In this video we discuss right and wrong ways when it comes to PRP treatment.
Hello, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly live broadcast. It’s September 16th, 2020. I hope everyone’s doing well. Hope everyone is healthy and staying happy and healthy. So on this weekly broadcast, I discuss topics relevant to what we do here in the clinic at Chicago Arthritis and Regenerative Medicine, where we focus on nonsurgical treatment and evaluation of arthritis, tendonitis injuries, and back pain. Key concepts, key understandings that explain what we’re doing, how we’re doing things, our approach to things, and even try to answer a lot of your questions that you may have as well.
So today I wanted to discuss something that came up because a patient of mine had some questions. So a patient of mine who had come to me asking about his right knee pain, right knee osteoarthritis. He’d been treated by a couple other physicians in the past, and he’d had umbilical cord fluid injected at one point, he’d had PRP treatments injected about a month ago, and he had questions about what to do next, because he wasn’t really responding. And it occurred to me that the manner that he had been treated from a regenerative medicine standpoint, they were missing certain key principles. And one of those key principles is understanding how to use platelets in a correct way.
So a key understanding when it comes to regenerative medicine is how to utilize the orthobiologics. How to utilize the cells and the products that you’re using to treat people for their musculoskeletal conditions. And in his case, the way that he was treated was not optimal. There was a lot of things that were missing. There were technique issues, target issues in terms of what tissues they were treating, imaging, no imaging and what kind of cells that they were using. From the platelets standpoint, there were some definite problems.
So the way that he got treated was, he got a succession of treatments split apart by two weeks. And immediately I could tell he didn’t get the right kind of treatment for his condition. And it’s because they didn’t have a really correct understanding for how platelet-rich plasma works and how to get the best e6ffects from platelet-rich plasma. The reality is that there are best practices in this sort of field, there are ways to do it right and optimal, and there are ways that you can do it that maybe are not optimal and that may belie a lack of experience or expertise in the field. And I think that’s unfortunately what this patient of mine had dealt with from another provider.
So key concepts behind platelet-rich plasma, number one, we know that concentration of platelets makes a difference. So platelet-rich plasma is essentially a process where we take a sample of your own blood, concentrate that over multiple centrifugations until you have a very high concentration of your own platelets, and then inject that under ultrasound guidance into tissue that’s been damaged. That’s the basics.
So there’s a couple of things that we know about platelet-rich plasma. Number one, we know that if you have osteoarthritis, that the correct way to treat your condition is by utilizing a high concentration of your own platelets. If you utilize a low concentration of platelets, the problem is that you’re not going to get the right kind of response. So utilizing a high concentration of platelets, 14 to 20 times a normal concentration of platelets, will give you a better response to osteoarthritis treatment.
So what does that mean, exactly? the way that platelets work is a couple of ways. Number one, the growth factor from the platelets help to stimulate your own local mesenchymal stem cells. Those stem cells are basically your body’s normal and natural way of trying to recover from injuries and keeping the joint healthy. An unhealthy joint, what you see are the wrong kind of proteins and enzymes, basically a chronically inflamed and unhealthy joint. So on a biochemical level, by stimulating those mesenchymal stem cells, you can get a better, healthier joint because those cells start pumping out the right kind of enzymes and proteins. A healthier biologic joint. So we know that a higher concentration of platelets will give you a better response to mesenchymal stem cells in terms of stimulating them, in terms of getting them to start functioning better as well.
I know that this patient didn’t get a high concentration injection because when you do that, you have more inflammation upfront and you have that inflammation for the first few weeks after, or for the first few days and stiffness for the first couple of weeks after treatment. So for a physician recommending to him that he should get repeat treatment automatically at every two weeks for the next two to three cycles, he was very likely utilizing a very low concentration of platelets because most people couldn’t tolerate that level of inflammation on a repetitive scale that frequently, if they’re doing it correctly.
The second thing is how much blood do they actually take from him? If you want to concentrate platelets to a very high concentration level for one joint, you’re going to have to take a couple hundred CCs of blood. That is at least six to nine ounces of blood. In his case, they took out 10 to 20 CC, one to two vials. I know they’re not doing it correctly because that’s not enough blood to get a high concentration. Unfortunately, when you ask that clinic that question, they didn’t understand what he was asking. And so it just belies their inexperience and lack of expertise in the field.
Second thing is there is, you can utilize platelets in different ways. So injecting a joint is one thing, but from a regenerate medicine standpoint, you need to be treating ligaments, tendons, other soft tissue structures, even nerves. You don’t use the same platelet concentration for each one of those areas. If I want to treat a tendon, I’ll use a slightly lower concentration of platelets. If I want to treat a nerve, I’ll end up treating that with platelet lysate, which is just the growth factor from the platelets. And if I want to treat the ligaments, I’m going to end up using either platelet lysate or platelet-poor plasma. And if I’m treating muscles, I’m using platelet-poor plasma. So there’s different types of platelets. There’s a higher concentration of platelets, a greater amount of blood.
There’s just much more subtlety to doing this the correct way. And unfortunately, this individual did not get this the correct way. Then the last thing is timing of prp treatment. So in this individual’s case, he’s being recommended getting multiple treatments in quick succession. If you’re doing this correctly, that elevated level of inflammation, you have to give it time for the body to properly heal and respond to that. So the optimal response, I tell patients, expect to be feeling better at the four to six week mark. Let’s reassess at the two month mark to see how much better you are. And if you’re still getting better, let’s give it more time just to let you continue to get better on your own. On the other end, if you start plateauing and you’re not at your goal, then let’s repeat treatment at that point.
So in this patient’s case, it was a wrong platelet preparation. It was a wrong frequency of treatment as well. The other thing is knowing when to treat more aggressively and when to treat a little bit more mildly. So in this individual’s case, he wanted to get back to some level of activity, exercise activity at a faster level than what I would normally recommend after PRP treatment. He wanted to get to more high-impact activity within the first month after treatment. I said, that might be possible. However, if you’re looking to get back into something much faster, you may want to give it a little bit more time from the platelet standpoint. If you want to get back into something faster, let’s say in season during a competitive sports season, you may be better off getting dextrose prolotherapy, which is less inflammatory, that can kind of help out short-term, and then when you have a little bit more time, maybe two months, then maybe let’s do platelet-rich plasma at that time.
The keys to platelet-rich plasma, getting the right concentration, the right lab prep to do it properly, the right platelet types to do it as well. Your physician, if they’re doing this correctly, should be able to answer those questions. Meaning what’s the concentration of platelet-rich plasma that’s been using, how much blood are they drawing. Are they using different types of platelet preparations for different tissues that are being treated at the same time. And what’s the progression of this. It shouldn’t be over two weeks. It really should be over that couple month period.
I hope that’s helpful. I hope that gives you some sense of how platelet-rich plasma should be utilized to give you some sense for how physicians should be utilizing this correctly. As a reminder, I’m doing a webinar later on today at 5:00 PM central standard time. You’ll see a link for that below, where I’ll be talking more about regenerative medicine in a more expansive way. The truth about regenerative medicine. Also, as a reminder, I do a live broadcast live stream twice per week, Mondays and Wednesdays. Any questions, concerns, or thoughts, email, leave them down below and until next time, have a good day and live well. Bye bye.