finding:  “osteoarthritis of the left knee".  Osteoarthritis, commonly known as wear-and-tear arthritis, is a condition in which the natural cushioning between joints -- cartilage -- wears away. When this happens, the bones of the joints rub more closely against one another with less of the shock-absorbing benefits of cartilage. The rubbing results in pain, swelling, stiffness, decreased ability to move and, sometimes, the formation of bone spurs.  Aside from cutting back on my weekly running mileage and alternating my exercise routine with other activities that would lessen the stress on my knee (i.e. biking and swimming), my doctor suggested I try Platelet Rich Plasma or PRP injections.  To date, I have undergone two sessions of PRP. The first treatment was last July. 
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What is PRP ?

Platelet-rich plasma therapy, sometimes called PRP therapy or autologous conditioned plasma (ACP) therapy, attempts to take advantage of the blood’s natural healing properties to repair damaged cartilage, tendons, ligaments, muscles, or even bone.

When treating osteoarthritis with platelet-rich plasma, a doctor injects PRP directly into the affected joint. The goal is to:
  • Reduce pain
  • Improve joint function
  • Possibly slow, halt, or even repair damage to cartilage
Platelet-rich plasma is derived from a sample of the patient's own blood. The therapeutic injections contain plasma with a higher concentration of platelets than is found in normal blood.
  • What is plasma? Plasma refers to the liquid component of blood; it is the medium for red and white blood cells and other material traveling in the blood stream. Plasma is mostly water but also includes proteins, nutrients, glucose, and antibodies, among other components.
    What are platelets? Like red and white blood cells, platelets are a normal component of blood. Platelets alone do not have any restorative or healing properties; rather, they secrete substances called growth factors and other proteins that regulate cell division, stimulate tissue regeneration, and promote healing. Platelets also help the blood to clot; a person with defective platelets or too few platelets will bleed excessively from a cut.
How Is Platelet-Rich Plasma Made?

The most common way to prepare PRP involves centrifuging a patient's blood sample. A vial of blood is placed in a centrifuge, where it is spun at intensely high speeds. The spinning causes the blood to  separate into layers:
  • Red blood cells, approximately 45% of blood, are forced to the bottom of the vial.
  • White blood cells and platelets form a thin middle layer, called a buffy coat, which comprises less than 1% of the centrifuged blood.
  • "Platelet-poor" plasma, or plasma with a low concentration of platelets, makes up the remaining top layer, about 55% of the centrifuged blood sample.
Once the centrifuge process is complete the doctor or medical technician will remove the vial from the centrifuge and prepare the PRP solution for injection.
Centrifugation speed and time can vary. Differences in centrifugation speed and time affect the composition of PRP. There is no clear consensus on what centrifugation process produces the best results for treating osteoarthritis.

Platelet-Rich Plasma Injection Procedure
Platelet-rich plasma injections are outpatient procedures. Because the patient's blood must be drawn and prepared for injection, a typical procedure may take anywhere from 45 to 90 minutes.
Whether the patient has a one-time injection or a series of injections spaced over weeks or months is up to the individual patient and doctor. If a series of injections is planned, a doctor may recommend a single blood draw during the first visit and use fresh PRP in the first injection and freezing and thaw the remaining PRP as needed for future injections. However, some experts believe freezing and thawing PRP negatively affects its usefulness and prefer to do a separate blood draw for each PRP injection.3

Efficacy of Platelet-Rich Plasma Injections
PRP has been used in surgeries to promote cell regeneration since 1987,10,11 and a growing body of evidence shows it is a viable treatment for tendinosis.12,13,14,15 Not until recently, though, have experts researched and debated whether or not platelet-rich plasma (PRP) injections are an effective treatment for osteoarthritis.
Nearly all of the research investigating the use of PRP to treat osteoarthritis and other cartilage defects has been done since 2000, and the vast majority of research articles on the topic have been published since 2010.
Not all studies support the use of PRP to treat osteoarthritis; however, experts who have reviewed the existing body of research believe the evidence is largely encouraging and merits further investigation.16,17,1

Potential Pros and Cons of PRP Injections
Like almost all medical treatments, there are potential advantages as well as potential drawbacks and uncertainties to using PRP injections to treat osteoarthritis.

