PRP - Platelet-Rich Plasma Therapy
What is PRP?
PRP, or “platelet-rich plasma,” is a revolutionary new treatment for chronic sports and musculoskeletal injuries that is taking the sports medicine and orthopedic community by storm. Professional and recreational athletes alike credit PRP treatment for enabling them to get back in the game, and patients with joint arthritis are experiencing less pain and greater function.
Drs. Tortland and Kozar have been performing PRP treatments since December 2007, making them among the first--and most experienced--physicians in the country offering this treatment.
Why Does PRP Work?
Platelets are a specialized type of blood cell. Blood is made up of
93% red cells (RBCs), 6% platelets, 1% white blood cells (WBCs), and plasma. The goal of PRP is to maximize the number or concentration of platelets while minimizing the number of RBCs. Generally speaking, the higher the concentration of platelets, the better.
Most people associate platelets with clot formation. While that
certainly is an important function of platelets, they are also very much
involved in injury healing. Human platelets are naturally extremely rich in connective tissue
growth factors. Injecting these growth factors into damaged ligaments, tendons, and joints stimulates a natural repair process. But in order to
benefit from these natural healing proteins, the platelets must first
be concentrated. In other words, PRP recreates and stimulates the
body’s natural healing process.
How is PRP Done?
In the office, blood is drawn from the patient (just like getting a blood test) and placed in a
special centrifuge. The centrifuge separates the RBCs, and the remaining platelets and plasma are then highly concentrated. (The WBCs, which comprise only a fraction of the total cells, go along for the ride with the platelets and plasma.) The red blood
cells are discarded, and the resulting platelet concentrate is used for
Unlike many other practices, at Valley Sports Physicians all of our PRP injections are given under direct ultrasound guidance to insure accurate placement of the platelet concentrate in the damaged area. In fact, Drs. Tortland and Kozar are nationally-recognized experts in musculoskeletal ultrasound.
The entire treatment, from
blood draw, to solution preparation, to injection, takes 30-40 minutes. Before injections are given the skin and underlying tissue is first anesthetized to minimize the discomfort.
How Often are Injections Given?
After the initial treatment, a follow up visit is scheduled 6-8
weeks later to check on healing progress. Some patients respond very well to just one treatment.
However, typically 2-3 treatments are necessary. Injections are given every 8-12 weeks on average.
What Conditions Benefit From PRP?
PRP treatment works best for chronic ligament and tendon
sprains/strains that have failed other conservative treatment,
- Rotator cuff injuries, including partial-thickness and full-thickness tears
- Shoulder pain and instability
- Tennis & golfer’s elbow
- Hamstring and hip strains
- Knee sprains and instability
- Patellofemoral syndrome and patellar tendinosis
- Ankle sprains
- Achilles tendinosis & plantar fasciitis
- Knee, hip, and other joint osteoarthritis
- Sports hernias & athletic pubalgia
- Other chronic tendon and ligament problems
In addition, PRP can be very helpful for many cases of osteoarthritis
(the "wear & tear" kind). PRP can help stimulate a "smoothing over" of the roughened and arthritic cartilage, reducing the pain and disability of arthritis. This includes:
- Knee arthritis
- Hip joint arthritis
- And other joint arthritis
Is PRP Covered by Insurance?
Most insurance plans, including Medicare, do NOT pay for PRP injections.
Do PRP Injections Hurt?
The level of discomfort of the treatment depends in part on the area being treated. For example, injections given into a joint often are minimally uncomfortable and in some cases painless. Injections given into tendons tend to be more uncomfortable. There is usually moderate pain for the next
For the first week after the injections it is critical to
avoid anti-inflammatory medications, including Advil, Motrin,
ibuprofen, Aleve, Celebrex, and Mobic. These will interfere with the healing
response. Tylenol is OK. Your doctor may prescribe pain medication also for post-injection discomfort.
When Can I Expect to See Improvement?
On average, most patients start to see signs of improvement anywhere from 4-8 weeks after treatment. This can be less overall pain, an ability to do more activity before pain sets in, and/or faster recovery from pain.
