Arthritis Treatment: What Musculoskeletal Problems Can Be Treated With Platelet-Rich Plasma?

Platelet-rich plasma (PRP) is an ultraconcentrate of blood that contains a large number of platelets, roughly four to seven times baseline amounts. For example, normal peripheral blood contains about six per cent platelets. A platelet-rich plasma specimen contains ninety-four per cent platelets.

Platelets are cells in the blood that are responsible for a number of tasks. First, they have factors that aid in forming a clot. Second, they have multiple growth and healing factors that help tissue injuries with recovery. Examples of these factors include platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and transforming growth factor (TGF). Healing occurs because platelet-derived growth factors stimulate the growth and multiplication of stem cells that aid in healing.

So where can PRP be used in a clinical setting? Fenton and colleagues have reported that in their hands they have been able to successfully treat a number of musculoskeletal problems including tendinopathies, ligament laxity and tears, osteoarthritis, cartilage injury, stress fractures, and non-unions. There are contraindications to the use of PRP. They are the use of anti-platelet and anti-inflammatory medication such as non-steroidal anti-inflammatory drugs, warfarin, aspirin, as well as high dose fish oil.

Patients with anemia, low platelet counts, and clotting or bleeding disorders are also not good candidates. There is some evidence that cigarette smoking also has a negative effect on the effectiveness of PRP.

In the spine, the sacroiliac joints, facet joints, costotransverse (rib) joints, and spinal ligaments have been treated.

In the shoulder, rotator cuff injuries, glenohumeral ligament issues, as well as arthritis involving the acromioclavicular joint and glenohumeral joint have been treated.

Elbow disorders such as medial and lateral epicondylitis, ulnar collateral ligament strains, biceps tendon partial tears, and osteoarthritis have been treated with PRP.

Problems in the wrist and hand such as osteoarthritis, tendon problems, and ligament strains have also responded to PRP.

In the hip, hamstring tendinosis, gluteus medius tendinosis, as well as osteoarthritis have responded to PRP.

Knee issues that have responded to PRP treatment include: tendinosis of the patellar and quadriceps tendon, collateral ligament strains, meniscus tears, osteoarthritis, and bursitis.

Disorders in the ankle and foot that have successfully responded to PRP are: tendinosis in the Achilles, peroneal, and posterior tibial tendons, as well as plantar fasciitis, osteoarthritis, ligament tears.

So it is abundantly clear that in the right hands, PRP can be a useful adjunct to current treatment measures for musculoskeletal injuries. One caveat: PRP must be administered using tenotomy technique and ultrasound guidance by an experienced practitioner.