– PRP is more effective than HA as measured by pain and function. It also caused cartilage growth, better blood flow to the joint capsule, and less swelling of the knee.
– PRP is helpful at all stages of OA. “Although research has shown a tendency toward better efficacy at earlier stages of osteoarthritis (OA), evidence exists to indicate positive effects at all stages of OA.”
– Benefits of PRP combined with HA injections.
– PRP aids with tendon injuries. PRP is involved in all different phases of the repair process (recruitment and mobilization of MSCs, stimulating tendon cells to secrete collagen, VEGF, and HGF (all of them reparative), proliferation and division of MSCs, maturation of newly formed collagen, clean up of excess cells).
– PRP accelerates tendon repair.
Peak of fastest growth occurs at a platelet concentration of 500,000/uL–too high of too low is inhibitory. (this is a breakthrough because most providers will try to concentrate PRP for tendons as high as possible).
– PRP and its application in trauma and orthopedic surgery. Patients who did not respond to conservative therapy (PT and cortisone) for epicondylitis were treated with PRP. A single injection helped all, sustained over 1 year, with no complications.
Not all PRP is created equal:
Monocytes are good.
– Peripheral blood mononuclear cells enhance the anabolic effects of platelet-rich plasma on anterior cruciate ligament fibroblasts.
Neutrophils are catabolic (stimulate tissue breakdown).
Monocytes are anabolic (stimulate tissue growth).
– Monocytes are the driving influence in the progression through the phases of healing.
The primary function is regenerative–remodeling, vascularization, and prevention of scar tissue.
– Contributions for classification of platelet-rich plasma. Monocytes are as important as platelets, key elements in the repair process.
RBCs are bad:
– There should be an upper limit to the number of RBCs allowed in PRP because of chondrotoxicity.
-RBCs decrease cell function and cause cell death.
-If RBCs are too high, it abolishes the capacity for stem cells to migrate.
Neutrophils are bad:
– Neutrophils release toxic molecules which damage muscle cells.
– Neutrophils are primarily responsible for WBC-induced inflammation, catabolism, and scar tissue formation.
Catabolic signals may hinder healing because of inflammatory cytokines.
HA (Hyaluronic Acid Injections)
– The effect of repeated intra-articular injections of hyaluronic acid in knee osteoarthritis
– Do Hyaluronic Acid Injections Delay Total Knee Replacement Surgery?
Physical Therapy
– Physical therapy increases natural HA production
Injection Method
– Blind injections
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Performing a Diagnosis:
-Back pain does not always originate from the spine