Are There Risks With PRP?
Anytime a needle is placed anywhere in the body, even getting blood
drawn, there is a risk of infection, bleeding, and nerve damage.
However, these are very rare. Other complications, though rare, can
occur depending on the area being treated, and will be discussed by
your doctor before starting treatment. Because PRP uses your own blood, you cannot be allergic to it.
What is the Success Rate?
Studies suggest an improvement of 80-85%, though some arthritic joints, namely the hip, do not respond as well. Some patients experience
complete relief of their pain. In the case of tendon and ligament injuries the results are generally permanent. In the case of joint arthritis, how long the treatment lasts depends partly on the severity of the condition. Mild arthritis may not need another round of treatments. More advanced arthritis, on the other hand, typically requires a repeat course of treatment, usually in 1-3 years.
Will PRP Regrow New Cartilage In My Joint?
The goal of PRP treatment is to reduce pain and to improve function. While there is some weak evidence that treatment occasionally does result in increased cartilage thickness, the important point to keep in mind is that the cartilage lining the joint surfaces has no pain fibers! For example, often we see patients with knee or hip arthritis where the joint that does NOT hurt has WORSE arthritis on x-ray! Pain from arthritis is very complex and involves far more than just how thick the cartilage is.
Will PRP Help Me Avoid A Joint Replacement?
This is a frequently asked question. In the case of mild arthritis, PRP treatment may halt the development of further arthritic decay. However, in advanced arthritis, as noted above the goal of treatment is to reduce pain and improve function. In some cases the arthritis is so severe that PRP is not a viable option. In severe or advanced osteoarthritis PRP treatments may help delay the eventual need for a joint replacement, but it is rarely a treatment that eliminates the need for it. Some patients are not surgical candidates because of other medical conditions. Other patients simply do not want joint replacement surgery under any circumstance. In these cases PRP may be a viable treatment option, but it is not a permanent solution in these specific situations--treatments will need to be repeated periodically.
What Does PRP Treatment Cost?
At Valley Sports Physicians the cost of PRP treatment is based on the level of complexity involved in treating a given area(s). Prices range from $700 to $1100 per treatment. If two joints or areas are treated at the same time, the cost is NOT double-- there is a slight increase. A cash discount of $50 is given if payment is made at the time of service.
In the case of moderate-to-large tendon and muscle tears, such as rotator cuff, tennis elbow, and Achilles, simple PRP may be less effective because the liquid PRP has less tendency to stay in the tear; it leaks out. In order to combat this we often will combine PRP with fat to create a gel that fills the defect and promotes more effective healing.
Likewise with more advanced joint arthritis, the fat acts a matrix to help hold the platelets in place and also helps activate them to release their growth factors more effectively. Think of a garden trellis that helps hold a growing vine in place. In fact, for moderate-to-advanced arthritis, our standard treatment is to combine the PRP with the fat due to the fact that it seems to work that much better than PRP alone.
The fat is harvested from the patient's belly, buttocks, "love handles," or hips using a gentle liposuction technique. (The amount harvested generally is NOT enough to have a cosmetic effect.) The fat is concentrated via centrifuge, and the resulting fat concentrate is subsequently mixed with the PRP to create a gel. The gel fills the tear in the case of tendons/muscles, and helps maintain more constant contact with the joint surfaces in the case of arthritis.
Fat grafting adds an additional $700 to the cost of treatment.
To get maximum benefit from the treatment, and to help prevent
re-injury, a specially-designed rehabilitation and exercise
program is incorporated into your treatment. This helps the newly
developing connective tissue mature into healthy and strong tendon or
ligament fibers. In addition, nutritional support, such as glucosamine, MSM, and increased protein intake can help the healing process.
View a CNN news story on PRP.
View a Fox News story on PRP.
Download a 2009 review article on PRP from the American Academy of Orthopedic Surgeons.
Download our informational handout.
Download a scientific review article on PRP.
Read a New York Times article on PRP.
Read a Philadelphia Inquirer article on PRP.