PRP injections are performed as an outpatient procedure. Because the patient’s blood must be drawn and prepared for injection, a typical procedure may take anywhere from 45 to 90 minutes.

Platelet-Rich Plasma Injections Require Precision

An experienced physician should perform the injections. The use of imaging technology, such as ultrasound, may be used to ensure a safe and precise placement of the injection into the damaged tendon.

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Pre-Injection Precautions

The American Academy of Orthopaedic Surgeons recommends patients avoid or discontinue certain medications prior to injection:

  • Avoid corticosteroid medications for 2 to 3 weeks prior to the procedure
  • Stop taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin (low dose, 81mg, aspirin may be permissible), or arthritis medications such as Celebrex, a week prior to the procedure
  • Do not take anticoagulation medication for 5 days before the procedure (done only under doctor supervision)

In addition, patients are advised to drink plenty of fluids the day before the procedure. Some patients may require anti-anxiety medication immediately before the procedure.

The American Academy of Orthopaedic Surgeons does not advocate for or against platelet-rich plasma treatment.21

Platelet-Rich Plasma Injections, Step-by-Step

This is an in-office procedure that involves a blood draw, preparation of the PRP, and the injection:

  • Blood is drawn from a vein in the patient’s arm into a syringe (15 to 60mL, or 0.5 to 2 ounces, or more may be needed).
  • The blood is processed using a centrifuge machine.
  • A doctor or technician prepares the centrifuged platelet-rich plasma for injection.
  • The affected joint area is cleansed with disinfectant such as alcohol or iodine.
  • A lidocaine injection and/or another local anesthetic may be used to numb the injection site. However, some experts believe that anesthetics decrease the effectiveness of PRP.22
  • If ultrasound is being used, a special gel will be applied to an area of skin near the injection site. An ultrasound probe will be pressed against the gel-covered skin. A live image of the tendon will be projected onscreen for the doctor to see.
  • The patient is asked to relax; this will facilitate the injection and also can make the injection less painful.
  • Using a syringe and needle, the doctor injects a small amount (often just 3 to 6 mL23 ) of platelet-rich plasma into the affected tendon.
  • The injection area is cleansed and bandaged.

The platelet-rich plasma typically stimulates a series of biological responses, including inflammation, so the injection site may be swollen and painful for about 3 to 5 days.

After the PRP Injection: Immediate Follow-up Care

Platelet rich plasma injections may cause temporary inflammation, pain, and swelling. Patients are often advised to take it easy for a few days and avoid putting strain on the affected joint.

A doctor may recommend that a patient:

  • Avoid anti-inflammatory pain medication; the doctor may prescribe or recommend another pain medication.
  • Use crutches, wear a brace, and/or wear or sling to protect and immobilize the affected joint.
  • Apply a cold compress a few times a day for 10 to 20 minutes at a time to help decrease post-injection pain and swelling. (Some doctors may recommend a warm compress instead.)

If the patient does not have a physically demanding job, he or she can usually go back to work the next day. Patients can usually resume normal activities a few days after the injections, when swelling and pain decrease. Patients should not begin taking anti-inflammatory medications until approved by the doctor.

Physical therapy

The patient will likely be prescribed post-injection physical therapy. A licensed physical therapist can teach the patient exercises that build and maintain joint strength and flexibility.

References

  1. Santo F. Martinez, M.D. Practical Guidelines for Using PRP in the Orthopaedic Office. American Academy of Orthopaedic Surgeons. http://www.aaos.org/news/aaosnow/sep10/clinical3.asp Published September 10, 2010. Accessed November 15, 2012.
  2. Kaux J-F, Bouvard M, Lecut C, et al. Reflections about the optimisation of the treatment of tendinopathies with PRP. Muscles, Ligaments and Tendons Journal. 2015;5(1):1-4.
  3. Halpern B, Chaudhury S, Rodeo SA, Hayter C, Bogner E, Potter HG, Nguyen J. Clinical and MRI Outcomes After Platelet-Rich Plasma Treatment for Knee Osteoarthritis. Clin J Sport Med. 2012 Dec 12.

Complete Listing of References

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