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PRP – Plateled Rich Plasma
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PRP – Plateled Rich Plasma

Blood is a mixture of red blood cells, white blood cells, platelets and a solution of proteins called ‘plasma’. PRP, or ‘platelet-rich plasma’, is a concentrated solution of platelets taken from ‘autologous’ blood; in other words, from your own blood that is then injected to treat a variety of musculoskeletal disorders including cartilage defects and arthritis.

Intended audience

This article is intended for anyone suffering from damage to their articular cartilage and their families who would like to find out about PRP, as well as anyone interested in cartilage problems.

What is PRP – Plateled Rich Plasma?

There are numerous ways of preparing PRP, but, in essence, a volume of blood, ranging from 10–60 ml, depending on the process being used, is drawn from the patient. Commercially available devices are available that can prepare the solution in a one- or two-stage process. Some hospitals and centres with haematology labs can produce the solution themselves using only a centrifuge. However, the most common method is to use a commercial device.

The centrifugation process basically separates the red blood cells, white blood cells and platelets into a number of different layers. One is rich in red blood cells, another layer (the buffy coat) may be rich in platelets and white cells, and another layer will contain platelet-poor plasma. The basic concept behind PRP centers around isolating the layer that the platelet-rich plasma, while trying to leave as many of the red and white blood cells behind as possible. However, depending on the preparation method, some products will create a platelet-rich plasma that either contains lots of white blood cells, known as ‘white blood cell enriched’, or one that is ‘white blood cell depleted’.

The issue here is that a white blood cell enriched solution will contain proteins, known as pro-inflammatory cytokines that can potentially trigger an inflammatory reaction. In other words, it may contain factors that can create inflammation in tissues, be it in the joint or in the soft tissues where the PRP is injected. Depending upon the indication for the PRP, this may or may not be helpful. Recent research would suggest that leucocyte rich PRP might be detrimental to tissue healing.

PRP has been around for many years, but it gained significant popularity in 2006, when it was used to treat the American football player, Hines Ward, who had sustained an injury to his medial collateral ligament (MCL). There was great media attention because this injury occurred about two weeks prior the Super Bowl, which is the championship game and a major sporting event, and it was reported that he was given a PRP injection into his MCL and this allowed him to return and play a significant role in the championship game of the season.

The use of PRP has grown significantly since then. A number of PRP studies were also published around that time, and interest in research into PRP rose exponentially. Although PRP has been investigated extensively in the basic science laboratory, and numerous clinical studies have been published, the evidence justifying it’s clinical use is not very strong. However, because it is relatively harmless and patients appear to like the idea of being injected with a solution derived from their own blood, it’s use has taken off.

Frequently Asked Questions (FAQs)

The main questions that patients who are considering having PRP ask include:

  • Does PRP work?
  • Are there any side effects?
  • What are the downsides?
  • How much is PRP going to cost?
  • Would you have PRP in your own knee or another joint?

While the majority of these questions are covered in general in this topic, you should talk to your physician in detail about the particular type of PRP to be used and the potential risks and benefits, alongside the clinical evidence for that product. You should also discuss any costs you would incur in your healthcare system, and whether they would be covered by your insurance.

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