By Michael Siciliano, MD
Not all platelet-rich plasma (PRP) is created equal.
First, let’s recap some basics. PRP has been around for decades but in the past few years it had explosive growth mostly due to the public’s desire for treatments that address the root cause of the problem rather than mask it with potentially harmful drugs, not to mention an increasing population eager to avoid the pitfalls of surgery. Our blood contains platelets that are essentially little packets of powerful growth factors floating in the bloodstream. These growth factors (GF) come in many forms and with very medical-sounding names. It is those growth factors that run to the aid of damaged tissue in order to repair it. Whenever you cut yourself, they not only clot the bleeding, but also repair the damaged areas. This is why PRP can be so incredibly effective, however, you must understand that not all PRP is created equal!
As you probably already know, platelet-rich plasma is harvested by collecting a small sample of the patient’s blood and processing it in order to extract and concentrate the platelets. This concentrate is then injected into the affected area, promoting cellular regrowth to help heal degenerated and damaged tendons, ligaments, discs, cartilage, and even nerves in some cases.
Amongst practices that offer PRP treatments for musculoskeletal conditions, the vast majority are limited to concentrations of two to five times, which is called regular PRP. However, it is possible to concentrate PRP to 20 times normal levels and even higher concentration can be achieved with the right equipment and training. This is called super concentrated PRP or SC-PRP and is not available everywhere.
The more horsepower you give a sports car, the faster and more powerful it will be. The same applies with platelet-rich plasma. The more concentrated the platelets are, the more growth factor packets, and thus the more powerful the healing potential. the PRP concentrations were increased but cell food and oxygen were not. To better illustrate this, car engines need more fuel to go faster but if oxygen intake is not increased proportionately, the engine may sputter and die. The good news is that in several well- designed studies, including one presented However, it is possible to concentrate PRP to 20 times normal levels and even higher concentration can be achieved with the right equipment and training.
So, why doesn’t everyone do this?
Many of the PRP studies conducted to determine the optimal PRP concentration for healing appeared to show that anything over four times concentration seemed to bring less healing. These flawed studies were the impetus for everyone to jump on that bandwagon, citing these flawed studies, including most of the PRP equipment manufacturers. Subsequently, most of the PRP systems sold to doctor’s offices are designed only for regular PRP. Most of these studies were performed in-vivo (basically in a test tube) and not in the human body. Platelets, growth factors, tissue remodeling, and healing do not operate by themselves and require oxygen, cell food and nutrition, namely carbs, glucose, vitamins and minerals. Think of it as a healthy nutritious soup to feed the biochemistry needed for PRP to do its job. During these flawed studies, at the Interventional Orthopedic Foundation (IOF), it was demonstrated that concentrating PRP up to 40 times with the needed cell food, netted increasing healing properties.
SC-PRP with added oxygen and nutrients is created by using special equipment and training that the average PRP doctor does not have. When you consider that growth factor levels in normal blood negatively correlate with increasing age (as we age, growth factors decrease), it is important to use SC-PRP to achieve the best possible outcome, especially if the patient is older than 40.
To find out more or to see if you are a candidate, even if you have tried PRP before with lackluster results, call or email.