To Main Page


To PRP - Prolotherapy
 Directory

  P.R.P & Prolotherapy  

Article Written By:

Dr. Donna Alderman

Medical Director
Hemwall Center for Orthopedic Regenerative Medicine
http://www.prolotherapy.com
info@prolotherapy.com 
28212 Kelly Johnson Parkway Suite 135
Valencia, CA 91355
Tel: (661) 295-1110 
or (818) 957-3000  

To Main Page


About BMOTV™

About BMOTV™

Platelet Rich Plasma (PRP) and Prolotherapy

What is it?
Can it heal soft tissues and bones
 in humans & animals?

To Top

To Top

Platelet Rich Plasma (PRP) Prolotherapy, like Dextrose Prolotherapy,
 is a method of injection designed to stimulate healing. “Platelet rich plasma”
is defined as “autologous blood with concentrations of platelets above
 baseline levels, which contains at least seven growth factors.” 
 Cell ratios in normal blood contain only 6% platelets, however in PRP 
there is a concentration of 94% platelets.  Platelets contain a number of proteins, 
cytokines and other bioactive factors that initiate and regulate basic aspects
of natural wound healing. Circulating platelets secrete growth factors, 
such as platelet-derived growth factor (stimulates cell replication, angiogenesis),
 vascular endothelial growth factor (angiogenesis),
 fibroblast growth factor (proliferation of myoblasts and angiogenesis), 
and insulin- like growth factor-1 (mediates growth and repair of skeletal muscle),
 among others. Enhanced healing is possible when platelet concentration
is increased with PRP. Activated platelets “signal” to distant repair cells,
 including adult stem cells, to come to the injury site. Increasing the volume
 of platelets accordingly increases the subsequent influx of repair and stem cells.
 Because the concentrated platelets are suspended in a small volume of plasma, 
the three plasma proteins fibrin, fibronectin, and vitronectin contribute
 to a repair matrix. You could compare dextrose Prolotherapy
 and PRP this way:

Prolotherapy is like planting seeds in a garden; 
PRP Prolotherapy is planting seeds with fertilizer.



PRP mode of action:  Activated platelets signal for help 
from local repair stem cells.
 

To Main Page

HISTORY OF PLATELET RICH PLASMA THERAPY  
(PRP)

To Main Page

Beginning in the 1990s and continuing until now,
 “growth factors” have been a hot topic in the medical world.
 It is clear that growth factors play a pivotal role in all types of wound healing. 
Investigation into the use of PRP has been reported as early
 as the 1970s, but the necessary equipment was large, expensive 
($40,000 in 1996), and required a large quantity of a patients blood (450 cc) 
and therefore limited to the operating room for large scale surgeries.

 Starting in the early 1990s, multiple reports and studies
 in maxillofacial dental, periodontal surgery, cosmetic surgery,
 and skin grafting showed dramatically
 improved healing with PRP.  

In the early 2000s, the use of PRP expanded into orthopedics 
to augment healing in bone grafts and fractures. Success there encouraged
 its use in sports medicine for connective tissue repair. Mishra and Pavelko, 
associated with Stanford University, published the first human study
 supporting the use of PRP for chronic tendon problems in 2006. 
This study reported a 93% reduction in pain at two year follow up. 

Then, in 2008, Pittsburgh Steelers’ wide receiver, 
Hines Ward, received PRP for a knee medial collateral ligament sprain, 
and the Steelers went on to win SuperBowl XLII. Ward credited PRP
 for his ability to play in that game and his success with this treatment
 was discussed on national television.

To Top

To Top

Since then, other high profile athletes - such as Takashi Saito, 
closing pitcher for the L.A. Dodgers, and golfer Tiger Woods - credit PRP 
for helping them return to their sport. PRP continues to gain wider acceptance
in the sports world with studies continuing to validate the use of PRP for ligament 
and tendon injuries, knee osteoarthritis, degenerative knee cartilage,  
chronic elbow tendonosis, muscle  strain and tears, jumpers knee, 
plantar fasciitis and rotator cuff tendinopathy - albeit some skeptics 
and controversy remains.

As the use of PRP has grown the demand and availability for smaller,
 more portable and affordable machines has also grown. 

There are now several available models which allow the physician
 to create PRP from a small sample of a patient’s blood in the office setting.
 Machines are very affordable and many companies offer a complimentary
 machine with a minimum purchase of PRP preparation kits over a period of time.

However, not all marketed PRP devices are equal; 
they vary in quantity of blood required, platelet concentration, 
viability and number of spin cycles.

 Harvest Technologies was one of the first PRP devices
 to gain FDA approval. This system uses a floating shelf technology
 which preserves the viability of platelets until use.

