In recent years, doctors have learned more about the body’s remarkable ability to heal itself.Platelet-rich plasma therapy is a form of regenerative medicine that harnesses those abilities to heal many joint, tendon and spine injuries.
What is plasma and what are platelets?
Plasma is the liquid portion of your blood. It is primarily composed of water and proteins and provides a means for red blood cells, white blood cells and platelets to circulate throughout the body.Platelets are a special type of blood cell that stimulate healing.They contain hundreds of growth factors that initiate the healing process and encourage tissue regeneration.
Platelet-rich plasma (PRP) contains a concentration of platelets that is greater than that found in the blood. This significantly increased concentration of growth factors creates an increased stimulus to injured tissues, encouraging them to complete the healing process.
How does Platelet-Rich Plasma Therapy Work?
Scientific studies show that by increasing the concentration of growth factors, the body can speed up the healing process. By injecting inflamed or damaged tissue, injuries are encouraged to heal quickly even if they have persisted for years.
How is the PRP treatment performed?
About 4 tablespoons of blood are drawn from the patient using techniques similar to a typical blood exam.The sample is placed into a centrifuge which spins the blood and separates the platelets from the other blood components.After numbing the injured area, the concentrated platelet solution is injected under the visual guidance of an ultrasound or digital xray by your physician.
Areas where PRP therapy has been shown to be effective include:
Chronic tendon injuries: Platelet-rich plasma therapy can treat sports injuries, such as tennis elbow, gluteal tendinopathy, plantar fasciitis, patellar tendinitis and Achilles tendonitis.
Joint arthritis: PRP is used to reduce the inflammation, pain and stiffness caused by arthritis of knees, hips and other joints. PRP also improves the cushion in the joint and kills the cartilage destroying cells.
Spine pain:PRP therapy can reduce the pain of chronic disc tears, irritated nerves (sciatica) or joint arthritis.
The effectiveness of PRP therapy varies among different patients as a result of:
Overall health of the patient
The severity of the injured tissues
The length of time the tissue has been injured
Preparing for PRP therapy
The patient should eat and be well hydrated before the procedure to avoid lightheadedness. Patients should tell their doctor about any medications or prescriptions they use on a regular basis. It’s also important to follow the doctor’s instructions when it comes to anti-inflammatory medications or blood thinners.
The PRP Treatment
The procedure is typically performed in a doctor’s clinic. The doctor begins by drawing blood from the patient, and uses a centrifuge to separate the platelets and plasma from the rest of the blood cells. The doctor will then numb the area to be treated and carefully inject the PRP into the injured tissues or joint. The platelets release growth factors which will initiate tissue healing. This treatment takes approximately 30-60 minutes.
After Receiving PRP Therapy
The injection site may be sore for a few days following the procedure.Patients may take mild analgesics like Tylenol or use ice to minimize soreness.Patients usually resume gentle activities within the first week after treatment.The results of PRP are not immediate and patients can observe slow gradual improvement over a couple of months. A review of our clinic data shows that most patients continue to have relief even years after PRP treatment.
Talk with your doctor today if you are interested in learning more about PRP therapy.
Chronic degenerative tendon disorders (tendinopathy) occur frequently and are difficult to treat. Tendon injuries are often associated with significant physical dysfunction and disability, due to the limited self-repair capacity and propensity for scar formation. Non-insertional Achilles tendinopathy is a common cause of ankle pain and typically occurs 2 – 6 cm proximal to the tendon insertion on the calcaneus.
Athletes, whether elite or recreational, are the most common group to present with Achilles tendinopathy, but it is also found in people with advanced age, obesity, diabetes or hypertension. Other risk factors for Achilles tendinopathy include previous tendon injury, decreased muscle strength, altered gait kinematics, limited ankle dorsiflexion, training errors, and the use of steroids or fluoroquinolones.
Conservative Treatment for Achilles Tendon Tears
Conservative care of Achilles tendinopathy includes removal of precipitating factors, rest, training routine modifications and the use of orthotics to correct foot or ankle malalignment. Decreased myotendinous flexibility may be treated with stretching. Muscle weakness is treated with progressive eccentric strengthening exercises twice a day for up to 12 weeks using either the Alfredson or Silbernagel protocol. Combining these protocols with low-energy shock-wave therapy (ESWT) may improve outcomes. With this said, up to 33% of patients will fail conservative care and consider surgical excision of the pathologic tissue with or without tendon transfer augmentation.
