Platelets are the components of your blood that are best known for blood clotting. Blood is made up of 55% plasma, 45% red blood cells, and about 1% white blood cells and platelets. Platelets also contain hundreds of proteins called growth factors, which may stimulate healing of damaged tissues. PRP is the separation of those platelets and plasma from the rest of blood, which results in a high concentration of the platelets within the plasma, hence, platelet-rich plasma. Clinical work over the last several years has established the safety and usefulness of PRP for tissue repair and healing in joints, resulting in reduced pain and improved function. The technique involves injection of PRP at the site where the ligament or tendon is injured or inside the affected joint. Autologous Conditioned Plasma (ACP) is a type of PRP (Leukocyte reduced) which is prepared by a proprietary technique developed and marketed by Arthrex, Inc.
For knee pain, ACP-PRP is indicated in patients who have failed to respond adequately to conservative non-pharmacologic therapy and simple analgesics, e.g. Paracetamol. It is a 1-3 session, injection treatment that supplements the fluid in your knee, reduces pro-inflammatory cytokines and improves the milieu inside the joint. ACP-PRP is injected directly into your knee.
The PRP injection is performed on an outpatient basis. After check-in, the patient will have between 15-30ml of blood drawn into a special syringe. The syringe is then placed in a special centrifuge, which will separate the PRP from the rest of the blood, yielding between 2-8ml. The separated PRP is then drawn into another syringe, which will be injected into the effected area. We generally apply a numbing agent before your injection. You may feel some pressure, but it shouldn’t be painful. The entire procedure from blood collection to injection takes about 20 minutes.
Although uncommon, the risks include those symptoms/signs associated with an injection including; pain, infection, no relief of symptoms, worsening of symptoms, blood clot, nerve injury, skin discoloration, calcification, scarring, loss of fat to the affected area, and allergic reaction.
Patients may experience an increase in pain, which normally subsides to a dull ache, and can last up to 2-5 days. For localized soreness and discomfort, patients may apply ice as needed. You can resume normal day-to-day activities immediately after the injection, but you should avoid any strenuous activities for about 48 hours. In the first 48 hours after a ACP-PRP injection:
Avoid activities that put excessive strain on your knee such as jogging, lifting or prolonged standing.
Ice the knee 4-6 hourly for 5-10 minutes. (Take care to avoid an ice-burn!)
Start exercises as taught by the physiotherapist and gradually increase after 48 hours.
PRP treatment is not a “quick-fix” and is designed to promote long term healing. The process of PRP requires time and rehabilitation. Patients who follow a course of physical therapy are likely to see the most improvement in the affected area. PRP accelerates and shortens the recovery process in chronic injuries and new acute injuries. Depending on a patient’s condition, a series of 1-3 injections may be required.
Dr. Miten Sheth will discuss the need, details and consequences of the ACP-PRP procedure during the OPD consultation. An extensive discussion is always conducted about the natural history of disease and the variety of surgical and non-surgical treatment options available to the patient. A risk/benefit analysis is done with the patients reviewing the advantages and disadvantages of the PRP procedure. A full explanation is always given about the risks involved, the possibility of complications, the foreseeable consequences of the procedures and the possible results of non-treatment. There is NO guarantee that the procedure will cure your pain, and in rare cases, it could become WORSE, even when the procedure is performed in a technically perfect manner. The degree and duration of pain relief varies from person to person, so after your procedure, we will reevaluate your progress and determine if further treatment is necessary.
Please inform us if you are taking any blood thinners such as Aspirin, Clopidogrel, Warfarin, any form of Heparin, any herbal ayurvedic medications as these can cause excessive bleeding and the PRP procedure should NOT be performed.
We believe the benefits of the procedure outweigh its risks or it would not have been offered to you, and it is your decision and right to accept or decline to have the procedure done.