What is PRP?
PRP (Platelet Rich Plasma), also known as Platelet Rich Plasma (PRP), is a method used to stimulate and regulate healing by being prepared from the patient’s own blood.
Using an existing PRP preparation kit, approximately 10-60ml of blood is taken from the patient, this blood is separated with special disposable filters and centrifugation devices and the unwanted parts are removed.
The separated portion, about 2-6 ml, contains platelet-rich plasma and has found application in many musculoskeletal injuries.
The main role of platelets is to form the clot that stops the bleeding that occurs when an injury occurs. They also contain dozens of growth factors that contribute to tissue repair and healing. When these growth factors are introduced into the environment, they help repair damaged tissues by supporting the body’s own healing mechanisms.
Is PRP a medicine? Is there any harm in having PRP?
PRP is not a medicine. It does not contain any substance other than the person’s own blood. Unlike drugs, the effect of PRP is limited to the area where it is applied. It does not cause side effects on kidney, liver and stomach. It does not contain cortisone. PRP contains growth factors that enable the cells in the body’s healing response to reach the area and multiply. These factors also have positive effects on the formation of new blood vessels, the prevention of infections and the production of tissue proteins.
Today, for some intra-articular PRP applications, forms containing hyaluronic acid or collagen have also been developed.
PRP fluid has stem cells in itmıdır?
Contrary to popular belief, PRP fluid contains very few stem cells. Stem cells are found in small numbers in many tissues in the musculoskeletal system such as muscle, bone marrow, adipose tissue, synovia (the thin membrane layer lining the joint).
For the therapeutic use of stem cells, either the tissue taken from the bone marrow must be concentrated with special techniques or cells obtained from other tissues must be applied. PRP application kits are different from bone marrow concentrate or fat concentrate application kits.
Can PRP fluid be applied to other people?
Although blood products can be administered to other people according to emergency needs, PRP fluid can only be administered to the person himself/herself. This eliminates the risk of transmitting diseases such as hepatitis and AIDS. PRP fluid should be used immediately after preparation, its effect will decrease over time.
How many times and how is PRP fluid applied?
There is no definitive evidence on how many times PRP fluid application should be performed. In some cases, a single application is sufficient, while it can be repeated at intervals of 2 or 3 weeks depending on the response of the disease.
PRP application should be performed under sterile conditions. Today, PRP can be applied in several ways. The most common application method is to inject it into the target tissue with the help of a needle. Another application method is to place the PRP prepared in the form of jelly in the area where it is desired to have an effect during surgery. PRP fluid can also be used to increase the effectiveness of implants placed for cartilage repair.
In which diseases is PRP fluid effective?
PRP procedure is safely used in the treatment of orthopedic diseases.
1. Chronic tendinopathies:
◦ Tennis Elbow (Lateral Epicondylitis) 79-93% successful results have been obtained with PRP applications. This rate is slightly better than the results obtained with cortisone application, and the disadvantages of cortisone application are avoided.
◦ Successful results of around 80% have been reported with PRP applications in Achilles tendon diseases, chronic patellar tendon injuries and plantar fascitis. In this patient group, PRP should be preferred in cases where rest, medications and physical therapy methods do not provide adequate results.
2. Knee ligament injuries:
There are studies showing faster recovery and return to sports in a shorter time with PRP injections after internal lateral ligament injuries, which are common in athletes.
3. Muscle injuries:Faster return to sport has been reported with PRP injections in muscle shrinkage or intramuscular bleeding in athletes.
4. Osteoarthritis (Calcification):In the early stages of osteoarthritis in the knee joint, PRP injections have been reported to reduce pain and improve function for 6 months. However, PRP treatment does not change the natural course of the disease and cannot reverse existing wear and tear. Some studies have shown that PRP injections are slightly superior to hyaluronic acid injections.
5. In support of cartilage repair:Treatment of cartilage injuries in young patients is still a major problem. Today, it is not possible to reconstruct damaged articular cartilage with its original architectural structure and biological properties. In order to improve the quality of the repair tissue created by many treatment modalities
PRP applications have come to the agenda. Biological covers called matrices, which are used in cartilage repair, are synthetic and fusible structures that provide a suitable environment for cells to grow and transform into cartilage. It has been shown that PRP or bone marrow concentrate applications together with these matrices can provide a higher quality repair tissue. Today, this is the most studied and exciting area of PRP.
What should I do after PRP is applied?
