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Autologous Rich Plasma
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Autologous 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 Autologous 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.

What are the advantages and disadvantages of Autologous Rich Plasma?

What are the advantages of Autologous Rich Plasma?

If you look at the basic science studies, PRP supports the growth of articular cartilage cells (chondrocytes) in the laboratory by nourishing chondrocytes and growing extracellular matrix. In other words, it grows the constituents of cartilage around it, within a culture medium. This ability is known as being ‘chrondrogenic’. PRP has also been shown to be chondrogenic by making stem cells, whether they are derived from bone marrow or from fat, go down a more cartilage-producing lineage than a bone-producing lineage, which could be very promising area of research in the future.

What has been problematic is the translation of those basic science studies to clinical practice. There are numerous case reports in which PRP has been used for treating cartilage injury or osteoarthritis, and they have reported good results. However, there are very few well-performed randomised clinical trials that have shown a clear, long-lasting clinical effect with PRP. Systematic reviews of the available evidence have shown that the use of PRP has led to improved clinical outcomes in patients with osteoarthritis. Furthermore, the use of PRP has also been shown to have a beneficial effect for the treatment of osteochondral defects. A recent systematic review found that compared to the use of HA and a placebo saline injection, that the use of PRP was associated with some beneficial effects in terms of clinical outcomes in patients with mild to moderate knee OA. Although these effects lasted up to 6 months, the use of PRP should be carefully studied because it was associated with a slight higher adverse effect rate.

The limited literature available on PRP suggests that the type of patient who may benefit from a PRP injection is one with mild to moderate arthritis and is not a candidate for surgical intervention. Although the literature is limited, some surgeons are also using PRP to augment cartilage repair and it will be interesting to see the results of a high quality randomised study that looks at the outcomes of this promising treatment modality.

What are the disadvantages of Autologous Rich Plasma?

Although PRP is derived from the patient, there are still risks involved with its use. There is evidence in the literature that suggests that injections of PRP into ligaments, particularly into the patella tendon for patellatendonitis, cause an inflammatory reaction. These effects have largely been seen with PRPs that are leucocyte, or white cell, rich, but more studies are needed to determine if the use of ‘white blood cell depleted’ PRP would help prevent this reaction.

Major impedance to the use of PRP is its extremely high cost, which is typically not covered by your insurance company. Therefore, it is important to discuss the use, risks and benefits of PRP with you healthcare provider prior to making a significant financial investment.

Further reading
  • Filardo G, Kon E, et al. Platelet-rich plasma: why intra-articular? A systematic review of preclinical studies and clinical evidence on PRP for joint degeneration. Knee Surg Sports Traumatol Arthrosc. 2013.
  • Kon E, Filardo G, et al. PRP for the treatment of cartilage pathology. Open Orthop J. 2013;7:120-128.
  • Willits K, Kaniki N, et al. The use of platelet-rich plasma in orthopedic injuries. Sports Med Arthrosc. 2013;21:225-230.
  • Khoshbin A, Leroux T, et al. The efficacy of platelet-rich plasma in the treatment of symptomatic knee osteoarthritis: a systematic review with quantitative synthesis. Arthroscopy. 2013 Dec;29(12):2037-48.
  • Hsu WK, Mishra A, et al. Platelet-rich plasma in orthopaedic applications: evidence-based recommendations for treatment. J Am Acad Orthop Surg. 2013 Dec;21(12):739-48.
Blood is a mixture…
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