PRP: Platelets Reach Plasma

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Platelets rich in growth factor PRP are now a well-established therapeutic method for the treatment of many orthopedic diseases. It belongs to the field of regenerative medicine among with stem cell and autologous protein therapies. The goal of PRP therapy is to improve the process of tissue repair by the transport and deposition of bioactive agents that will influence the physiological mechanisms of inflammation, angiogenesis, and assist in the formation and synthesis of the matrix.

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The most common applications of PRP are found in the treatment of mild to moderate arthritis (osteoarthritis) as well as in Sports Medicine to treat traumatic lesion of the articular cartilage, muscles, tendons and ligaments trauma as well as meniscus ruptures.

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Cartilage loss is not considered the key pathological process that causes knee osteoarthritis. The initiating factor seems to be the result of a malfunction present in the whole joint, including all tissues crucial for maintaining articular homeostasis. The management of articular cartilage injuries remains one of the most important and interesting chapters of Orthopedics to this day. Articular cartilage regeneration is the goal of modern therapeutic approaches because the articular cartilage does not have an identical regenerative capacity.

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PRPs have proven their protective and anti-inflammatory properties on articular cartilage. Intra-articular injections with PRP transport many bioactive mediators into an autologous fibrin network, which are gradually released and improve pain, mobility and stiffness of the affected joint.

Platelet-derived growth factors, along with plasma growth factors (hepatocyte growth factor (HGF) and insulin-like growth factor-1 (IGF1)), stimulate cell proliferation as well as migration and matrix synthesis. Thus, PRP injection delivers growth factors locally while simultaneously mimicking and enhancing the spontaneous therapeutic response in injured areas and in special cell niches which would otherwise be inaccessible.

Recent studies highlight the important role of the subchondral bone in the role of arthritis. Separation of subchondral bone with articular cartilage appears to disrupt joint homeostasis by creating an inflammatory environment. Injecting PRP into the hypodermic bone helps restore the balance of articular homeostasis because growth factors aid the mechanical and biological connectivity of the tissues (transforming growth factor-b).

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PRP treatment is performed in the medical office and the whole procedure does not exceed 35 minutes. Initially 8cc blood is taken from the patient. Then, after special procedure, the plasma and platelet-rich growth factors are isolated from the blood and are injected, under ultrasound guidance, into the affected joint (knee, hip, shoulder, wrist, ankle joint). The therapeutic method is painless, and the patient can move immediately without assistance. A two-day rest is recommended to optimize cellular activity. Treatment may be repeated in 7-15 days depending on the severity of symptoms (up to 3 doses) or may be combined with intra-articular treatment with hyaluronic acid and collagen. The use of anti-inflammatory drugs is not allowed for 3 days before and 20 days after PRP injection.

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