After the PRP procedure, it is appropriate to apply cold compress or ice to the painful area and use paracetamol-derived painkillers.
Non-steriod anti-inflammatory drugs (such as voltaren, naproxen, majezik) are not recommended as they may reduce the effectiveness of PRP application.
Rest is an important part of recovery and therefore strenuous exercise and sports are not recommended after PRP application.
Simple stretching exercises can be done, but weight training against resistance should be avoided.
Bandages and simple wrist bracelets can be applied.
Return to sports and training may vary between 3-6 weeks. During this period, the use of nonsteriod anti-inflammatory drugs (classical painkillers) should be avoided.
It will be appropriate to ask your doctor about the medications you can use after PRP application and your return to sports.
Are there any drawbacks and side effects of PRP application?
After PRP application, there may be increased swelling and pain at the injection site at a low rate. This pain may persist for a few days, but this problem can be relieved with simple painkillers and ice application. Apart from this, PRP has no side effects on internal organs such as kidney, liver and stomach.
Since the person’s own blood is used, there is no risk of allergic reaction. There is no information on its use during pregnancy.
Does PRP affect doping tests?
The use of PRP as an injection in the musculoskeletal system has been removed from the International Olympic Committee’s World Anti-Doping Agency (WADA) banned substances and practices and is not considered doping. Since it is not a drug excreted in urine, it is not possible to identify it in doping tests. PRP injected intravenously is still prohibited.
What is Prolotherapy Treatment?
Today I will tell you about prolotherapy. Let’s get down to the root of the word;
PROLO (PROLIFERATION): proliferation; THERAPY: treatment is the Latin of the words and is used in the sense of treatment by multiplying. This method, which has been used in the treatment of pain in the USA, Canada and Japan since the 1930s, has proven its effectiveness with a positive response of up to 90% when performed in competent hands and in the right people.
Why is Prolotherapy Applied?
It can be used for all diseases of the musculoskeletal system. The aim is not only to eliminate pain, because pain is a symptom of damaged tissues. Prolotherapy treatment treats these tissues with the body’s own elements, thus eliminating the pain.
How is Prolotherapy Treatment Applied?Injection therapy. While the bleeding caused by the needle allows the body’s rescue elements (cells) to come to this area, the sugar in the serum allows the reaction in the area to proceed in a controlled manner. After the procedure, this reaction continues for up to 3 weeks, during which time the rescue elements multiply in the damaged tissues and work as needed, and tissue healing begins.
Are There Side Effects of Prolotherapy Treatment?
Short answer; none. However, as with any treatment, side effects and complications can be seen in prolotherapy treatment.
Does Prolotherapy Treatment include Cortisone/Steroid?
Absolutely not. Because steroids known as cortisone suppress the healing response in damaged tissues, unlike the controlled reaction we try to implement with prolotherapy. Today, such drugs are only used under the supervision of a doctor in diseases caused by the body for various reasons.
Which Diseases Is Prolotherapy Treatment Used For?
It can be used in all diseases originating from the musculoskeletal system:
Migraine, neck hernia, neck pain of unknown origin, tension-type pain
Operated/unoperated herniated discs
Arthritis (shoulder, knee, waist and other joints)
Shoulder (fiber tear) and Elbow diseases (tennis elbow, golfer’s elbow)
Wrist nerve compression (carpal tunnel)
Ankle nerve compression
Knee and ankle muscle and connective tissue diseases
In many orthopedic diseases such as heel spurs…!!!!
Who Can Receive Prolotherapy Treatment?
It can be applied to everyone from 7 to 70. It does not affect the baby in pregnant women, but since it may trigger labor in expectant mothers with low pain tolerance, the application should be left until after delivery. It can be safely applied in breastfeeding mothers. In children, care should be taken to avoid psychological trauma due to fear of needles and pain during the application.
What is the Duration of Prolotherapy Treatment?
Since the number of injections varies according to the size of the application area, it takes an average of 10-20 minutes.
When is full recovery seen with prolotherapy treatment?
Although we have patients who recover in a single session, repeated applications are needed afterwards, and complete recovery is usually seen in 3 to 4 sessions. The number of sessions may increase to 5-7 for complete recovery in proletherapy, which can also be applied after lumbar, cervical hernia surgery, knee arthritis, open or closed surgeries for meniscus, but the benefit rate is the same as our patients who have not undergone surgery. Recovery periods are observed in 3-6 weeks following the injection.
