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Platelet rich plasma: The scientific evidence

Platelet rich plasma: The scientific evidence

Feb 17, 2024

We have already had a look at how platelet rich plasma (PRP) works (if you haven’t had a chance to read this yet, you can find it here), but now we are going to dive more deeply into the scientific evidence behind this treatment.
Randomised controlled trials (RCTs) are the gold standard study for determining if one treatment offers superior benefits over another. In these trials, patients are randomly assigned to either receive the treatment of interest or an alternative treatment, usually the standard of care or a placebo. Moreover, the patients are ‘blind’ to what treatment they are receiving. Here, we are going to look at two RCTs that investigated the use of PRP to treat knee osteoarthritis and chronic tennis elbow.

Knee osteoarthritis

A study by Bansal et al. (2021) investigated the optimal dose and concentration of therapeutic PRP required to achieve the desired physiologic efficacy. One hundred and fifty patients were enrolled in this trial, with then being randomised to either receive PRP or hyaluronic acid for their knee osteoarthritis.
The results revealed a significant improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), International Knee Documentation Committee (IKDC) score*, and six-minute pain free walking distance. Besides external improvements, this trial also noted a significant decline in IL-6 and TNF-a levels in the PRP group when compared to the hyaluronic acid group at six months, both of which assist in mediating an inflammatory state (Bansal et al., 2021). If you would like to read more about the role of these cytokines in osteoarthritis, we have an additional blog post discussing just that.
Collectively, this trial, along with several others, demonstrate the efficacy of PRP, specifically with an absolute count of ten billion platelets, in achieving a long sustained chondroprotective effective in arthritis.
*The WOMAC represents an osteoarthritis index and measures a patients’ physical function, pain, and stiffness over a 48 hour period. The IKDC, on the other hand, gives an indication of a patients’ condition, containing questions on knee symptoms, overall function, and sports activities. The scoring system ranges from zero to one hundred, with zero representing the lowest level of function and the highest level of symptoms.

Chronic tennis elbow

A study by Mishra et al. (2014) evaluated the clinical value of tendon needling with PRP in 230 patients with chronic tennis elbow compared with an active control group. Patient outcomes were followed for up to 24 weeks, with the findings revealing several beneficial results at this mark. In those treated with PRP, a significant improvement of 71.5% was observed in their pain scores. Moreover, the percentage of patients reporting significant elbow tenderness notably decreased over this time. This demonstrates the clinical efficacy of PRP in the treatment of chronic tennis elbow on a larger scale (Mishra et al., 2014).

References

Bansal, H., Leon, J., Pont, J. L., Wilson, D. A., Bansal, A., Agarwal, D. & Preoteasa, I. 2021. Platelet-rich plasma (PRP) in osteoarthritis (OA) knee: Correct dose critical for long term clinical efficacy. Scientific Reports, 11, 3971. Mishra, A. K., Skrepnik, N. V., Edwards, S. G., Jones, G. L., Sampson, S., Vermillion, D. A., Ramsey, M. L., Karli, D. C. & Rettig, A. C. 2014. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med, 42, 463-71.
Platelet rich plasma injections for tendonitis

Platelet rich plasma injections for tendonitis

Feb 17, 2024

Platelet rich plasma treatment(PRP)
represents a promising approach to therapy for a range of conditions, including torn tendons, arthritis, muscle injuries, and tendonitis. We have already looked at the process of PRP and the underlying scientific evidence in our previous posts. Now, we are going to look specifically at the use of PRP in the treatment of tendonitis. But first, what is tendonitis, and how does it affect a person?

Tendonitis is a term used to define inflammation and pain following a tendon injury. This usually causes significant pain, stiffness and alters how the tendon can move. The most common areas that are affected by tendonitis are the rotator cuff, the elbow, and the Achilles tendon, with an overall prevalence of an estimated 11.6% in the general population. Although most cases of tendonitis resolve themselves within two to three weeks with relative rest of the area, icing, and strengthening exercises, a number of cases require medical intervention if they persist.

