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Platelet-rich Plasma as musculoskeletal medicine

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Musculoskeletal

According to Dr William ‘Bill’ Murrell, MD, MSc; Orthopaedic Sports Medicine at Dr Humeira Badsha Medical Center, a new era in the treatment of orthopaedic and musculoskeletal conditions is now being firmly established. The use of platelet rich plasma (PRP) and other biologic materials has captured the interest of not only medical practitioners, but more importantly, patients too. The theoretical benefit being that conditions previousl y treated with medications such corticosteroids and non-steroidal anti-inflammatory agents can now be treated with a more natural solution, a preparation made from the person’s blood. To many people this sort of treatment is very attractive and desirable.

About Platelet-rich Plasma (PRP)
PRP is a preparation made from a patient’ s own blood. Collection is a simple and safe procedure: Around 20-60cc of blood is obtained from the patient, mixed with an anticoagulant using EDTA or in some cases heparin and separated into three distinct layers using a centrifuge. In the top layer where there are not many cells, but mostly serum and proteins – this is called the platelet poor layer or PPP (platelet poor plasma). The middle layer is called the buffy coat, and it contains some smaller white blood cells and most of the platelets and is aptly called PRP or platelet rich plasma and is ready to use. The top-most layer is mostly red blood cells.

Why PRP?
Platelets contain bodies called a-granules, and inside these granules are a collection of important factors that are essential for healing and regeneration. Among the well-known proteins or cytokines found in the a-granules are VEGF (vaso-endothelial growth factor), PDGF (platelet-derived growth factor), IGF (insulin derived growth factor), and TGF-b (transforming growth factor beta). PRP is mostly injected into areas of injury or degeneration, and because of the potent factors that are found within the platelets, when they become active, these factors stimulate a healing or regenerative response at the site of interest.

PRP was first used in the early 90s by oral and maxillofacial surgeons who were trying to find ways to improve fixation of dental implants. It was found that when PRP was used, improved bone growth occurred. Later PRP was used in orthopaedics to successfully treat conditions like tennis elbow, heel spurs, and delayed healing of long bones. More recently, PRP has been used to treat tendonitis of shoulder, elbow, knee, ankle, as well as arthritic conditions of the ankle, knee, hip, shoulder, hand and foot.

How it works
Years ago, scientists unravelled some of the action mechanisms in the lab and found that the PDGF (platelet derived growth factor) activates pericytes. Later it was discovered that these pericytes were unactivated mesenchymal stem cells. Once these cells become activated, they act as ‘general directors’ of healing and regeneration and release a myriad of cytokines and other factors that have trophic, anti-inflammatory, mitogenic, anti-scarring, and anti-infection attributes. In the case of osteoarthritis of the knee, the cartilage that is lost as an after -effect of the normal ageing process is not ‘regrown’ but the environment is altered so that there is less pain, and less further loss of the knee cartilages. In many respects it alters the progression or worsening of the disease, and it is hoped by many that surgeries such as knee replacements, are delayed or avoided all together. Today, PRP is used in many areas of medicine in the US and Europe f or treating musculoskeletal problems, plastics, aesthetics, dermatology, general surgery, ENT, rheumatology, primary care, pain management, and physical medicine and rehabilitation.

Click here to read Dr. William Murrell’s article ‘Platelet rich plasma: Ready for prime time in musculoskeletal medicine?’ published in arabhealthmagazine.com

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