PRP, in my experience and with some of the data showing, is worthwhile for partial rotator cuff tears, partial tears in the elbow, otherwise known as tennis elbow, and for partial Achilles’ tendon tears. I’ve also used it for some meniscus tears. Where PRP comes into play is for patients that may or may not need surgery, but have some sort of a tear, and they’re looking for options other than surgery. In these cases, we will talk to them about the potential of PRP.
Essentially, the way PRP works is, we draw the patient’s blood, just like a typical lab draw, and put it in a centrifuge machine, spinning down the blood for about five minutes or so. The centrifuge action separates the red blood cells, which we don’t wanna inject, from the platelets, which we do wanna inject. The goal is to harvest the platelets for PRP therapy.
We put red blood in the machine, and what we get out are yellow platelets separated from the red blood cells. We take the platelets, and we correlate where the patients hurts with an MRI and sterilize the area. This is a in-office procedure. Sometimes we use ultrasound to localize the needle and we place the PRP at the location of the tear.
Initially, patients get an inflammatory reaction and can feel increased pain and inflammation for a few days to a week. We ask them not to take anti-inflammatories because we want that inflammation to happen. That’s part of the healing process. Over the next few weeks, we usually find that the patient reports decreased pain in the area. It doesn’t work all the time. There’s nothing that works all the time.
We typically tell patients when it’s worth trying for them, and we will quote about a 50% success rate, although I think it’s higher than that, we just don’t want to over-promise patients. The downside of PRP is that insurance doesn’t cover it. So, it’s an out-of-pocket expense. The upside of PRP is that it’s not surgery and it’s done in the office. We should know whether the procedure worked or not in about 6 weeks.
Early on, I was reluctant to get into PRP therapy, because the data wasn’t there, but as the data and the medical literature has supported it, we are now having this discussion with many of our patients on a daily basis, and we’re finding that it’s helping out a lot of our patients.