PRP therapy for tendonitis generally involves three injections, given at two to three week intervals; however, in certain cases, further injections may be needed to complete your journey. But do not worry; our doctors at Opus will discuss this and the treatment protocol with you throughout the process. The procedure itself follows three stages:

    1. The plasma, the liquid where the platelets reside, is drawn from your body through the blood.
    2. This is then placed in a machine to separate the PRP from the rest of your blood.
    3. The PRP is then injected into the area where you are experiencing tendonitis.

    Once the platelets are in the target area, they will break down, releasing growth factors. These growth factors are the pivotal component of PRP and are the reason that this treatment has shown great promise in conditions such as tendonitis. Growth factors are important proteins that stimulate cell growth, differentiation, survival, inflammation, and tissue repair; collectively, triggering your body’s healing process. Specifically, in the treatment of tendonitis, growth factors play an important role in the tendon healing process. Not only are they directly involved in tendon tissue engineering, but they have also been shown to stimulate the action of mesenchymal stem cells. To understand the role of these stem cells in regenerative medicine, we discuss them in more detail here.

    If you or someone you know are suffering from tendonitis, book an appointment today to speak to one of our team at Opus on the next steps to reduce your pain and improve your everyday function.

    Antibodies and the Immune System

    Antibodies and the Immune System

    Dec 20, 2023

    Photo by Artem Podrez from Pexels

    We have already looked at the role of antibody testing in the fight against COVID-19; however, there was just too much information to discuss in one post. Therefore, this post is aimed at diving into a bit more detail on antibody testing for SARS-CoV-2 and looking at misconceptions surrounding this.

    When taking an antibody test, we are looking for anti-SARS-CoV-2 antibodies, which can be found in your blood as early as ten days after experiencing COVID-19 symptoms. Therefore, not only is antibody testing useful on its own, when combined with PCR testing, these detection methods minimise the likelihood of receiving a false-negative test. Moreover, antibody tests for SARS-CoV-2 are based primarily on the detection of antibodies against specific proteins. But, what does this mean? The novel coronavirus has four main structural proteins, the nucleocapsid (N), the spike (S), the membrane (M), and the envelope (E), as seen in the image below. However, antibody testing solely focuses on the detection of the S protein, consisting of S1 and S2 subunits, and the N protein, as these are the main immunogens of this virus.

    The S protein of SARS-CoV-2 is located on the surface of the virus and is highly immunogenic. Each subunit of this protein plays a different role, with the S1 protein containing the receptor binding domain, a key target of neutralising antibodies. The N protein, on the other hand, plays a crucial role in the replication of viral RNA, enabling the virus to survive in our system. Its role in transcription enables the virus’s genome to be packaged into virions and also inhibits the cell cycle process of our cells. During infections, the N protein is vastly expressed and possesses high immunogenic activity.

    Image taken from: https://www.invivogen.com/covid-19-related-genes

    Although antibody testing is focused on detecting antibodies against either the S or N protein of SARS-CoV-2, it has been recommended that a testing method that detects antibodies against both proteins be used to gain the most accurate results. This method has been adopted across the UK, and the antibody testing at Opus is no exception to this.

    Health Screening: Why regular appointments are important

    Health Screening: Why regular appointments are important

    Dec 20, 2023

    Photo by MART PRODUCTION from Pexels

    Health screening checks are a great option if you are looking for a summary of your overall health. They enable us to identify any risk factors you may have for more serious health conditions that could develop later down the line. Beyond this, our health screening checks can assist you in your long term health goals, whether that be losing weight, reducing stress, or simply getting in better shape.

    Our team at Opus will support you on this journey and help contribute to your healthier lifestyle. So, what exactly can our health screening checks tell you?