Lipogems® for Achilles Tendon Tears
There is a new treatment option out there. Recent studies have demonstrated that lipoaspirate contains and produces growth-factors, such as platelet-derived growth-factor (PDGF), fibroblast growth-factor (FGF), transforming growth-factor beta (TGF-β), and vascular endothelial growth-factor (VEGF) 1. These growth factors are known to play an important regulatory role in cellular proliferation, cellular migration, matrix synthesis and angiogenesis. The Lipogems® system can produce a non-expanded, rinsed, and microfragmented adipose tissue graft that maintains an intact stromal vascular niche and contains cellular elements with mesenchymal stem cell and pericyte characteristics
Recent Case Study
Dr. Christopher Rogers recently presented a case study at the TOBY conference in Las Vegas. He and his team were able to successfully treat a 16 year old girl who had developed functionally limiting chronic Achilles tendinopathy and partial tear that were non-responsive to conservative care. She was treated with ultrasound guided lipoaspirate (Lipogems®) and LP-PRP injection combined with a progressive strengthening program. She achieved a resolution of her pain and restoration of physical function at the six month follow-up. Ultrasound and MRI imaging revealed a diffuse fibrillar pattern consistent with regenerated tendon fibers that had replaced the tendinopathic and partially torn tendon regions.
Tendon engineering is an interesting challenge for the orthopedic medicine physician. Lipoaspirate and LP-PRP have the potential to stimulate tenocyte proliferation, matrix synthesis and angiogenesis which can lead to regeneration of a degenerated Achilles tendon. Future clinical trials using lipoaspirate for the treatment of chronic Achilles tendinopathy and partial tears are warranted.
We’re pleased to have been the first medical center in San Diego to offer the revolutionary LIPOGEMS® regenerative medicine therapy. Call us today to schedule an appointment. 760-909-2355
Do you suffer from an injury or ailment that limits your normal daily functioning due to a soft tissue defect in the tendon, ligament, muscle or cartilage? Have treatment options, such as physical therapy, medications or steroid injections, not provided permanent relief for you? You may want to consider Lipogems as a minimally invasive alternative to a major surgical procedure.
What is Lipogems Treatment?
Lipogems® is a disposable, single-use, FDA approved device for processing and same-day injection of fat tissue. It’s a non-expanded and micro-fractured autologous fat tissue product for treating joint and tendon injuries. This cutting-edge technology uses your body’s own fat tissue to cushion and support areas of injury or damage as your body heals itself. The fat tissue can be removed from the abdomen or thigh areas. This tissue is then precisely injected into the patient’s injured areas with the use of ultrasound or X-ray guidance.
Lipogems has now been successfully performed in more than 8,000 clinical cases globally, and we’re pleased to have been the first medical center in San Diego to offer this revolutionary regenerative medicine therapy.
Benefits of Lipogems
Mesenchymal stem cells require support from other cells and proteins to exert their healing benefits. Unlike other so-called “stem cell” treatments, the unique advantage of Lipogems® is that the complete healing environment of the fat tissue is captured, carefully processed, and then precisely injected. This improves cell viability and regenerative capacity.
Unlike steroid or gel injections, the tissue will stay in the treated area for years allowing your body to maximize the benefits for an extended period of time.
The Lipogems procedure can be performed in less than one to two hours in an outpatient clinical setting.
Due to their innovation, Lipogems was awarded Best New Technology in Sports Medicine in 2016 by leading sports medicine physicians.
How quickly will you see results?
Seeing improvements following the Lipogems® procedure typically depends on your age, degree of injury and overall health. Some of our patients note improvement the day following the procedure, while other people may take up to 2-3 months to see improvement. More than 90% of our patients have seen significant improvement in less than 3 months.
Patients undergoing the Lipogems procedure at our clinic undergo a strict screening procedure to assure that they are very good candidates for the treatment. We have been tracking our outcomes for more than 15 months. At this time, more than 90% of our patients have seen significant relief with the treatment, often being able to resume normal, pain-free physical activity. This has led them to improve their fitness, lose weight and improve the quality of their lives in a meaningful way. If you think you can benefit from Lipogems treatment, call us today at 760-483-9060.
Platelet rich plasma therapy augments your body’s natural healing capacity to reduce pain and improve function after a tendon, joint, disc or ligament injury. PRP may also reduce the pain from inflammation and osteoarthritis.
At San Diego Orthobiologics Medical Group, we use the latest in cellular biology and orthopedic clinical research to optimize your care. We use advanced technology to harvest, process and administer PRP to maximize your results. Because we use your own blood to stimulate healing, each treatment is unique and must be customized to your personal situation.
