PRP (Platelet Rich Plasma), also known as Platelet Rich Plasma, is a method prepared from one’s own blood and used to stimulate and regulate healing in many areas of medicine. With the help of dozens of PRP preparation kits in use, 10-60 ml of blood is taken from the patient, this blood is separated with disposable special filters and centrifuge devices and the unwanted parts are removed. The separated 2-6 ml portion contains platelet-rich plasma and has found application in many musculoskeletal injuries.
The main task of platelets is to form the clot that stops the bleeding that occurs as soon as an injury occurs. In addition, they contain dozens of growth factors that contribute to tissue repair and healing. When these growth factors are given to the environment, they help repair damaged tissues by supporting the body’s own healing mechanisms.
PRP is not a drug. It does not contain any substance other than the person’s own blood. Its effect is limited to the area where it is applied, unlike drugs. It does not cause side effects in the kidney, liver and stomach. It does not contain cortisone. PRP contains growth factors that allow cells in the body’s healing response to reach the area and multiply.
These factors also have positive effects on the formation of new vessels, the prevention of infections and the production of tissue proteins. In recent years, forms containing hyaluronic acid have also been developed for some intra-articular PRP applications. In this type of injections, PRP is first prepared from the blood taken from the patient, then mixed with hyaluronic acid and injected into the joint.
ARE THERE STEM CELLS IN PRP?
Contrary to popular belief, very few stem cells are found in PRP. Stem cells are found in small numbers in many tissues in the musculoskeletal system such as muscle, bone marrow, adipose tissue, synovium (thin membrane layer that covers the joint). For the therapeutic use of stem cells, either the tissue taken from the bone marrow must be concentrated with special techniques or the cells obtained from the above-mentioned tissues must be produced in a laboratory environment and applied in a second session a few weeks later. PRP application kits and bone marrow concentrate application kits are different.
CAN PRP BE APPLIED TO OTHER PEOPLE?
Although blood products can be applied to other people when needed, PRP can only be applied to the person himself. Thus, the risk of transmitting diseases such as hepatitis and AIDS is eliminated. PRP should be used within a few minutes after preparation, its effect will decrease significantly after the 10th minute.
HOW MANY TIMES AND HOW IS PRP APPLIED?
There is no definite evidence about how many times PRP should be applied. While a single application is sufficient in some cases, it can be repeated at intervals of 2 or 3 weeks depending on the response of the disease. PRP application should be done under sterile conditions. Today, PRP can be applied in several ways. The most common method of administration is injection into the target tissue with the help of a needle. Another application method is to place the PRP prepared in the form of jelly on the area where it is desired to have an effect during the surgery. Finally, PRP can be used by impregnating these implants during surgery to increase the effectiveness of implants placed for cartilage repair.
IN WHICH DISEASES IS PRP EFFECTIVE?
PRP has been applied in different fields of general surgery, plastic surgery and orthopedics. Among these, orthopedic uses can be summarized under several headings.
Chronic tendinopathies: 79-93% successful results have been obtained with PRP applications in tennis elbow. This rate is slightly better than the results obtained with cortisone application, and the disadvantages of cortisone application are avoided. Similarly, 80% successful results have been reported with PRP applications in Achilles tendon diseases, chronic patellar tendon injuries and plantar fascitis disease. In this patient group, PRP should be preferred in cases where adequate results cannot be obtained with rest, medications and physical therapy methods.
Knee ligament injuries:There are studies showing that PRP injections result in faster recovery and return to sports in a shorter time after collateral ligament injuries, which are common in athletes.
Muscle injuries:Again, faster return to sports has been reported with PRP injections in muscle pulling or intramuscular bleeding seen in athletes.
Osteoarthritis (Calcification): In the early stages of knee osteoarthritis, PRP injections have been reported to reduce pain and improve function for 6 months. However, PRP treatment does not change the natural course of the disease and cannot reverse the existing wear and tear. Comparative studies have shown that PRP injections are slightly superior to hyaluronic acid injections.
In support of cartilage repair: Treatment of cartilage injuries in young patients is still an important problem. Today, it is not possible to reconstruct the damaged articular cartilage with its original architectural structure and biological properties. PRP applications have come to the fore to increase the quality of the repair tissue created by many treatment methods.
Biological covers called matrix, which are used in cartilage repair, are synthetic and soluble structures that provide the appropriate environment for the development of cells and transformation into cartilage. It has been shown that a higher quality of repair tissue can be obtained with PRP or bone marrow concentrate applications with these matrices. This is the most studied and most exciting area of PRP today.
As an aid during surgery: In various studies, the jelly form of PRP has been used in knee replacement, repair of shoulder muscle ruptures and anterior cruciate ligament repairs. Although it reduces postoperative bleeding, it has not been shown to have a positive effect on outcomes.
WHAT SHOULD I DO AFTER PRP APPLIED?
After PRP is applied, it is appropriate to apply ice and use paracetamol derivative pain relievers for pain. Non-steroidal anti-inflammatory drugs (such as voltaren, naproxen, magesic) are not recommended as they will reduce the effectiveness of PRP application. Rest is an important part of recovery, and therefore, compelling exercise and sports are not recommended after PRP application. Simple stretching exercises can be done, but resistance-to-weight training should be avoided.
Bandages and simple wristbands can be applied. The time to return to sports and training can vary between 3-6 weeks. During this period, it is necessary to avoid the use of non-steroidal anti-inflammatory drugs. It would be appropriate to ask your doctor about the drugs you can use after PRP application and your return to sports.
ARE THERE ANY COMPLICATIONS AND SIDE EFFECTS OF PRP APPLICATION?
After PRP application, there may be increased swelling and pain at the injection site at a low rate. This pain may last for several days, but this problem can be relieved with simple painkillers and ice application. Apart from that, PRP has no side effects on internal organs such as kidney, liver, stomach. Since the person’s own blood is used, there is no risk of allergic reaction. There is no information about its use in pregnancy.
DOES PRP AFFECT DOPING TESTS?
The use of PRP as an injection in the musculoskeletal system has been excluded from the scope of banned substances and applications by the International Olympic Committee’s World Anti-Doping Agency (WADA) and is not considered doping. Since it is not a drug that is excreted in the urine, it cannot be identified in doping tests. PRP injected intravenously is still prohibited.