By Cary Gronner
A relatively new type of therapy is being used to treat some types of tendon, ligament, and muscle injuries. Platelet-rich plasma (PRP) therapy may help some injuries heal faster, but doctors still have many questions about the type of injuries — and patients — for which it’s most appropriate.
In order to understand platelet-rich plasma therapy, you need to get a handle on two concepts: blood plasma and platelets. Blood plasma is the liquid component of blood, and is made up of about 90 percent water, and 10 percent proteins, hormones, and electrolytes. Platelets are cell fragments that are suspended within blood plasma. Platelets are produced by bone marrow, and contain several growth factors that stimulate bone and tissue healing.
In PRP therapy, a small amount (about 30 milliliters) of the patient’s blood is drawn and then spun in a centrifuge so the PRP can be separated, collected, and prepared (more on that later); it’s then injected into the injured tissue. The idea is that the super-concentration of platelets — about three to nine times the normal amount — will then supercharge the healing process.
PRP therapy is reasonably safe because what’s injected comes from the patient’s own body. But does it work?
Some researchers have reported that PRP isn’t any better than placebo saline injections (a mixture of water and salt). Others have found that it significantly shortens healing times. For example, in a study of athletes who had surgery for torn Achilles tendons, those who received PRP treatment healed about 36 percent faster than those who didn’t.
Like many studies in this relatively new field, however, this one was conducted in a small number of subjects, so clinicians hesitate to put too much weight on the results.
Part of the debate about PRP therapy stems from the fact that there are many different ways that PRP is prepared before it is injected into the tissue. Platelets work by releasing special growth factors into the tissue when they are injected, and must be “activated” in order to perform this release. Some PRP preparations are designed to be activated with chemical compounds (such as calcium, calcium chloride, or thrombin); others are activated after injection, by the patient’s own collagen. The method of activation determines how quickly the platelets release growth factor. For example, preparations activated by the patient’s collagen release growth factor slower and over a longer period of time than preparations activated by chemical compounds.
Different preparations have different platelet concentrations and may be relatively rich or poor in white blood cells (leukocytes). Because studies have been done using PRP prepared in a variety of ways, it can be problematic to compare results. Moreover, researchers have been unable to correlate platelet concentrations with outcomes.
Some physicians argue that more established therapies — eccentric exercise (the lowering part of a motion, as when the hand moves down and away from the body after performing a biceps curl) or percutaneous needle tenotomy, for example — may be more appropriate than PRP therapy. (In tenotomy, the clinician jabs the affected part of the tendon repeatedly with a small needle; the resulting inflammatory response can reawaken the healing process and get things moving again.)
Another issue is that PRP therapy is rarely covered by insurance. As a result, those who choose it may simply be those who can afford it, or those for whom even a slightly quicker return to athletic activities is crucial. One group of people that fits both of these descriptions is professional athletes, and their use of PRP has generated much of the media hype surrounding it. For everyone else, it may be better to just wait a little longer to heal.
One thing many doctors do agree on, however, is that trying PRP therapy is better than resorting to surgery. Even if it doesn’t work, PRP therapy is low-risk, and patients still have the surgical option to fall back on.
There are some clear cases where PRP therapy is beneficial. For instance, PRP therapy is used successfully in several types of surgery to speed healing. In patients who had fractured their lower-leg bone and were treated with PRP, a study showed that the bone fused about twice as fast, versus a control group of patients who didn’t get PRP treatment.
PRP therapy has also been studied in other conditions including tennis elbow, chronic tendinopathy of the patellar tendon, plantar fasciitis, acute injuries of ligaments or muscles, and reconstruction surgery of the anterior cruciate ligament (ACL) of the knee. Some studies have shown promise, but because they were conducted in small numbers of subjects and failed to include a control group (a similar number of subjects who did not receive PRP), doctors aren’t sure how much to trust the results.
Very promising results have been reported when PRP is used to heal wounds associated with diabetes, however. This is noteworthy because diabetes can increase the risk of wounds, slow the healing process, and make it more difficult for patients to know they have an injury. For instance, diabetic foot ulcers (a type of foot wound that results as a complication of diabetes) can be challenging to treat because patients often lose pain sensation due to nerve damage from their diabetes. That, along with poor circulation — another diabetes complication — can cause the wounds to become deeply infected and can lead to amputation of the toes, feet, and even legs. Some research suggests that treating the tissue around such wounds with PRP may help improve healing rates significantly.
If you’re a professional athlete, or even a dedicated weekend warrior, and your doctor has diagnosed you with either an acute or chronic tendon injury, you may want to discuss PRP therapy (and see if your insurance company will pay for it). If you don’t want to spend the money, however — or if you don’t like needles — you may want to consider other options, including, primarily, patience.
If you have diabetes and have a slow-healing foot wound, it may make sense to ask your physician about PRP therapy.
As more and better-designed research is conducted on this promising therapy, PRP treatments may enter the mainstream as an option for people with a variety of injuries and issues. Until then, rest, physiotherapy, or other more traditional treatments may be what the doctor orders.
Published May 29, 2012.