QUESTIONS FOR YOUR DOCTOR
Regenerative Medicine is an exciting new field that will forever change the way we treat orthopedic injuries. Many physicians are excited to leap into this field with varying levels of knowledge and experience.
So how do you, the patient, decide if you are a good candidate for this therapy. And who should you decide to use as your treating physician? We suggest that you ask your doctor the following questions to help you understand your care. Dr. Rogers has provided his responses to these questions below.
How much experience do you have treating musculoskeletal injuries?
Musculoskeletal injuries are best managed by specialists in the field of sports medicine. These include board certified physical medicine and rehabilitation physicians (physiatrists), orthopedic surgeons, and fellowship trained sports medicine physicians. It takes years to gain the experience and knowledge necessary to appropriately treat these kinds of injuries.
Accurate diagnosis is essential to successful treatment. And, in many cases, it is necessary to exhaust all conventional forms of treatment before even considering PRP therapy.
Dr. Rogers graduated as chief resident of the University of Texas, Health Science Center in San Antonio, Texas Physical Medicine, and Rehabilitation program in 1997. He completed a nonsurgical interventional spine fellowship in 1998 before joining the University of California, San Diego Orthopedic Surgery Department as an assistant clinical professor. He has practiced nonsurgical musculoskeletal medicine in private practice since 2000 and has treated more than 80,000 people just like you.
How much experience do you have with PRP?
PRP is a relatively new technology to orthopedics and our field is learning more about it all the time. Dr. Rogers was one of the first physicians in San Diego to use PRP for his patients in 2009. The protocols and algorithms that he uses have been shaped by his experience and the current medical literature to produce the best results possible. Dr. Rogers teaches PRP therapy to physicians at the Regenerative Medicine Therapy Institute, the BREG musculoskeletal ultrasound course, and The Orthobiologic Institute (TOBI) courses.
It is not a bad idea to ask your doctor how he or she stays up to date on Regenerative Medicine. As this is a new field, most physicians did not receive any specialized training in medical school. Doctors advance their knowledge by participation in continuing medical education, reading medical journal articles or attending Regenerative Medicine conferences. This discussion will give you an idea of the commitment your doctor has made in this emerging field.
How much experience do you have with diagnostic musculoskeletal ultrasound?
Administration of PRP with high precision and comfort leads to better outcomes and reduces the likelihood of additional expensive or risky procedures. Diagnostic ultrasound has radically changed the practice of orthopedic medicine allowing for better diagnostics and improved comfort with office based treatments.
For more than a decade, Dr. Rogers has trained his fellow physicians in the proper use of diagnostic musculoskeletal ultrasound. Dr. Rogers currently teaches musculoskeletal ultrasound at the BREG ultrasound courses, the American Academy of Physical Medicine and Rehabilitation workshops, and the OrthoBiologic Institute (TOBI) courses. He utilizes the most advanced diagnostic ultrasound equipment for his patient care.
What kind of PRP will you use?
There are many methods used to harvest, process and deliver PRP therapy. The cost and clinical results of each method vary widely as well. For example, the platelet concentration may range from two to fifteen times baseline in the blood depending upon which process is used. The healing response is largely determined by the concentration and quality of the proteins released from the platelets. Improvements in your condition may be slower or faster depending upon the method used to concentrate your platelets.
White blood cells are helpful in reducing the risk of infection and eliminating debris from a chronic injury. They also stimulate resident cells to produce healing proteins. However, these cells also release cytotoxic proteins and free radicals that can lead to cellular damage and a delayed healing response. Your doctor will need to assess the risk and benefit of using white blood cells in your PRP therapy.
Nutritional status, hormonal status, exercise, medications, and supplements all influence the quality of the cells and proteins in your blood. Prior to performing PRP therapy, we will often need to assess and modify these factors to improve your results.
What system (s) do you use to produce your PRP?
There are several commercially available products that assist in the production of PRP. The cost of each system varies and more sophisticated systems are generally more expensive. However, more sophisticated systems will allow your physician to customize your treatment and optimize the results. At San Diego Orthobiologics Medical Group we use three different cell concentrating systems depending upon the goals of treatment. Furthermore, we can measure the cell concentration which allows us to better understand why treatment results may vary from one person to the next.
Will you combine PRP therapy with any other form of therapy?
PRP often functions very well as a stand-alone treatment. However, many times additional forms of treatment need to be performed at the same time to maximize outcomes.
