Rehabilitation of Joints, Tendons, and Muscles with Platelet-Rich Plasma

• PRP injection Local anesthesia cannot be used because its pH level may affect the function of the injected platelets. Therefore, patients may need to endure pain or soreness from the PRP injection.
• Treatment with PRP in chronic patients requires a longer duration, and the outcomes may not be as favorable as in those treated immediately after injury.

PRP injection (Platelet Rich Plasma) is a medical technique used to treat injuries of joints, tendons, and muscles. Studies and clinical use of PRP have shown good results with low side effects because the substance is extracted from the patient's own blood, providing high safety and treatment efficacy.Previously, there have beenmany patients and athletes choosing this method to treat their injuries.

Treatment with PRP

PRP stands for Platelet Rich Plasma and is a treatment using the patient's own platelets. Blood is processed to concentrate platelets at levels higher than normal. Currently, PRP is categorized into two groups: one with very high platelet concentrations of about 5-10 times normal, and another with concentrations about 2-3 times normal.

The treatment principle uses platelets separated by centrifugation to obtain a blood component suitable for therapy. Platelets secrete factors that stimulate repair of injured tissues and improve the affected area. This is based on the observation that normally, when the body suffers skin wounds or blood vessel rupture, platelets aggregate to form clots to stop bleeding and then activate white blood cells or other cells to repair the injured tissue.

In orthopedic injury treatment, the same principle applies. This method is suitable for treating injuries of tendons and muscles by injecting platelets into the injured site, such as a torn muscle, to promote muscle repair there.

Injuries treatable with PRP

• Injuries to various tendons, degenerative tendons around the elbow known as Tennis Elbow, and degenerative shoulder tendons.
• Osteoarthritis
• Postoperative injuries, such as after anterior cruciate ligament surgery or tendon and joint repairs.

Limitations and side effects of PRP

Since the platelets used come from the patient’s own blood, there is no risk of tissue developing into tumors or side effects for the patient. However, there are some limitations as follows.

• Local anesthesia cannot be used because its pH may affect platelet function, so patients might experience pain or soreness from the PRP injection.
• Patients must discontinue anti-inflammatory or steroid medications at least two weeks before the injection because these drugs can reduce platelet efficacy.
• PRP treatment is not covered by health insurance benefits.

Duration, frequency of injections, and treatment outcomes

• Optimal effectiveness depends on the injured tissue; muscle injuries may require less time than tendon injuries.
• Chronic patients generally need longer treatment periods and may have less favorable outcomes compared to those treated promptly after injury.
• Size of the jointthat is injuredFor example, treating the elbow versus the shoulder requires different durations and results.
• PRP injections are typically given 2-3 times per injured tendon or muscle, spaced 7-10 days apart, depending on the physician's assessment.
• Treatment effects can be seen from 4-6 weeks onward.

Method and procedure for injection

1. Patients should not be dehydrated, as dehydration can make blood collection difficult.

2. Patients must stop medications as prescribed by the doctor, especially anti-inflammatory drugs and steroids, about two weeks before the injection.

3. Blood is drawn from the patient and placed in a special device that centrifuges it to obtain platelets suitable for treatment, which takes about 15 minutes.

4. After injection, patients should continue to avoid anti-inflammatory drugs and steroids. If pain occurs, painkillers or cold compresses may be used.

Differences between PRP and steroids

Steroids work by reducing inflammation, but since inflammation is a key part of the body's natural repair process, reducing it may improve pain and swelling but interfere with tendon or muscle healing. PRP, on the other hand, stimulates repair processes so tendons regain their normal properties, though pain and inflammation may still occur.

Moreover, long-term use of steroid medications may have adverse effects, whereas PRP, derived from the patient’s own blood, has no side effects or other adverse impacts.

Information provided by Prof. Dr. Chonlawit Janlalit, Medical License No. 23625, Orthopedic Surgeon specializing in knee, elbow, shoulder arthroscopy and sports medicine, Chief Consultant Physician at the Arthroscopic Surgery and Sports Injury Center (ASC)Samitivej Srinakarin Hospital