PRP – Platelet Rich Plasma

The next level of sophistication beyond just creating a healing micro injury (like prolotherapy) is making the conditions in the area more conducive to healing or “anabolic”.  You may have heard this term associated with body builders that use steroids.  This is not the same use here, although body builders “build” muscle, so this is why they use “anabolic” steroids (literally steroids that build”).  Here the term means making an area pro-repair or better able to heal.

Creating an anabolic healing environment is not a new concept in medicine and surgery.  For centuries, physicians have known that some people have better innate abilities to heal, while others have less healing capabilities.  The acronym “PPP” (piss poor protoplasm) was used in my residency training to mean a patient that due to disease or extreme old age was unable to heal after surgery.  While surgeons have always known that some patients could have a compromised ability to heal, not much attention has been paid in how to make routine and otherwise healthy patients heal better.  Surgeons have always understood the basics, like good nutrition, young age, high levels of fitness, good blood supply, etc…  About 20 years ago that started to change in the dental community.  Some dentists began experimenting with a simple concoction called “PRP” or “Platelet Rich Plasma”. The dentists used this stuff made from the patient’s own blood to help their dental implants heal.

Dr. Schultz and Hanson made me a believer in non-surgical knee repair. I had a snow mobile accident that resulted in a torn medial meniscus and a torn MCL. Having never had knee problems and living a very active lifestyle I was devastated when my ortho quickly suggested surgery and wanted to schedule me immediately. I researched non-surgical techniques and contacted The Centeno-Schultz Clinic about PRP. His team was highly skilled in the processing of my blood and the injections were successful- I’m back on the road bike logging lots of base miles and looking forward to a great cycling season! Thanks Doc! NO SURGERY NEEDED! You made me a believer!! Best-John S. (Broomfield)

PRP is a simple example of how we can improve the healing environment.  The blood has platelets which contain growth factors that help to ramp up healing.  To understand how these platelets work, a paper cut will illustrate the basic points.  When we cut ourselves, we bleed into the cut.  The blood coagulates because of little cells in our blood called platelets.  The job of the platelets doesn’t stop there, they go on to release certain factors that help to heal the cut.

Growth factors are like espresso shots for cells.  A cell works at a certain pace to do its job.  If  we add growth factors (like those in PRP), it’s like buying all of the cells trying to repair the area a bunch of Starbucks gift cards.  The cells react to the growth factors like people react to triple espresso shots, they work harder and faster.  So if we use an example of a construction site, where we have a few brick layers building a new wall, if we add growth factors, our brick layers will build our wall faster.

We use these same concepts to promote healing.  The most basic level II procedure today is PRP, which can be mixed up from a patient blood sample in a bedside centrifuge or in a simple hospital or clinic based lab.  PRP means that the healing platelets have been concentrated.  Injecting the patient’s own blood can often accomplish the same thing, as it’s also rich in platelets.  In our clinic, we also use next generation level II tools beyond PRP.  These include platelet lysate or PL.  In the case of PL, our advanced cell biology lab makes PRP from the patient’s blood and then breaks open the platelets to make all of the growth factors immediately available.  We also use various activated, incubated platelet supernatants or next generation PRP.  Think of these as PRP 2.0.  To make these next generation solutions, our lab starts with PRP, activates it with various natural substances, and incubates the platelets for several hours to several days.  During this time the platelets are directed to produce certain natural growth factors that are important in specific types of healing.  We then take that soup of natural, growth factors and use that instead of PRP.  So for example, we can inject a solution that is rich in the joint and cartilage repair growth factor TGF-beta by telling the patient’s platelets to produce more of that natural growth factor.