Platelet-rich plasma injections are a new technique that may help heal painful knee injuries.
Athletes such as Tiger Woods and Rafael Nadal are rumored to have undergone a relatively new treatment that involves injections of platelet-rich plasma.
The technique uses plasma from the individual’s own blood.
Proponents say the therapy offers cutting-edge treatment for previously debilitating injuries, including painful knee problems due to osteoarthritis.
However, guidelines from the American College of Rheumatology and the Arthritis Foundation strongly recommend that people do not use this therapy because the treatment has not been standardized. This means that a person cannot be sure what an injection contains.
Platelets are fragments of cells in the blood and are best known for their ability to help the blood clot. However, they also contain a variety of proteins called growth factors.
Platelet-rich plasma therapy is built on the notion that these growth factors can support healing. The process, which uses the person’s own blood, involves separating the blood cells from the plasma, the liquid part of the blood. The process increases the number of platelets, which are then put back into the plasma.
This plasma now contains a higher than usual concentration of platelets, which a doctor can inject into an area damaged by disease and injury.
Research has shown that platelet-rich plasma can help with knee pain, and may be particularly helpful for those who have had no success with other treatments.
Platelet-rich plasma has been used to treat:
- instability and pain in various joints.
- injuries throughout the body, including in the knee, shoulder, elbow, and other joints.
- carpal tunnel syndrome
- chronic pain conditions
- sprains and strains
Although researchers think that growth factors play a role in healing, it is unclear precisely how platelet-rich plasma aids healing. It does not work for everyone, but people who see improvements usually experience healing over several weeks.
Among people who experience a reduction in pain after protein-rich plasma treatment, the results are usually permanent. However, some people may need follow-up treatments if their pain returns.
Some articles about platelet-rich plasma talk about protein-rich plasma. This can be confusing, but the two terms mean basically the same thing
Both blood platelets and plasma are rich in proteins. These proteins include growth factors and numerous other compounds that can support healing. So, regarding definition, either term is acceptable.
Although platelet-rich plasma injections are a relatively new treatment, preliminary research suggests that they can be very effective for knee pain.
A 2009 study evaluated the effects of platelet-rich plasma injections on 100 people with degenerative cartilage lesions in their knees. Participants saw significant improvements in pain 6 months after the treatment.
At 12 months, the participants had begun to experience pain again. This suggests that some recipients of platelet-rich plasma injections may need follow-up treatment.
A 2012 study of 120 patients with various degrees of knee osteoarthritis compared platelet-rich plasma injections to injections with hyaluronic acid. The people who had platelet-rich plasma injections experienced greater improvements in pain and functioning.
A 2013 study followed 78 patients with osteoarthritis in both knees. Compared with a group that received placebo injections, people that received platelet-rich plasma injections also experienced significant reductions in pain.
Most people saw results within a few weeks and continued to experience pain relief for the entire 6 months of the study. At the 6-month mark, however, most had begun to experience pain again.
Other studies have found that platelet-rich plasma can effectively treat injuries in other areas of the body. For instance, a 2006 study found a 60 percent improvement in elbow tendinosis in people who underwent platelet-rich plasma injections.
Most studies have found few or no side effects, and suggest that platelet-rich plasma is a safe, less invasive alternative to knee surgery. Because injections involve the person’s own blood, an allergic or other adverse reaction is less likely than with other injections.
Treatment begins when a doctor draws blood from a vein, usually in the arm. The blood is separated out to create the platelet-rich plasma, which a doctor injects directly into the area in need of treatment.
This process sometimes requires the use of an ultrasound machine. An ultrasound image helps the doctor find the right injection site. The ultrasound is painless. During the procedure, a doctor or technician will put gel on the skin and place an ultrasound device on the area of the injection.
Some people worry about pain. Drawing blood is usually only mildly painful with a quick, sharp sticking sensation. Some people feel dizzy when their blood is drawn.
The injection itself may hurt, depending on how sensitive the joint is and the precise location of the injection. Relaxing and deep breathing may help reduce pain. The injection itself takes only 1-2 minutes.
The injection site might be tender after the injection, but should not be painful. Some people develop a bruise or small wound at the site of the injection.
In the weeks after the injection, the following steps can increase the likelihood that treatment will work:
- Avoiding strenuous exercise, particularly movements that put weight on the knee joint.
- Avoiding using anti-inflammatory medications, such as aspirin and ibuprofen. These drugs can interfere with treatment. People who need pain relief can ask their doctors about other options.
- Wearing a splint for the first few weeks to stabilize the joint. Some providers recommend using crutches to avoid putting unnecessary weight on the knee.
- Using cold compresses to decrease swelling and reduce pain. Some people find that alternating hot and cold packs is helpful.
- Elevating the joint at night, by sleeping with the knee (or affected joint) raised on a few pillows.
- Following all instructions from the doctor.
People should immediately contact their doctor if swelling is severe, the pain increases, or they experience a subsequent injury, such as a fall.
Following treatment, physical therapy can help restore movement to the joint, reduce the risk of future injuries, and prevent the condition worsening.
Most people start physical therapy 1-2 months after treatment. Anyone undergoing platelet-rich plasma injections should ask the provider of their injections for a physical therapy referral.
Platelet-rich plasma injections are an emerging treatment that may help relieve symptoms of a joint injury or osteoarthritis. However, there is a lack of standardization regarding the preparation of the injections.
The Food and Drug Administration (FDA) have made recommendations about how to prepare and store platelet-rich plasma, but the American College of Rheumatology and the Arthritis Foundation note that it is not possible to be sure what the injection will contain.
For this reason, they advise people not to use this type of treatment for osteoarthritis.