What is Platelet-Rich Plasma (PRP)
Platelet-rich plasma (PRP) therapy is one of the most common regenerative medicine procedures performed today. PRP, which in our case is known as super-concentrated platelet therapy and utilizes specific protocols from industry-leader Regenexx, uses a precise mechanical centrifugation process to refine a patient’s own blood and create a substance containing a much higher concentration of platelets than that which is typically found in unprocessed blood. These platelets, which are responsible for the clotting process that the body uses to slow and stop bleeding, play an integral role in the healing process due to the specialized proteins, called growth factors, that comprise them. Growth factors are known to promote healing, fight inflammation, and drive recovery.
By using advanced imaging guidance to precisely deliver this highly-concentrated preparation of healing cells to the site of injury, PRP therapy can initiate the healing process and repair damaged or diseased tissue, thereby reducing pain and increasing function without the need for major surgery. However, it is absolutely critical that the orthobiologic payload contained in a PRP injection be precisely targeted at the site of injury. If a PRP injection is delivered blindly into the joint space, it will only address the “low hanging fruit” of a given injury. Therefore, in order to maximize a patient’s chances of recovery, a physician must precisely target the injection on the injured ligaments, tendons, or bones, completely bathing them in the PRP mixture.
In the case of more severe injuries like a meniscus tear, PRP alone may not be enough to heal the injured tissue. While PRP injections might help manage the symptoms of pain and diminished function, it may not provide for complete healing of a meniscal tear. In these cases, it may be more appropriate to use cell therapy from bone marrow, fat or adipose tissue.
What is a Meniscus Tear?
The meniscus is a crescent-shaped piece of cartilage that acts as a cushion and a stabilizer between the femur (thigh bone) and the tibia (shinbone). Each knee contains two menisci, the lateral and medial meniscus, which can tear from an acute injury, especially twisting with a load on the knee, or over time from degeneration caused by the natural process of aging. Common symptoms of a meniscus tear include pain, particularly along the joint line; swelling; stiffness; and difficulty extending the leg.
Types of Meniscus Tears
There are four common types of meniscus tears, generally best described by the tear pattern they create.
Most meniscus tears, contrary to popular belief, should NOT be managed with an arthroscopic or surgical “clean out.” There is clear evidence to show that arthroscopic debridement is not the most effective therapy for many meniscus tears, and in some cases can actually advance the arthritic process making joint replacement much more likely. In fact, the British Journal of Medicine strongly recommended against arthroscopy in almost all cases of knee arthritis and meniscal tears. The meniscus tears that should be managed non-surgically include
- Degenerative tears, which have ill-defined borders as they are caused by pressures and disease processes that can change over time.
- Flap tears, in which the tear starts centrally and spreads to the edges, leaving a flap of cartilage.
- Radial tears, which start on the edge of the meniscus and slice directly to the middle, leaving no flap.
- Bucket handle tears, in which the tear is centered in the meniscus and does not spread to its edges, giving it the appearance of a doughnut and eliminating the critical center of the cartilage structure.
In addition to the mechanics of the tear, meniscus injuries are also classified into three grades by severity. Mild tears generally have minor pain and swelling but can heal on their own within four to six weeks with minimal intervention. Moderate tears have greater pain and swelling that worsens in the two to three days following an injury and are generally accompanied by joint stiffness that makes extending the knee difficult. If left untreated, the effects of a moderate meniscus tear can linger for years. Severe tears generally have even greater pain, stiffness, and swelling, accompanied by clicking, popping, or locking caused by fragments on the meniscus moving into the joint space and blocking the free range of motion in the knee.
Can PRP Heal a Meniscus Tear?
As a result of the rapidly increasing interest in non-surgical, orthobiologic treatments for common musculoskeletal injuries, numerous studies around the world have been undertaken to examine the safety and efficacy of PRP and cell injections for the treatment of meniscus tears. These studies have proven the safety of this procedure and, equally as important, have shown that PRP, bone marrow, and fat can be used as a viable, efficacious, and long-term management for meniscus tears. This holds true both as an adjunct and stand-alone treatment, meaning PRP can be used on its own to treat meniscus tears or in tandem with surgery for severe, or Grade 3, tears. Furthermore, RestorePDX has seen numerous patients experience similar results, and we’ve witnessed a number of drastic, objective changes in patients’ MRI studies following targeted PRP and/or cell therapy.
However, one important distinction to make is the fact that these studies all highlight the critical importance of precision delivery to the site of injury. Simply injecting the PRP mixture into the joint space will not drive the healing and recovery seen both in these studies and in the patients at RestorePDX. The injured tissues must be targeted directly, bathing the site of injury in a precisely formulated PRP/cell mixture. And at the end of the day, the only way to perform this procedure with that level of precision is by using ultrasound guidance in the hands of an experienced, qualified regenerative medicine physician.
In short, it can only be accomplished with an approach like that of RestorePDX!
What to Expect from PRP and Cellular Therapy
PRP and cell therapy is a safe, painless procedure performed in the outpatient office setting. The procedure begins with a blood draw, similar to that which is performed to undergo routine lab work. The blood is then refined using a precise, calculated centrifugation process to separate the blood into its component parts: plasma and red blood cells. The precise settings and duration of the centrifugation process will determine the exact ratio of platelets in the final preparation, and different injuries and patients will respond better to different preparations. It’s important that any physician performing PRP intimately understands the nuance of the procedure and does not approach preparation with a “one size fits all” mentality, as is, unfortunately, the case in many practices.
Cell therapy is a more powerful, albeit also more invasive, therapy in the regenerative medicine armamentarium. The current standard of care favors the use of autologous (the patient’s own) cells for these joint treatments. The required cellular product is harvested from the bone marrow or from fatty (adipose) tissues using a small needle and imaging guidance. The entire process takes 20-30 minutes, is relatively painless, and the needle is so small that only a bandage is required in recovery; in short, no sutures, and very little post-procedure discomfort!
After the preparation is complete, the team at RestorePDX will use ultrasound guidance, and/or fluoroscopic guidance, to maneuver the needle to the precise location needed to deliver the orthobiologic payload to the site of injury. Once in position, the injection will be used to bathe the inflamed, damaged tissue with healing platelets. Then you’re up, and out the door on your way home, and on your journey towards a more natural, self-driven healing!
While some injuries can be treated with a single injection therapy, others may require repeat visits, and the exact schedule for your injections will be discussed and laid out by our team during your first visit. If you think you might be a candidate for PRP therapy, please reach out to the team of RestorePDX today; we look forward to serving you!