    There are so many different health problems that may arise throughout our life, and we cannot test for all of them. However, most health problems have a similar set of underlying risk factors that can be detected. This includes a sedentary lifestyle, an unhealthy diet, high blood pressure and cholesterol, and smoking, to name a few. If you are still wondering how health screening checks and lifestyle changes can lower your risk of health problems, let’s take a look.

    The phrase sedentary lifestyle often implies that your physical activity levels are very low; this may be a result of your occupation, but moving around throughout the day is detrimental to your health. The World Health Organization details that a sedentary lifestyle alone significantly increases the risk of cardiovascular diseases, diabetes, obesity, colon cancer, high blood pressure, osteoporosis, lipid disorders, depression and anxiety. Likewise, smoking represents one of the largest causes of health problems in the UK, including lung cancer, coronary heart disease, stroke, pneumonia, and bronchitis. Simply increasing your daily activity levels and cutting back on the number of cigarettes you have can significantly reduce the risk of developing these health problems in the future.

    During your health screening, we will start with gaining an understanding of your daily habits, identifying any that might increase your risk of health problems later on in life, before moving on to testing. Depending on the health screening package you have selected, or that has been tailored to your needs, tests may include hydration levels, body fat percentage, urine analysis, a full blood biochemistry profile including liver and kidney function, blood glucose test for diabetes, cholesterol profile, dietary analysis, a lung function test, resting ECG, and cardiovascular risk score, amongst many others. Collectively, these will provide a great starting point for the changes that need to be made in your everyday life.

    Booking a health screening can often be overwhelming, with a host of different options available online. Although we offer several different health screening and wellbeing packages available for you to book directly, our team are able to tailor the packages to your individual needs, providing you with that added peace of mind.

    Get in touch today to book your health screening check and start your journey to a healthy lifestyle with Opus.

    Platelet rich plasma injections for arthritis.

    Platelet rich plasma injections for arthritis.

    Dec 14, 2023

    Photo by Towfiqu barbhuiya from Pexels

    Arthritis is a term that encompasses several different conditions, including osteoarthritis and rheumatoid arthritis. The underlying pathophysiology of these conditions lies with inflammation of the joint, eventually resulting in a destruction of the cartilage and bone within the joint itself.

    The prevalence of this condition is astonishing, with more than 10 million people in the UK alone being affected by arthritis at some stage in their life. Osteoarthritis is one of the most prevalent arthritic conditions, with current statistics estimating that one in ten adults in the UK has symptomatic clinically diagnosed osteoarthritis. These figures alone call for more effective treatment options to be administered. This is where platelet rich plasma (PRP) injections come in.

    PRP has been adopted in clinical practice to promote cell regeneration for decades; however, only recently has it been considered as a potential approach to treating osteoarthritis.

    A 2013 study of 78 patients with osteoarthritis in both knees revealed that PRP injections resulted in a reduction in pain and stiffness, alongside an improvement in overall knee function at six weeks and three months post-administration. Similar results have been observed in many other studies, from animal models up to case reports. The goal of PRP in patients with osteoarthritis is to reduce pain, improve joint function, and halt or even repair the damage done to the cartilage. The higher concentration of platelets found in PRP enables an increased secretion of growth factors at the arthritic site, regulating cell division, stimulating tissue regeneration, and promoting healing.

    Several theories have been proposed that explain the promising impact of PRP on osteoarthritis:

    1. PRP inhibits inflammatory markers, reducing inflammation and halting the progression of your osteoarthritis,
    2.  Stimulates the action of mesenchymal stem cells, resulting in the formation of new cartilage at the arthritic site,
    3. Increase your body’s production of fluid at the joint site, reducing joint friction and the subsequent pain,
    4. It contains proteins that alter your pain receptors response to sensation, reducing the pain experienced from arthritis.

    Although there is no substantial evidence supporting the above theories, the promising improvements seen in osteoarthritis patients following PRP are widespread. If you are interested in finding out more about PRP, the conditions it can treat, and how Opus support you through your journey with us, get in touch today.