Why Prolotherapy with Platelet Rich Plasma is a Good Alternative for Labrum and Menisci Degeneration and/or Tears

Is PRP proven?  The answer to this question depends on what condition you are talking about and who you ask.  In regard to lateral epicondylosis, according to one author, “There is strong pilot-level evidence supporting the use of Prolotherapy, polidocanol, autologous white blood and platelet rich plasma injections in the treatment of lateral epicondylosis.”  If you ask Dr. Hauser, “Absolutely Prolotherapy with or without PRP works great for lateral epicondylosis (tennis elbow/lateral elbow pain)!  This is just one example.  In my experience, PRP works great for tendinosis, menisci or labrum degeneration or tears, and ligament injuries not healing with other Prolotherapy solutions.  

Why PRP makes sense?  Ligament injury like tendon pathology often involves tissues with poor blood supplies. Tendon pathology has many manifestations, for instance from spontaneous rupture to chronic tendinitis or tendinosis (degenerated tendon); the etiology and pathology of each are very different and poorly understood.  Tendon is a comparatively poorly vascularized tissue that relies heavily upon synovial fluid diffusion to provide nutrition. During tendon injury, as with damage to any tissue, there is a requirement for cell infiltration from the blood system to provide the necessary reparative factors for tissue healing. Obviously if a tissue has a poor blood supply (like tendons and ligaments) then the reparative factors necessary for healing are likely not going to get to the injured area or not mount a sufficient response to fully repair the tissue.  Thus, you see the need for Prolotherapy - with or without PRP!  One of the growth factors in PRP is vascular growth factor which helps with new blood vessel formation.  It could be this growth factor and others that causes the remarkable healing with PRP. 

What about using PRP in osteoarthrtic joints?  If you look at the various studies on PRP, a theoretical basis for using PRP to effect joint pathology exists at this time.  Study authors conclude, “Intra-articular administration of PRGF (platelet rich growth factor) might be beneficial restoring hyaluronic acid concentrations and switching angiogenesis to a more balanced status, but does not halt the effects of IL-1 beta on synovial cells.” 

What does this mean?  Bottom line in this study - PRGF significantly enhanced hyaluronic acid secretion compared with platelet-poor preparations.  When you see hyaluronic acid, you have to think joint fluid. If you think more joint fluid, think of the joint being lubricated. What would happen to a joint that was not lubricated if it were to become more lubricated?  You got it, less stiffness, more motion, and ,of course, less pain!  This is what we have found with Prolotherapy and with Prolotherapy and PRP. 

What is really great about PRP?  Ultrasound studies before and after PRP are showing that the tissue is healing! This is something we knew all along with Prolotherapy, but we just had a hard time proving it!   Now that ultrasounds are showing degenerated tendons being regenerated with Prolotherapy PRP, the critics are being answered.  Yes, it is true that Prolotherapy stimulates the body to repair painful areas. This can be done by injecting simple solutions such as dextrose in the area, to more complicated solutions using glucosamine, manganese, natural hormones, to a person’s own growth factors through the use of PRP. 

So what are you to do?  If you have pain or know of someone in pain that you care about, then let them know that there is a potential cure for chronic pain and that cure is Prolotherapy!

BIBLIOGRAPHY

1. Pietrzak WS, Eppley BL.  Platelet rich plasma:  biology and new technology.  Journal of Craniofacial Surgery.  2005; 16:1043-1054.
2. Crane D, Everts P.  Platelet Rich Plasma Matrix Grafts.  Practical Pain Management.  2008; Jan/Feb: 12-26.
3. Sampson S, Gerhardt M, Mandelbaum B.  Platelet rich plasma injection grafts for musculoskeletal injuries:  a review.  Current Reviews in Musculoskeletal Medicine.  2008; 3:165-174.
4. Rabago D, Best TM, Zgierska A, et al.  A systematic review of four injection therapies for lateral epicondylosis:  prolotherapy, polidocanol, whole blood and platelet rich plasma.  British Journal of Sports Medicine.  2009; 43: don’t know what pages (it is in the current issue issue is pages 157-234.
5. Sanchez A, Nurden AT, Zalduendo MM, et al.  Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients.  Rheumatology.  2007;46:1769-1772.