Advantages of Platelet-Rich Plasma (PRP) Therapy
There are several reasons why osteoarthritis patients might consider platelet-rich plasma injections:
  • Platelet-rich plasma is autologous, meaning it comes from the patient’s body, so it is natural and the injections carry few risks.
  • Other treatments for mild to moderate osteoarthritis can be unreliable or vary from person to person, and some have side effects or drawbacks:
    • Physical therapy and/or weight loss can often improve but not always eliminate symptoms.
    • Cortisone injections are proven to reduce osteoarthritis pain, but repeated injections can weaken ligaments and tendons over time, and may have a detrimental effect on healthy cartilage.26,27
    • Anti-inflammatory medications (NSAIDS) such as aspirin and ibuprofen can reduce pain, but long-term use can aggravate stomach problems, blood pressure and heart problems.
    • Minor surgeries to treat osteoarthritis, such as arthroscopic debridement, have mixed results, and may be no better than placebo.28,29
    • Joint replacement surgeries are major surgeries that require long-term rehabilitation, and should be reserved for more debilitating cases of arthritis
    • While more data are needed, research so far seems to be promising.
Because osteoarthritis has no surefire treatment and there are few risks associated with platelet-rich plasma injections, some doctors believe PRP therapy is worth trying.
Patients should keep in mind that PRP is not a cure-all, and it may be best used in combination with nonsurgical treatments and lifestyle changes, such as physical therapy, weight loss, bracing, and NSAIDs

Who Is a Candidate for Platelet-Rich Plasma Therapy?
Scientists are still exploring which arthritis patients should be eligible for PRP injections. While no definitive conclusions can be made, research suggests that PRP injections are appropriate for younger patients in the early stages of the disease.17,21,32
These patients may have already tried treatments such as rest and physical therapy but are not yet thinking about joint replacements or other surgeries.

While there is no universally adopted list of criteria describing who is eligible for PRP injections, professional organizations such as the American Academy of Orthopaedic Surgeons and the International Cellular Medicine Society have suggested guidelines, many of which are included below:
  • Osteoarthritis pain affects daily activities
  • Other more conservative treatments have failed or been eliminated:
    • Physical therapy to strengthen joint muscles has not helped
    • The patient is sensitive to anti-inflammatory medications (NSAIDs) such as ibuprofen, or find NSAIDs do not provide adequate pain relief
    • Joint aspirations are not appropriate or do not provide adequate pain relief
    • Steroid injections have not worked, or the patient wants to avoid steroid injections
Platelet-rich plasma injections are not typically recommended for the most severe cases of osteoarthritis.
All info above from : www.arthritis-health.com


"Ultrasound" checking what wrong with the knee.
MRI
MRI findings  -  “osteoarthritis of the left knee"
Blood Collection Infusion Set

Blood Extraction
The most common way to prepare PRP involves centrifuging a patient's blood sample. A vial of blood is placed in a centrifuge, where it is spun at intensely high speeds. The spinning causes the blood to  separate into layers:
  • Red blood cells, approximately 45% of blood, are forced to the bottom of the vial.
  • White blood cells and platelets form a thin middle layer, called a buffy coat, which comprises less than 1% of the centrifuged blood.
  • "Platelet-poor" plasma, or plasma with a low concentration of platelets, makes up the remaining top layer, about 55% of the centrifuged blood sample.                  www.arthritis-health.com
Injecting the Platelet-rich plasma (PRP) in my left knee 
"Hyaluronic synuisc" 
 a supplement fluid for the knee to help lubricate and cushion the joint.