Transition Content
What is Stem Cell Therapy? What is a stem cell?
Stem cells are ancestral cells located around the vessels in all tissues in humans. When tissue damage occurs, these cells become activated, secreting the growth factors needed for tissue repair, while they can differentiate into different tissues needed for healing, such as muscle, bone, articular cartilage and fat.
They act as part of the body’s healing and repair response. There have been many studies in recent years on the use of stem cells in the treatment of diseases.
There are two main types of stem cells. Stem cells derived from fetuses have a high transformation potential, but their use is currently very limited due to ethical issues. Adult stem cells, which are widely used today, are being widely researched because they are easy to obtain, although their transformation ability is lower.
Which diseases are stem cells used to treat?
Although many experimental studies have been conducted in musculoskeletal injuries, the most important use of stem cells today is in the regeneration of damaged articular cartilage. In addition, experimental studies are being conducted on their use in various muscle injuries and delayed union of fractures.
How are stem cells obtained?
Although they are present in many tissues in the body, stem cells, which are investigated in the treatment of musculoskeletal diseases, are most commonly obtained from bone marrow. Stem cells have also been obtained from tissues such as muscle, adipose tissue and the synovial membrane lining the knee. Since roughly one in every hundred thousand cells in these tissues is a stem cell, these cells need to be multiplied in order to be effective. This reproduction can be done in two ways. Stem cells can be multiplied by growing the tissue sample in cell culture or stem cells can be concentrated using special centrifugation systems.
Cell culture is a two-step process that involves first harvesting tissue and producing cells, followed by a second process to transplant them into diseased tissue. Cell culture procedures need to be carried out under specialized laboratory conditions with high standards to prevent disease transmission and to avoid transplanting unwanted cells. In contrast, centrifugation-derived stem cells can be applied in the same step and do not require specially designed laboratory environments.
How are stem cells administered?
After stem cells are obtained by culture or centrifugation, they are applied in two ways.
One of these is direct injection into the joint. In this technique, stem cells are expected to reach the damaged area on their own after being injected into the joint. In the second method, after the stem cells are placed on matrix-shaped carriers called matrix, the joint is surgically opened and this matrix containing stem cells is placed in the damaged area and fixed with various adhesives. These matrices can be made of animal collagen or synthetic polymers and their common feature is that they dissolve and disappear in the body over the years.
To increase the effectiveness of stem cells, growth factors and chemicals such as PRP (platelet-rich plasma) hyaluronic acid can also be added.
Stem cells placed on the matrix are aimed to transform into cartilage cells and form a repair tissue in the damaged area when the appropriate environment is provided.
Stem cells do not make any changes in the genetic structure of the person and are not considered gene therapy.
What are the results of stem cell therapy?
Although there are hundreds of animal studies on the use of stem cells in cartilage repair, their application in humans is very new. Around 20 human studies with a short follow-up period and a small number of patients have been published. In these studies, successful results were reported in roughly 80% of cases. The cartilage formed by stem cell therapy is in the form of a repair tissue but does not have the architectural structure of the original articular cartilage. The long-term durability of this repair tissue is not yet known. In many experimental studies, it has been shown that the addition of stem cells to classical cartilage regeneration techniques results in a better quality healing tissue.
Are there risks associated with stem cell therapy?
Stem cells have the ability to transform into all kinds of cells. This can sometimes result in transformation into unwanted cells. It has been reported that stem cells applied for cartilage repair can turn into bone instead of cartilage. Another problem is that cells that grow rapidly in the intra-articular environment continue to grow after the repair is completed. This excessive growth may require shaving with a second surgery. Stem cells taken from fetuses have a risk of turning into tumors. Tumor formation in stem cells from adults has not been reported so far.
Conclusion
There are many promising experimental studies and few human studies on the use of stem cells in the repair of cartilage injuries. Currently, the most appropriate cell source
There is no consensus on what it is, what dose of cells should be given, whether cell culture is necessary, whether the cells should be given by injection or on a carrier implant, which growth factors have a positive effect on cartilage formation and studies on this subject are ongoing. There are currently around 3000 clinical trials in various countries around the world investigating the application of stem cells in humans. The overgrowth of cells implanted in the joint and their transformation into bone instead of cartilage is still a problem. Although there are many promising results regarding the quality and durability of the healing tissue and its integration with the surrounding cartilage, the long-term results of the procedure are not yet known.