 In his 2005 text, Marx rated the PReP unit by Harvest Technologies, 
along with PCCS by Implant Innovations, as the two most effective
 and practical PRP devices for physician office use, 
outpatient surgery centers, and wound care center treatment.  
Since then, other companies have produced additional 
effective platelet concentrating systems.

To Main Page

To Main Page

Terms & Policies

Illustration of the split thickness skin graft donor site
 no PRP at 45 days.

To Top

Illustration of the split thickness skin graft donor site 
with PRP enhancement at 45 days. 

About BMOTV™

How To Participate in a Story

What is Prolotherapy?

Prolotherapy is a nonsurgical treatment which stimulates healing.
Short for "proliferation therapy," Prolotherapy is also known as nonsurgical
ligament and tendon reconstruction, or regenerative injection therapy.
Prolotherapy works by stimulating the body's own natural healing mechanisms
 to repair injured musculoskeletal tissue. The treatment originated in the 1930's
 when Dr. Earl Gedney, an osteopathic surgeon successfully treated
 his own severe hand injury. Prolotherapy works by getting the body
 to use its own natural healing mechanisms to repair injured 
and painful joint areas.

To Main Page

To Main Page

Types of Prolotherapy:

 include Dextrose Prolotherapy, Platelet Rich Plasma Prolotherapy 
Referred to as "PRP") or bone marrow and/or fat (adipose)
tissue from an individual's own body which contain adult stem stromal cells 
(known as Biocellular Prolotherapy).
At the Hemwall Center these multiple types of Prolotherapy
are done as needed to achieve the best result. 
We also use diagnostic musculoskeletal ultrasound imaging to detect 
and direct injections to the correct injury site.

To Top

To Top

After Blood is Separated in Centrifuge

Terms & Policies

Top in red:
Cell ratios in a normal blood clot: Red blood cells (RBC), 
platelets (PLTS), and white blood cells (WBC).

 Bottom in Yellow
Cell ratios in a platelet rich plasma:  red blood cells (RBC), 
platelets (PLTS), and white blood cells (WBC). Bottom Yellow

How To Participate in a Story

Peripheral blood smear in normal blood.

To Main Page

A peripheral blood smear of platelet rich plasma.

To Main Page

THE HARVEST MACHINE
(CENTRIFUGE)

To Top

To Top

CREATION AND ACTIVATION OF PRP
A small amount of the patient's blood is drawn (20-120 cc) into a syringe 
with a small amount of citrate (an anti-clotting agent) then typically spun 
for about 15 minutes in a special centrifugation system
 that separates the platelets, blood, and plasma. 
The plasma-poor layer is then drained off and the “buffy coat” plasma layer
 is extracted along with a small amount of plasma and red cells.

In the surgical setting, PRP is activated by the surgeon mixing in calcium
 chloride and/or thrombin to make a gel-like graft and then placing it where
 he/she wants accelerated healing.

 Type I collagen has also been found to be effective in activating and
creating a PRP graft.
 In 2006, Murray et al demonstrated successful increase in healing
 of a central anterior cruciate ligament (ACL) defect in a canine ACL using 
a collagen-platelet rich plasma matrix graft.
 In some musculoskeletal studies, a 10% solution of calcium chloride is 
added to the PRP just prior to injection or is injected simultaneously
via another syringe into the area being injected with PRP.  

Activation also occurs by exposure to tendon-derived collagen released
 by the injured tissue which is being treated. “Peppering” the tissue
 during injection with the needle tip can help ensure endogenous thrombin
 release needed for activation.

Growth Factors in PRP granules are released  when  platelets
  are  activated. 

After  activation,  secretion  of growth  factors  begins  
within  10  minutes. The viability of the platelets and continued release
 of growth factors into the tissue continues for seven days.
Meantime, the platelets stimulate the influx of macrophages, 
stem cells and other repair cells, as discussed previously.

Micro-trauma created by the injection itself also stimulates influx 
of macrophages and growth factors as in the case of dextrose Prolotherapy.

Once the platelets die (average life span 7-10 days), the macrophages 
continue wound healing regulation by secreting some of the same growth factors 
as the platelets did, as well as others. The amount of initial platelets present
 in the wound determines the rate of wound healing and explains why
 PRP used during a surgical procedure speeds recovery.

 This may be because PRP has a strong effect in the early phase
 of healing. Use of a “matrix” such as adipose tissue or
collagen fibers to hold the PRP material has been used
especially in the case of a large defect.   
  

To Main Page

Tear of long head biceps tendon in a 70 year-old patient
 (ultrasound image)
BEFORE PRP TREATMENTS

AFTER 3 PRP INJECTIONS
Resolved tear of long head biceps tendon post three ultrasound
image-guided PRP injections.

To Main Page

To Top

In our upcoming stories we will be testing
the many uses of PRP combined with Fat Transfers
to rejuvenate soft tissues and bones
in the face, gums, neck & hands.

To Top

To Main Page

To Main Page