How many treatments will I need?
More than 90% of our patients only require one treatment. More challenging conditions may require additional PRP treatments or be combined with other cellular-based therapies.
Have you ever had a complication?
PRP is generally a very safe procedure. It is certainly safer than most other orthopedic treatments and surgery. Potential complications include pain, infection, fever, allergic reaction, swelling, tissue injury, and a failure to relieve symptoms. At the San Diego Orthobiologic Medical Group, we have never had a significant complication with any procedure in more than 20 years.
Do I have any reason to not consider PRP therapy?
Contraindications to PRP therapy include infection, very low platelet count, fever, anemia with symptoms, or use of anti-platelet medications, anti-inflammatory medications, steroids or statin medications.
Will you combine exercise or physical therapy with my PRP therapy?
This important step is often overlooked by some medical clinics. Exercise is crucial to expedite and maximize healing with PRP therapy. PRP simply addresses incomplete healing of a specific tissue, whereas stretching and strengthening are necessary to restore function to the entire joint. We have developed physical therapy protocols that you can do at home or with your therapist to allow the restoration of mobility, strength, and endurance.
How long will it take for my condition to improve after treatment with PRP?
This depends on the severity of your injury and your ability to regenerative healthy tissue. Some people heal very quickly and others more slowly. However, on average most people feel some significant improvement within six to eight weeks. Healing will continue for many more months after treatment. Many studies have demonstrated continued healing for up to a year.
What are your clinical results?
Very few medical practices track clinical outcomes. Although there are several clinical outcome studies in the medical literature, consensus regarding the exact type of PRP to use for a specific condition does not exist. Therefore, it is critical that each physician tracks the results of their treatment and share this information with prospective patients. At San Diego Orthobiologics Medical Group we have been tracking our results for years.
Your body has an amazing ability to heal itself. Over the last decade, significant advances in Regenerative Medicine have led to a greater understanding of healing. This knowledge allows us to stimulate healing using your own stem cells and other orthobiologics. The new science of Regenerative Medicine supports and enhances your body’s natural abilities in ways never before thought possible.
Effective
More and more scientific articles are published each year demonstrating the effectiveness of Regenerative Medicine. For example, there is now validated scientific evidence that platelet rich plasma is more effective than surgery for certain forms of tennis elbow, lower back pain, and knee osteoarthritis. More importantly, our patients have shared their life-changing results with us every day.
Safe
Scientific studies have demonstrated the safety of using your own cells to treat many different kinds of orthopedic conditions. Unlike prescription medications, Regenerative Medicine therapies do not cause side effects or allergic reactions. Unlike surgery, we do not disrupt healthy tissue which minimizes the risk of injury or infection.
Actual Healing, Not Just Pain Relief
Many traditional forms of medical care simply mask pain. Regenerative Medicine actually leads to healing. Once the injury is healed and rehabilitated, no further treatment is necessary.
More Comfortable than Other Forms of Treatment
Most Regenerative Medicine treatments involve office based procedures and do not require anesthesia. To minimize discomfort we use local anesthesia and, rarely, mild sedatives. Our doctors are experts in interventional procedures and can perform your treatment quickly and comfortably.
Evidence Based Therapy
Researchers are making new discoveries every week. But those advances don’t always translate into clinical solutions. Our physicians are knowledgeable in the field of Regenerative Medicine and do not leap recklessly to offer unproven treatments. We only offer medical treatments that are deemed safe and effective.
Faster Recovery
Many professional athletes have turned to Regenerative Medicine therapy as a way to quickly recover from a sports injury. Unlike surgery which may require several months to completely recover, Regenerative Medicine treatments require only a few days of down time.
Safe to Repeat
Corticosteroid injections and surgery can result in difficulties when repeated. Most patients improve from a single Regenerative Medicine treatment, however it is safe to repeat if necessary.
Saves Time and Money
Regenerative Medicine therapies are cost effective and save time. Most of our patients have alreadly tried multiple forms of other treatments such as chiropractice care, physical therapy or surgery. These forms of therapy can be time consuming and expensive. After a Regenerative Medicine physician has made an accurate diagnosis, treatment often results in resolution of the problem without the need for additional costly therapies.
Real Hope
Regenerative Medicine therapy fills a critical gap in the conventional medical model. Many patients have not responded to conservative care, but are not candidates for surgical care either. In the past, these patients were told to “just live with the pain”. Regenerative Medicine therapy has offerred new solutions and real hope for these patients.
