Scientists around the world have been working on the treatment of joint pain and there are many approved substances designed specifically for joint injections. Each person’s needs should be taken into account with their individual circumstances and at the same time each joint will have a specific environment and need. At MSK Doctors, our experts will take into account all these factors and offer you the most appropriate treatment solutions.
What is PRP and how can it treat MSK and Sports injuries?
Platelet Rich Plasma (PRP) promises enhanced recovery from injuries. However, it’s still an emerging treatment, it’s important to understand how it works and how to navigate the options on offer.
There are over 400 type of Platelet Rich Plasma (PRP) in the market and there are 10 medical article related to PRP every hour. It is a rapidly evolving filed of medicine. Over 10 level 1 randomised control trial (RCT) has confirmed the effectively of PRP, on the other hand there are many studies reports PRP being ineffective. Effective treatment with PRP requires a solid understanding of the biology of the condition. Although it is true to claim that PRP can treat all these conditions, the devil is in the details when it comes to preparing the solution.
Steroid and cortisone for Joint and MSK injury?
Many clinics offer joint injections; depending on the funding and the expertise of the practitioner, results vary. In the public sector, local anaesthetic and steroid mixtures are the commonest substances used for joint injections. Although the toxic effects of this combination of drugs are well known and published in the scientific literature, it is still the treatment of choice in the public sector based purely on cost.
Most practitioners will take the one size fits all attitude of ‘we have always done it that way’ when it comes to MSK injections. High concentrations of local anaesthetic and steroid are toxic to cartilage cells (chondrocytes), in fact, it is the substance that the scientists use in the lab if they want to kill these cells. It makes little sense to inject such a high concentration of toxic substances to an enclosed environment such as the knee joint. Perhaps the objective is to ‘kill’ the cells and nerve endings so it will not be painful anymore.
How did PRP emerge as a treatment for MSK injury?
It is a known fact that there are growth factors and other signalling molecules such as cytokines in our blood. Due to its properties, blood serum has been used to treat many medical conditions for over 50 years.
PRP stands for platelet-rich plasma. Essentially it is the technique of separating and concentrating the useful substances that you find in your own blood, then injecting this into the area we want to treat.
What do we mean by “useful substances” in PRP?
It depends on the condition we’re trying to treat. Some substances in the blood are ideal for improving the quality of your skin and making it look more youthful. Other substances can help to repair the cartilage in your knee and some can help ligament to heal.
It is therefore essential to extract the right substances for the right condition. As a result, the PRP that we use to treat knee osteoarthritis, for example, is different to the PRP we use to treat acute meniscus tear or shoulder injuries. Depends on the time, speed and size of the machine different type of PRP can be produced.
What kind of conditions can PRP be used to treat? – (the devil is in the details)
PRP can be used to treat a wide range of conditions and injuries, including damage to the muscle, cartilage and meniscus. However, effective treatment requires a solid understanding of the biology of the condition. Although it is true to claim that PRP can treat all these conditions, the devil is in the details when it comes to preparing the solution.
A good analogy is to say that all things with wheels can move you from A to B. However, you would not use a push bike to go from London to Grantham, if you are going to try to be there for a meeting before 8 am. It’s important to use the right tool. Yes, PRP can be used to treat most soft tissue conditions, but without proper application of knowledge and experience is it just pot luck.
Can PRP be combined with other treatments?
Depending on the need of the condition, PRP can be combined with other treatments:
• Combined with the appropriate hyaluronan, PRP can become a very powerful tool to treat osteoarthritis. The hyaluronan offers a neutral scaffold to support the cartilage, while the PRP can deliver signals to promote cells regeneration.
• PRP can be combined with surgery such as ACL, cartilage and meniscus repair to augment the patient’s recovery
• PRP can be combined effectively with (and enhance) fat cell or cartilage cell therapy
What’s the current evidence base for this treatment?
Due to recent advances in medicine and the increased interest in biological solutions, the medical literature has expanded over a thousand times on the topic in PRP. There are now more than 5,000 methods to produce PRP, so it is very difficult to compare evidence across all of the studies.
There are many level 1 RCT clinical studies suggested that it is have great effects but at the same time that are also level 1 studies says it have no effects. To complicate the matters, meta-analyses (where we group the results of several studies together) conclude that PRP makes no difference. This is no surprise, since each PRP treatment is different – grouping it all together makes no sense and will not produce a useful conclusion. It is like saying that antibiotics medication is not effective against infection. It certainly can be, as long as it is the right medication!
Our PRP treatment:
Properly practised PRP treatment should be knowledge and evidence-based. It is very important for the clinician to interpret studies relevant to the condition they are planning to treat and the preparation of the PRP they choose to prescribe. It is no different to any kind of medicine.