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Dr. Silberman specializes in regenerative injections, PRP or Platelet Rich Plasma Therapy and second generation platelet rich plasma, Platelet Rich Fibrin (PRF or i-PRF=injectable PRF) for arthritis, degenerative osteoarthritis, rheumatoid arthritis, tendon, muscle, nerve, cartilage, ligament injuries and chronic pain conditions.  Dr. Silberman has been performing platelet rich plasma therapy injections longer than any other provider in New Jersey.

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Dr. Silberman trained under one of the pioneers in the field of regenerative medicine, Dr. Brian Shiple, while a fellow at the Crozer Chester Medical Center Sports Medicine Institute.

What is platelet rich plasma (PRP) therapy?
Platelet rich plasma therapy or PRP is a treatment where blood is drawn from you arm via a venipuncture (like a lab draw) and then the tubes of blood are spun in a centrifuge, while you wait, to separate out the platelets (rich in cytokines and growth factors) and then are injected under ultrasound guidance into your injured joint, tendon, ligament, muscle, body part to treat pain, injury, improve function, range of motion, and stimulate your own body to heal damaged tissue.  

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Over 300 molecules are released by platelets when injected into your body accelerating the natural healing process and promoting cartilage repair (Moussa et al in Experimental Cell Research, February 2017).

The normal number of platelets in blood is 150,000 to 400,000 platelets per mcL.  PRP would contain any number greater than baseline, 5 to 10 times the number at baseline.  Some authors have reported an ideal platelet concentration of 1 to 1.5 million / mcL.

Dr. Silberman uses a pioneering method of creating high quality PRP developed and researched over years to create a high quality PRP, 10 billion platelets per 8ml, containing an average of 1.5 million platelets per microliter (well above the commercial PRP average), essentially free of RBCs, and containing helpful pro-growth WBCs while eliminating the inflammatory WBCs.  Dr. Silberman's method was validated via independent clinical laboratory testing.  You can be assured that the PRP injection you receive from New Jersey Sports Medicine is among the highest quality, purity, and effectiveness available.

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Intra-articular joint injection of 3 doses of PRP for arthritis have been found to yield superior outcome to single and double doses (similar to hyaluronic acid gel viscosupplementation injections). Repeat doses are given 2 weeks apart.

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Conditions Dr. Silberman may treat with Platelet Rich Plasma (PRP):

Any condition that your orthopedic surgeon might treat with cortisone can be treated with PRP.  While cortisone is catabolic and can eat away at tissue, weakening tendons, cartilage and bone, believed to me more detrimental than previously reported, PRP is anabolic and stimulate healing and regeneration.  Common conditions treated are knee arthritis, hip arthritis, shoulder arthritis, rotator cuff tears, meniscus tears, labral tears, tendinosis and tendon tears. 

While BMAC (bone marrow aspirate concentrate) stem cell injections are more often for intra-articular joint injections, PRP platelet rich plasma is more often used for tendon injuries though both can be used for either with success.

Arthritis of the knee, hip, shoulder, any joint arthritis

Meniscus tears

Labral tears

Rotator cuff tears

Frozen shoulder

Frozen Shoulder (adhesive capsulitis)

PTT Posterior Tibial Tendon Tear

Sports Hernia or Athletic Pubalgia (Adductor Tendon Tear)

Post Impairment Syndrome Cerebral Palsy
Rheumatoid Arthritis

Carpal Tunnel Syndrome
Chondromalacia Patella
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
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
Low back pain, sacroiliac joint pain (SI joint pain), buttock pain

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How does PRP platelet rich plasma therapy compare to BMAC (bone marrow aspirate concentrate) stem cell injection?

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PRP is obtained from a blood draw.  BMAC is obtained from a bone marrow aspiration.  While BMAC (bone marrow aspirate concentrate) stem cell injections are more often used for intra-articular joint injections such as for arthritis, PRP platelet rich plasma is more often used for tendon injuries though both can be used for either with success.  PRP may require more treatments and visits than BMAC injection and thus may be more costly in the long run.  Both are highly successful upwards of 85% percent depending on the condition with no clear winner in current studies.  Bone on bone arthritis has a higher failure rate.  And neither BMAC or PRP will heal complete tendon tears with retraction though they can help in pain and slow down the degradation.

 

How does PRP platelet rich plasma compare to gel lubrication, viscosupplementation, hyaluronic gel injections such as synvisc or orthovisc or euflexxa, etc?

Gel lubrication is hyaluronic acid made from a rooster coomb (chicken) or synthetically in a lab, is most commonly given as a series of injections once a week for 3 weeks though can be one injection, is covered by insurance usually, is only covered by insurance for knee joint injections, is authorized by insurance to be given every 6 months, and can give pain relief in arthritis for usually 5 months only.  Gel can be injected in any joint but would not be covered by insurance if not for the knee joint.

