1. Platelet-Rich Plasma Therapy (PRP Therapy)
What is it and why do we care?
Inservice presented by
Elly Tucker, NAU

2. What is it?
PRP consists of the application of autologous plasma containing a high concentration of platelets
Preparation process includes centrifugation of patient’s own blood to allow for separation of blood components
Can be used as primary treatment or in conjunction with either conservative or surgical treatment
Application via direct injection or stitching
If used as primary treatment, typically will receive a series of injections (2+) each 4-6 weeks apart
Actual parameters depend on physician, injury site, and nature of injury

3. Why is it used? Platelets contain high concentration of growth factors
Thought to increase…
healing
fiber reorganization
cell proliferation
vascularity
tensile strength
May help to decrease pain
Expert opinion supports these claims, more research still needed…

4. Research
A review of studies utilizing PRP therapy found the previous results to be supported
No one benefit occurred in the majority of studies (variable results)
No standardized procedures
PRP therapy parameters often not included
Support for use on lateral epicondylitis
Preliminary results are “promising” for other chronic tendon conditions
Ongoing research into other tissues
Muscles (strains)
Joints (arthritis)
Ligaments (tears, strains)
Bone (fractures)

5. Why do we care? Physical therapy protocol Medication restrictions
Tend to be more conservative
Want to guide healing with mechanical stress
See included protocol
Medication restrictions
No NSAIDs one week prior to application and for one to four weeks post-application (varies with physician)
If having multiple injections, no NSAIDs between treatments
Reasoning: don’t want to inhibit the natural inflammatory process stimulated by the application

6. Other Information Currently legal under the World Anti-Doping Code
Contraindications:
Cancer or metastatic disease
Active infection
Low platelet count
Pregnancy or currently breastfeeding
Insurance coverage varies due to lack of supporting research
Medicare will only cover under very specific circumstances

7. What’s the bottom line?
May provide numerous benefits during the healing process, however there is little research supporting these claims for injuries other than lateral epicondylitis
Autologous procedure, so no harm other than cost ($750+)
Conservative PT protocol
Adhere to NSAID restrictions to allow for greatest healing potential (Tylenol is okay)

8. References
(2014). In Platelet Rich Plasma Injections. Retrieved June 13, 2014, from Baksh, N., Hannon, C., Murawski, C., Smyth, N., & Kennedy, J. (2013, March). Platelet-rich plasma in tendon models: a systematic review of basic science literature. Arthroscopy: The Journal Of Arthroscopic & Related Surgery, 29(3), Retrieved June 12, 2014 Griffin, L. Y. (2010, September). Treating tendinopathy with PRP. In American Academy of Orthopaedic Surgeons. Retrieved June 12, 2014, from Hannafin, J. A. (2010, September). Platelet-rich plasma: Clarifying the issues. In American Academy of Orthopaedic Surgeons. Retrieved June 12, 2014, from Platelet-Rich Plasma. (2011, September). In American Academy of Orthopaedic Surgeons. Retrieved June 12, 2014, from van Ark, M., van den Akker-Scheek, I., Meijer, L., & Zwerver, J. (2012, May). An exercise-based physical therapy program for patients with patellar tendinopathy after platelet-rich plasma injection. Physical Therapy in Sport, 14, Retrieved June 12, 2014