Cary Groner is a writer based in the San Francisco Bay Area. His recent novel, Exiles, placed fourth on the Chicago Tribune’s list of the best books of 2011.
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Na Cary Gronner Aina mpya ya tiba inatumiwa kutibu aina fulani za majeraha ya tendon, ligament, na misuli. Tiba ya plasma yenye platelet nyingi (PRP) inaweza kusaidia baadhi ya majeraha kupona haraka, lakini madaktari bado wana maswali mengi juu ya aina ya majeraha na wagonjwa ambao ni sahihi zaidi. Ili kuelewa matibabu ya plasma yenye plateleti nyingi, unahitaji kuelewa dhana mbili: plasma ya damu na platelets. Plasma ya damu ni sehemu ya maji ya damu, ambayo ina asilimia 90 ya maji na asilimia 10 ya protini, homoni na electrolytes. Vitambaa vya damu ni vipande vya chembe ambazo huhifadhiwa ndani ya plasma ya damu. Platelets hutengenezwa na uti wa mgongo wa mifupa, na zina mambo kadhaa ya ukuaji ambayo huchochea uponyaji wa mifupa na tishu. Katika matibabu ya PRP, kiasi kidogo (karibu mililita 30) ya damu ya mgonjwa huchukuliwa na kisha kuzungushwa katika centrifuge ili PRP iweze kutenganishwa, kukusanywa, na kutayarishwa (zaidi juu ya hiyo baadaye); kisha huingizwa kwenye tishu iliyojeruhiwa. Wazo ni kwamba mkusanyiko mkubwa wa vidonge vya damu - karibu mara tatu hadi tisa ya kiasi cha kawaida - kisha utaongeza mchakato wa uponyaji. Tiba ya PRP ni salama kwa sababu kile kinachowekwa katika sindano hutoka kwenye mwili wa mgonjwa mwenyewe. Lakini je, inafanya kazi? Watafiti fulani wameripoti kwamba PRP si bora kuliko sindano za saline za placebo (mchanganyiko wa maji na chumvi). Wengine wamegundua kwamba hupunguza sana wakati wa uponyaji. Kwa mfano, katika utafiti wa wanariadha ambao walikuwa na upasuaji kwa ajili ya kuvunjika tendons Achilles, wale ambao walipata matibabu PRP kupona kuhusu 36% kwa kasi zaidi kuliko wale ambao hawakufanya hivyo. Hata hivyo, kama ilivyo na masomo mengine mengi katika uwanja huu mpya, utafiti huu ulifanywa kwa idadi ndogo ya watu, kwa hiyo wataalamu wa matibabu wanashangaa kuweka uzito mwingi juu ya matokeo. Mjadala kuhusu PRP hutokana na ukweli kwamba kuna njia nyingi tofauti ambazo PRP hutengenezwa kabla ya kuingizwa kwenye tishu. Platelets kazi kwa kutolewa mambo maalum ya ukuaji katika tishu wakati wao ni injected, na lazima <unk>activated<unk> ili kufanya kutolewa hii. Baadhi ya dawa za PRP zimetengenezwa ili kuanzishwa na kemikali (kama vile kalsiamu, kalsiamu kloridi, au thrombin); nyingine huanzishwa baada ya sindano, na mgonjwa mwenyewe collagen. Njia ya uanzishaji huamua jinsi haraka platelets hutolewa sababu ya ukuaji. Kwa mfano, maandalizi ya kiakili ya mgonjwa ya collagen release growth factor ni polepole zaidi na kwa muda mrefu kuliko maandalizi ya kiakili ya kemikali. Maandalizi tofauti yana mkusanyiko tofauti wa platelets na yanaweza kuwa na kiasi kikubwa au kidogo cha chembe nyeupe za damu (leukocytes). Kwa sababu utafiti umefanywa kwa kutumia PRP iliyotengenezwa kwa njia mbalimbali, inaweza kuwa na tatizo kulinganisha matokeo. Isitoshe, watafiti hawajaweza kuhusianisha viwango vya vidonge vya damu na matokeo. Baadhi ya madaktari wanasema kwamba matibabu zaidi ya kuanzishwa - mazoezi ya eccentric (sehemu ya chini ya mwendo, kama wakati mkono unakwenda chini na mbali na mwili baada ya kufanya curl biceps) au percutaneous sindano tenotomy, kwa mfano - inaweza kuwa sahihi zaidi kuliko PRP tiba. Katika tenotomy, daktari huchoma sehemu iliyoathiriwa ya tendon mara kwa mara kwa sindano ndogo; majibu ya uvimbe yanayotokana na hilo yanaweza kuamsha mchakato wa uponyaji na kufanya vitu viende tena. Kwa upande mwingine, matibabu ya PRP ni rahisi sana kufunikwa na bima. Kwa sababu hiyo, wale wanaochagua kufanya hivyo huenda wakawa ni wale tu wanaoweza kumudu, au wale ambao hata kurudi kwa haraka kidogo kwenye shughuli za michezo