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PRP comes from you own body, is not covered by insurance, is rich in cytokines and growth factors, has regenerative properties, and has been found to last longer and provide more pain relief when compared to gel hyaluronic injections for arthritis.

What to expect with a PRP injection?
Blood is withdrawn from a vein in your arm with a simple venipuncture.  About 60 ml for one joint or tendon or ligament may be drawn or 120ml for two joints or multiple tendons or ligaments.  Donating blood is 500ml.  If you had only a couple of tube drawn for PRP at another site not enough blood was taken.  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.

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How long does a PRP visit take?

The whole visit for a PRP injection door to door is about 45 minutes.

 

Are PRP injections painful?

PRP injections may be painful depending on the site being injected.  Tendon and ligaments will hurt more than a joint injection.  Hand and feet injections are more painful than a hip or shoulder.  Local lidocaine anesthetic injection is given to numb the injection entry site.  You may experience some pain or pressure during a tendon or ligament injection and less to no pain for a joint injection.  You may have temporary significant heaviness, pain, stiffness, throbbing in the office that subsides within 10 or 15 minutes in the office.  Soreness and some pain is expected after the procedure that may last for several hours. Most pain subsides by 75% by the next day however, some people report discomfort for up to a week or longer.  Most patients do not take any medication.  If pain is bothersome the first night and affecting sleep, Tylenol or acetaminophen may be taken.  No Nsaids or Advil or aspirin shall be taken after PRP. A small percentage can get severe pain for a few days requiring pain medication for a day or two such as Tylenol with codeine though this rare.  Most patients after PRP can drive themselves home and come alone depending on the body part being injected.

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Are there any side effects to PRP?

The side effect to a PRP injection such as an unintended reaction that happens in addition to the main goal of the injection are minimal to none.  They are the same side effects that occur with any injection such as pain, infection, bleeding.  Infection has been reported to occur in 1 in 20,000 to 1 in 50,000 injections.  Bleeding from the venipuncture may cause a small bruise but is rare and has never occurred in our office.  Unlike cortisone which can cause fat atrophy, tendon rupture, and eat away at cartilage and weaken bone, PRP won't cause these problems.  Allergic reaction to your own platelets and blood do not occur but rare reactions to anticoagulants used or lidocaine can occur though we have never seen this.
 

How many PRP treatments may be needed?

Multiple treatments may be needed for tendon or ligament injuries and three injections for arthritis.  Though most patients in my practice have had success after one injection.  Every case is unique.  Intra-articular joint injections of 3 doses of PRP at 2 week intervals were found to be superior for treating arthritis compared to single and double doses.

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How long does it take to see improvement after PRP?​

Some may see improvement in as little as two weeks but the norm is it may take up to 6 weeks so don't get discouraged if you see no change or increased pain initially, give it time.  

What are my instructions for prior to a 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.

What are my instructions for 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.   There are no restrictions on every day life for the first 2 weeks.  But for 2 weeks no strenuous activity should be done.  For a lower extremity, no running jumping hoping or skipping.  For 2 weeks post PRP nothing should be done to build fitness or strength but gentle range of motion activity and walking can be done.  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 sporting activity after week 2 with gradual return to play.  Every case is unique.  Follow-up appointment is made 6 weeks post PRP.

What is the cost of PRP injection?
Cost for one PRP Platelet Rich Plasma joint, ligament, or tendon injection is $750.  If injecting a knee joint and knee tendon or ligament at the same time the cost is $750.  If two body part sites are injected with PRP, such as two joints, bilateral knees or bilateral shoulders or bilateral hips or a hip and a shoulder, then the cost is $950.  Multiple different body sites would be more and may be discounted.  

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Are PRP injections covered by insurance?

PRP are injections are not covered by insurance.  That does not mean PRP injections are investigational or do not work.  It means insurance companies don't want to pay for new procedures they never paid for before or pay for a procedure or treatment they can not control. 

PRP Platelet Concentration that may be achieved:

Blood Volume  60 mL
PRP Volume  8 mL
Platelet Concentration  enrichment greater than five-fold increase
Platelet Count/µl  1,000,000 to 2,000,00 (average 1.5 million)

Absolute counts of more than 10 billion platelets

Literature on PRP:

A 2021  single-blind, randomized, superiority trial found that an injection of three doses of PRP (platelet rich plasma) yielded superior results compared to single and double doses of PRP when evaluating patient outcomes at the end of one year.

Subramanyam K, Alguvelly R, Mundargi A, Khanchandani P. Single versus multi-dose intra-articular injection of platelet rich plasma in early stages of osteoarthritis of the knee: A single-blind, randomized, superiority trial. Arch Rheumatol. 2021 Jan 14;36(3):326-334. doi: 10.46497/ArchRheumatol.2021.8408. PMID: 34870163; PMCID: PMC8612497.

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 therapy was successful in returning high level baseball players with UCL (ulnar collateral ligament) partial thickness tears to competition.

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