Our office will frequently receive an email or a phone call from a person who is interested in either Platelet Rich Plasma therapy or stem cell therapy. They will ask us, which is better? They are both good. We have found both PRP and stem cell therapy to be effective and reliable treatments for our patients. Effective and reliable are terms we use frequently. Reliable means we have a good understanding of how these treatments will work and how they will help..
Many times an emailer or caller will ask if we do both PRP and stem cell treatments simultaneously or within a few days of each other to enhance healing. This is the subject of my article here: Bone marrow aspirate injections | Plasma rich growth factors and mesenchymal stem cells. It explains the interaction between PRP and stem cells. I also want to point you to my article Growth factors in umbilical cord blood. The growth factors in umbilical cord stem cell therapy are similar in function and help inspire your own stem cells towards accelerated repair. We add PRP to the umbilical cord blood cell treatments as well.
The benefits of PRP
Why has the use of Platelet Rich Plasma therapy for knee osteoarthritis seen a dramatic increase in the past few years? Because researchers are showing that PRP can regenerate tissue in patients suffering from knee osteoarthritis and PRP can also enhance healing after ligament reconstruction.
In the medical journal Arthroscopy, a journal devoted to obviously arthroscopy, surgeons are told that Platelet Rich Plasma injections (PRP), offers better symptomatic relief to patients with early knee degenerative changes (than hyaluronic acid or placebo), and its use should be considered in patients with knee osteoarthritis.(1)
This is a verification of early research from the Mayo Clinic which came to the same conclusion – PRP showed better improvement than hyaluronic acid injection and placebo in reducing symptoms and improving function and quality of life.(2) In another study published in The Journal of the American Academy of Orthopaedic Surgeons. PRP was seen to be more effective than hyaluronic acid in younger, active patients with low-grade osteoarthritis.(3)
Doctors in Italy are suggesting that because of the many convincing studies on the benefits of PRP for knee osteoarthritis, doctors should be aware and make patients aware of this appealing alternative for the treatment of cartilage lesions and osteoarthritis.(4)
Below is what doctors are saying to each other about athletes who want to stay active:
“As a result of the complexity of the arthritic knee, athletes, particularly those with a history of knee injury, have an earlier onset and higher prevalence of osteoarthritis. This can present a clinical dilemma to the physician managing the patient who, despite the presence of radiologically confirmed disease, has few symptoms and wishes to maintain an active lifestyle.”(5)
The difficulty or “challenge” is in the prevention of advancing of knee osteoarthritis. Here the typical recommendations of anti-inflammatory medications, knee braces, and ice, those that the athlete can impose upon themselves, will lead to further knee deterioration. It is a challenge to convince an athlete of this when it may get them on the course, track of field this weekend.
In a recent study, researchers at Hospital for Special Surgery gave patients with early osteoarthritis an injection of PRP (6-mL), and then monitored them for one year. At baseline and then one year after the PRP injection, physicians evaluated the knee cartilage with magnetic resonance imaging (MRI). While previous studies have shown that patients with osteoarthritis can lose roughly five percent of knee cartilage per year, the Hospital for Special Surgery investigators found that a large majority of patients in their study had no further cartilage loss. At minimum PRP prevented further knee deterioration.
PRP injection delivers a high concentration of endogenous (your own “home-grown”) platelets to the knee where osteoarthritis is present. Blood is composed of plasma, red blood cells, white blood cells, and platelets. It’s these platelets that are the injury’s “first-responders” and help revascularize an injured area, construct new tissue, and stop the bleeding.
Because platelets play a significant role in the healing of tissue, reintroducing a high concentration of platelets directly into the injured area may enhance the healing process.
In regard to knee osteoarthritis here is what the research suggests:
In one study researchers looked at 261 patients with knee degeneration were treated with PRGF (plasma rich in growth factors) (PRP). At 6 months following intra-articular infiltration of PRGF in patients with osteoarthritis of the knee, improvements in function and quality of life were documented.(6)
Other research sought to “evaluate the clinical effects of intra-articular platelet-rich plasma (PRP) injections in a small group of patients with primary and secondary osteoarthritis. Most of the current treatments for osteoarthritis are palliative and attack the symptoms rather than influencing the biochemical environment of the joint. Autologous platelet-rich plasma has emerged as a treatment option for tendinopathies and chronic wounds…The study demonstrated significant and almost linear improvements in Knee Injury and Osteoarthritis Outcome Scores, including pain and symptom relief.”(7)
Let me know if you have questions about this article.
Ask Dr. Darrow about your knee pain
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References for Comparing PRP and stem cell treatments
1. Kanchanatawan W et al. Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 2015 Sep 19. [Epub ahead of print]
2. Pourcho AM, Smith J, Wisniewski SJ, Sellon JL.Intraarticular platelet-rich plasma injection in the treatment of knee osteoarthritis: review and recommendations. Am J Phys Med Rehabil. 2014 Nov;93(11 Suppl 3):S108-21. doi: 10.1097/PHM.0000000000000115.
3. Hsu WK, Mishra A, Rodeo SR, Fu F, Terry MA, Randelli P, Canale ST, Kelly FB. Platelet-rich plasma in orthopaedic applications: evidence-based recommendations for treatment. J Am Acad Orthop Surg. 2013 Dec;21(12):739-48. doi: 10.5435/JAAOS-21-12-739.
4. Marmotti A, et al. PRP and Articular Cartilage: A Clinical Update. Biomed Res Int. 2015;2015:542502. Epub 2015 May 5.
5 Kirkendall DT. Management of the Retired Athlete with Osteoarthritis of the Knee. Cartilage January 2012 vol. 3 no. 1 suppl 69S-76S
6 Wang-Saegusa A, Cugat R, Ares O, et al. Infiltration of plasma rich in growth factors for osteoarthritis of the knee short-term effects on function and quality of life. Arch Orthop Trauma Surg. 2011 Mar;131(3):311-7. Epub 2010 Aug 17.
Sampson S, Reed M, Silvers H, Meng M, Mandelbaum B. Injection of platelet-rich plasma in patients with primary and secondary knee osteoarthritis: a pilot study. American Journal of Physical Medicine & Rehabilitation. 2010 Dec 1;89(12):961-9.