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What is platelet rich plasma (PRP) and platelet rich fibrin (PRF)?

Platelet rich plasma therapy or PRP is a treatment where your own blood (autologous blood therapy) in a concentrated form of platelets (rich in growth factors and cytokines) is injected into an injured muscle, tendon, ligament, or arthritic joint to treat pain, improve function, and stimulate your own body to heal damaged tissue.

Platelet rich fibrin (PRF) is a second generation platelet concentrate referred to as Injectable Platelet Rich Fibrin Smart Blood with Stem Cells (Shukla 2019).   Platelet Rich Fibrin is an advancement of PRP that requires no additive to prepare, selectively enriching leukocytes, platelets, and growth factors with significantly higher numbers compared to traditional PRP (Choukron 2017).

Injectable Platelet Rich Fibrin (i-PRF) refers to the injectable form of platelet rich fibrin obtained by low speed centrifuge without any anticoagulants (Choukroun 2017).

Injectable Platelet Rich Fibrin (i-PRF) in addition to platelets and growth factors, contains B- and T-lymphocytes, monocytes, neutrophilic granulocytes, and stem cells required for neovascularization and angiogenesis used in healing (Choukron 2017).

More data is needed demonstrating how many leukocytes, growth factors, or platelets within PRF are sufficient for the best possible physiological condition for tissue and bone healing and regeneration.

Some Conditions Dr. Silberman may treat with Platelet Rich Fibrin (PRF) or Platelet Rich Plasma (PRP):
Arthritis of the knee, hip, shoulder, any joint arthritis
Rhuematoid Arthritis (2017 PRP Study on RA)
Chondromalacia Patella
Frozen Shoulder (adhesive capsulitis)
Tennis Elbow (lateral epicondylitis), Tears and Tendonosis
Rotator Cuff Tendonosis and Rotator Cuff Tears
Patella or Quadriceps Tendonosis and Tears (jumpers knee or runners knee)
Achilles Tendonosis, Achilles Tears, PTT Posterior Tibial Tendon Tear
Plantar Fasciitis or Fasciosis (heel pain)
High Hamstring Tendonitis / Tendonopathy
Hamstring and Quadriceps and Gastrocnemius Calf Muscle Tears
Chronic and Acute ligament sprains
Osteochondral defect and cartilage joint injuries
Carpal Tunnel Syndrome
Low back pain, sacroiliac joint pain (SI joint pain), buttock pain
Sports Hernia or Athletic Pubalgia (Adductor Tendon Tear)

What to expect with a PRP injection?
Blood is withdrawn from a vein in your arm with a simple venipuncture.  Your blood is then spun in a centrifuge to concentrate and separate the platelets from the other blood components. The platelet rich plasma (PRP) is then injected under ultrasound guidance into your site of  injury.  Local anesthetic is used to numb the injection entry site.  You may experience some pain or pressure during a tendon injection.  Soreness is expected after the procedure that may last for a few to several days. A small percentage can get severe pain for a few days requiring pain medication.  Two to three treatments may be needed and in some cases up to six for cartilage joint injuries, performed in 3-4 week intervals.  Most patients in my practice have required one injection.  You may see improvement in as little as two weeks but it can take up to 6 weeks.  

Prior to PRP Injection:
Eat clean.  You are what you eat.  You do not NOT want a lipemic or fatty blood sample.  Your plasma should be clear, yellow.  Do NOT take any NSAIDS (anti-inflammatories) such as ibuprofen, motrin, advil, naproxen, aleve, aspirin, etc. for at least 1 week prior to the PRP procedure.  Do not stop any
prescribed medications without consulting the prescribing physician.  Stop any supplements that may affect platelets such as tumeric, flaxseed oil, primrose oil, black currant seed oil, krill oil, etc.

Post PRP Injection:
Most patients can drive home themselves but for right lower extremity PRP a driver may be preferred.  I have not had to place any one on crutches post PRP. If your achilles was injected with PRP, a boot may be worn until pain subsides in a few days.  Do not take any NSAIDs or anti-inflammatories listed above for at
least 2 weeks after your PRP injection.  Pain medication may be prescribed for the small percentage (estimated 1 in 10) who get severe pain for 1-2 days.  I do not recommend icing after PRP injection.  Compression wrap may provide relief.   For the first week you should lay low, even if you feel great; we have had patients return to activity too soon and then feel as if they undid the work of the PRP.  Most can resume therapy exercises and light sport activity after week 2.  Every case is unique.  Follow-up appointment is made 4 weeks post PRP.

What is the cost of PRP injection?
Cost for one PRP Platelet Rich Plasma joint, ligament, or tendon injection is $600.  Multiple injections may be discounted.  It is not covered by insurance.

PRP Platelet Concentration that may be achieved:

Blood Volume  60 mL
PRP Volume  6 mL
Platelet Concentration  enrichment greater than five-fold increase
Platelet Count/µl  1,000,000 to 2,000,00 (average 1.5 million)

Is PRP (platelet rich plasma) for everyone?  
No.  I have seen many athletes and patients come from other locations treated with prolotherapy, prolozone, stem cells, and/or PRP when they should not have been treated with these out of pocket treatments.

Literature on PRP:
A 2017 article demonstrates how Platelet Rich Plasma (PRP) protects against cartilage degradation in arthritis by 1. increasing the proliferation of chondrocytes, the only cells located in cartilage, whose job it is to produce and
maintain your cartilage, 2. reversing senescence (deterioration with age) and increasing quiescent cells (non-aging cells that can withstand stress and preserve key functional features ), and by 3. significantly decreasing
chondrocyte apoptosis (cell death).

A 2017 meta-analysis of randomized clinical trials on platelet rich plasma (PRP) versus steroid cortisone injection for lateral epicondylitis or tennis elbow concludes PRP is more effective in relieving pain and improving function in the long term than cortisone and is now the recommended preferred first line treatment by these authors.

A study in 2017 on PRP in rheumatoid arthritis (RA) one of the most devastating kinds of arthritis, found platelet rich plasma inhibits inflammatory factors and represses rheumatoid fibroblast-like synoviocytes in rheumatoid arthritis.  Another 2017 article demonstrating PRP anti-inflammatory effect in rheumatoid arthritis.

A study in 2017 supports platelet rich plasma (PRP) over cortisone injection for tennis elbow as PRP had a longer duration of effect of improved function and decrease in pain and caused greater healing as demonstrated by ultrasound, with cortisone effect wearing off after 3 months.

A randomized prospective double blinded study in 2017 found evidence platelet rich plasma (PRP) is even effective for advanced late stage knee arthritis.

Platelet rich plasma PRP injections were found to be superior than gel injections for arthritis.  In a 2017 meta-analysis of ten Level I randomized control trials, PRP was found to provide superior pain relief and greater functional outcomes than viscosupplementation or gel injections (hyaluronic acid) in patients with symptomatic knee osteoarthritis one year after injection.

PRP superior to cortisone for tennis elbow in a double blind placebo controlled study.

A single ultrasound guided, injection of PRP in rotator cuff tears resulted in safe, significant, sustained improvement of pain, function, and MRI outcomes refractory to physical therapy and cortisone injection.

A single PRP injection for hamstring injuries combined with a rehabilitation program was significantly more effective than a rehabilitation program alone.

PRP injection of achilles and patella tendinopathy resulted in significant and lasting improvement of clinical symptoms.

Other injection therapies that Dr. Silberman may discuss with you:
Cortisone - covered by insurance
Viscosupplementation (Synvisc) - covered by insurance
Bone Marrow Aspirate Stem Cells - not covered by insurance