Regenerative Medicine

What is Regenerative Medicine?

The human body has the natural ability to heal itself in many ways. A cut to the skin repairs itself, broken bones mend and a living-donor's liver regenerates in a few weeks. Imagine if scientists could capture this naturally occurring ability to heal and apply it to a wide range of conditions.

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Regenerative medicine goes beyond disease management and prescribing medications to focus on regenerating and restoring the body itself to a state of well-being through science like platelet rich plasma (PRP).

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What is PRP?

PRP or Platelet Rich Plasma is the liquid part of blood (plasma) that has been separated from the red blood cells and white blood cells and concentrated with a higher proportion of platelets than would normally be found in blood.  Platelets are typically thought of as being important in the clotting of blood.  However, they also contain large amounts of growth factors.  These growth factors have a significant role in healing tissues after injuries.  PRP can dramatically increase the concentration of platelets in the plasma and therefore increases the amount of growth factors as well.

 

How is PRP created?

PRP is made by drawing blood from a patient and then using a centrifuge to separate the different parts of the blood.  The plasma and platelets are drawn up and then plasma is removed until the desired concentration of platelets is achieved. At Big Trees MD, we precisely adjust our PRP so we have the concentration that is right for the procedure we are doing, a process we refer to as leukocyte-poor (LP-PRP) or leukocyte-rich (LR-PRP).  Typically, effective levels of platelets are between 5 to 7 times the concentration found in normal blood.  This highly concentrated plasma is then used for injection or other treatments in the same patient. 

 

How does PRP work?

The increased concentration of platelets, and therefore growth factors, have been shown to speed up and enhance the body’s natural healing process.  Using targeted injections of PRP, we can stimulate healing to occur exactly where it is needed.  PRP is often referred to as regenerative medicine due to it’s ability to promote the body to heal tissues.

 

What can PRP treat?

PRP is emerging as an effective treatment for a variety of problems.  Most traditionally, PRP has been used to treat sports and musculoskeletal injuries as well as pain from osteoarthritis.  Ligament and tendon strains are common uses and many professional athletes have turned to PRP to help speed up recovery from injuries that used to be reserved to medications, physical therapy or surgeries.  PRP treatments have been shown to be effective for joint pain due to osteoarthritis or wear and tear injuries that may typically require steroid injections or even surgery as well.

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But, that’s not all.  PRP is often times being used for more cosmetic reasons and hair loss as well.  Treating the skin with PRP therapy can greatly reduce wrinkles, scars, and imperfections and help promote collagen repair that helps bring out the more youthful looking skin.   PRP also has been shown to be very effective in promoting hair regrowth for problems with baldness or thinning hair.

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How does PRP compare to Steroids or Synvisc?

Platelet-Rich Plasma (PRP):

PRP is an autologous blood product enriched with platelets, which release growth factors and cytokines that may promote tissue repair and reduce inflammation. PRP is usually administered in one to three injections spaced a week apart. Evidence suggests that PRP provides superior pain relief and functional improvement compared to corticosteroids and hyaluronic acid, with benefits lasting up to 12 months.

 

PRP has shown the highest likelihood of improvement in both pain and function scores in network meta-analyses.

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Synvisc (hylan G-F 20):

Synvisc is a viscosupplementation agent composed of hylan G-F 20, a cross-linked hyaluronan. It is typically administered as a series of three weekly injections. Synvisc aims to restore the viscoelastic properties of synovial fluid, thereby reducing pain and improving joint function. Studies have shown that Synvisc can provide pain relief and functional improvement comparable to NSAIDs and corticosteroids, with effects lasting up to 26 weeks.

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Cortisone:

Corticosteroids, such as triamcinolone acetonide and betamethasone, are potent anti-inflammatory agents. They are usually administered as a single intra-articular injection, with the option for repeat injections if necessary. Corticosteroids provide rapid pain relief, often within 24 hours, but their effects are generally short-lived, typically lasting from a few weeks to a few months. Studies indicate that corticosteroids are effective for short-term pain relief but may not offer sustained benefits compared to Synvisc or PRP.

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In summary, Synvisc offers moderate-term relief, corticosteroids provide rapid but short-term relief, and PRP offers longer-term benefits in pain and function for knee OA.

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Can I get a PRP injection after a Cortisone or Synvisc injection?

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Yes, it is possible to receive platelet-rich plasma (PRP) injections after having had a corticosteroid or Synvisc (hylan G-F 20) injection, but certain considerations should be taken into account. 

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After corticosteroid injections, it is generally recommended to wait a period of time before administering PRP. This is due to the potential for corticosteroids to suppress the inflammatory response, which could interfere with the regenerative effects of PRP. A study by Paschos et al. suggests waiting at least 4 weeks after an intra-articular corticosteroid injection before performing procedures like arthroscopy to minimize the risk of postoperative infection. This interval may also be prudent before administering PRP to ensure that the corticosteroid's effects have diminished.

 

After a Synvisc (hylan G-F 20) injection, there is no specific contraindication to receiving PRP after a viscosupplementation injection. However, it is important to consider the timing and the patient's overall treatment plan. Synvisc is used to provide temporary relief of osteoarthritic symptoms, and PRP is often used for its potential regenerative properties. Combining these treatments may be beneficial, but the timing should be optimized to maximize the therapeutic effects of each.​

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In summary, PRP can be administered after corticosteroid or Synvisc injections, it is advisable to wait at least 4 weeks after a corticosteroid injection to avoid potential interactions and to ensure the best possible outcome for the patient.

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