ni muhimu. Watu ambao wanafaa maelezo haya yote ni wanariadha wa kitaaluma, na matumizi yao ya PRP imesababisha mengi ya hype ya vyombo vya habari kuzunguka. Kwa wengine, huenda ikawa afadhali kungoja muda mrefu zaidi ili upone. Hata hivyo, kuna jambo moja ambalo madaktari wengi wanakubaliana nalo: Ni afadhali kujaribu tiba ya PRP kuliko kufanya upasuaji. Hata kama haifanyi kazi, tiba ya PRP ni ya hatari ya chini, na wagonjwa bado wana chaguo la upasuaji kurudi. Kuna baadhi ya kesi wazi ambapo PRP tiba ni muhimu. Kwa mfano, tiba ya PRP hutumiwa kwa mafanikio katika aina kadhaa za upasuaji ili kuharakisha uponyaji. Katika wagonjwa ambao walikuwa na mfupa wa mguu wa chini na walitibiwa na PRP, utafiti ulionyesha kwamba mfupa ulijumuisha mara mbili kwa kasi, ikilinganishwa na kikundi cha kudhibiti cha wagonjwa ambao hawakupata matibabu ya PRP. Tiba ya PRP pia imechunguzwa katika hali zingine ikiwa ni pamoja na elbow ya tenisi, tendinopathy ya muda mrefu ya tendon ya patellar, fasciitis ya plantar, majeraha ya haraka ya ligaments au misuli, na upasuaji wa ujenzi wa ligament ya mbele ya msalaba (ACL) ya goti. Uchunguzi huo umekuwa na matokeo mazuri, lakini kwa sababu ulifanywa kwa idadi ndogo ya watu na haukujumuisha kikundi cha kudhibiti (kiwango sawa cha watu ambao hawakupokea PRP), madaktari hawajui ni kiasi gani cha kuamini matokeo. Matokeo mazuri yametolewa wakati PRP inapoweza kutibu majeraha ya kisukari. Hii ni muhimu kwa sababu ugonjwa wa kisukari unaweza kuongeza hatari ya majeraha, kupunguza mchakato wa uponyaji, na kufanya iwe vigumu kwa wagonjwa kujua kuwa wana jeraha. Kwa mfano, vidonda vya mguu wa kisukari (aina ya jeraha la mguu ambalo hutokea kama tatizo la kisukari) inaweza kuwa changamoto kutibu kwa sababu wagonjwa mara nyingi hupoteza hisia za maumivu kutokana na uharibifu wa neva kutokana na ugonjwa wao wa kisukari. Hiyo, pamoja na mzunguko mbaya wa damu - tatizo jingine la kisukari - yaweza kusababisha majeraha yawe na maambukizo makubwa na yaweza kusababisha kukatwa kwa vidole vya miguu, miguu, na hata miguu. Utafiti unaonyesha kwamba kutibu tishu zinazozunguka majeraha kama hayo kwa PRP inaweza kusaidia kuboresha viwango vya uponyaji kwa kiasi kikubwa. Kama wewe ni mwanariadha wa kitaalamu, au hata mpiganaji wa mwisho wa wiki, na daktari wako amegundua wewe na ama acute au mgonjwa tendon jeraha, unaweza kutaka kujadili PRP tiba (na kuona kama kampuni yako ya bima kulipa kwa ajili yake). Kama hutaki kutumia pesa, hata hivyo <unk> au kama hupendi sindano <unk> unaweza kutaka kuzingatia chaguzi nyingine, ikiwa ni pamoja na, hasa, subira. Ikiwa una ugonjwa wa kisukari na una jeraha la mguu la kupona polepole, inaweza kuwa na maana kuuliza daktari wako juu ya matibabu ya PRP. Kwa kuwa utafiti zaidi na bora zaidi unafanywa juu ya tiba hii ya kuahidi, matibabu ya PRP yanaweza kuingia kwenye mtiririko mkuu kama chaguo kwa watu wenye majeraha na masuala mbalimbali. Kabla ya wakati huo, huenda daktari akaagiza upumziko, tiba ya mwili, au matibabu mengine ya kitamaduni. Ilichapishwa Mei 29, 2012. Cary Groner ni mwandishi anayeishi katika eneo la Ghuba ya San Francisco. "Kama mwandishi wa riwaya ya ""Exiles,"" Chicago Tribune ilichagua kitabu hiki kuwa kitabu bora cha mwaka 2011." Hebu angalia hapa chini kwa maelezo zaidi kuhusu Hepatitis C: Jifunze kuhusu virusi hivi vinavyoweza kutibiwa. Ugonjwa wa Hepatitis C: Ugonjwa huu unaweza kusababisha ugonjwa wa virusi vya kuambukiza. Je, umegunduliwa tu? Hapa ni nini ni Next 3 hatua muhimu ya kupata juu ya matibabu. Ugonjwa wa Hepatitis C: Hatua 4 za Kuanza Tiba Mwongozo wako wa Matibabu ya Hepatitis C Unachohitaji Kujua Kuhusu Dawa za Hepatitis C. Jinsi ya kusimamia athari za matibabu Jinsi dawa zinaweza kukuathiri. Jinsi ya Kufanya Matibabu ya Hepatitis C Yafaulu Vidokezo hivi vinaweza kuongeza uwezekano wako wa kupona.