Knee pain affects approximately 25% of adults. The prevalence of knee pain has increased by almost 65% over the past 20 years, accounting for nearly 4 million primary care visits annually. The knee is typically symptomatic with arthritis, resulting in pain and functional impairment. Other common injuries of the knee include meniscal tears, tendon tears (most commonly the ACL and PCL) bursitis, and tendonitis.
Typical treatment approaches tend to be physical therapy, oral vitamin supplementation, and standard non-regenerative injection therapy. Common injections from most traditional orthopedic doctors include cortisone shots and hyaluronic acid shots, which often must be repeated and do not contribute to the overall healing of the joint. An alternative healing approach is the use of PRP, or Platelet Rich Plasma, for reducing pain, healing the knee’s connective tissue, reducing inflammation, and improving joint function.
Case study: A 68 year-old woman who had chronic pain and moderate arthritis, with some meniscal swelling on both sides, had her knee injected with PRP two times, one year apart. The first injection worked so well that she did not feel she needed a 2nd shot until one year later. Her 2nd PRP injection resolved her pain, and she is still pain-free 2 years later. We also began her on one of my favorite joint healing formulas, Arthrosoothe, and an herbal anti-inflammatory combination of turmeric, Boswellia, and bromelain.
PRP (Platelet Rich Plasma) is a therapy that has been in use and studied since the 1980s. It is made from your blood, so it is very well-tolerated, and the side effects are almost non-existent. The exciting part is that the growth factors that are released are very stem-cell-like and will drive the healing of the tissue they are injected into.
Many people who think of regenerative therapies for their knees will often think that they must spend thousands for stem cell therapy to work on the regeneration of their knees. The great thing is that the research does not support that stem-cell therapy is necessarily better at healing the joint over PRP, and the cost of a typical PRP joint injection is hundreds and opposed to thousands.
A study comparing PRP to Stem-cell therapy (bone marrow stem cells, one of the strongest types) found that both groups had significant improvement at 3-, 6-, 9-, 12-, 18- and 24-months. And at the end they found no difference at any time in the study between PRP effectiveness and the stem cells. (Bone Marrow Aspirate Concentrate is Equivalent to PRP for the Treatment of Knee Osteoarthritis at 2 years: A Prospective Randomized Trial – American Journal of Sports Medicine)
A prospective level III study looked at the efficacy of PRP injections in chronic refractory patellar tendinopathy. The 15 patients were treated with multiple PRP injections and physiotherapy while 16 were treated exclusively with physiotherapy. Those who received PRP had a statistically significant better activity level after a short follow-up at six months.
One study, published in 2013, involved 78 patients with osteoarthritis in both knees (156 knees).11 Each knee received one of three treatments: 1 PRP injection, 2 PRP injections, or 1 placebo saline injection. Researchers evaluated the subjects’ knees 6 weeks, 3 months, and 6 months after injection. Researchers found:
- Knees treated with 1 or 2 PRP injections saw a reduction in pain and stiffness as well as improvement in knee function at 6 weeks and 3 months.
- At the 6-month mark positive results declined, though pain and function were still better than before PRP treatment.
- The group that received placebo injections saw a small increase in pain and stiffness and a decrease in knee function.
A second, smaller study examined patients who had experienced mild knee pain for an average of 14 months.12 Each arthritic knee underwent an MRI to evaluate joint damage and then received a single PRP injection. Patients’ knees were assessed at the 1 week, 3 month, 6 month and 1 year marks. In addition, each knee underwent a second MRI after one year. Researchers found:
- One year after receiving a PRP injection, most patients had less pain than they did the year before (though pain had not necessarily disappeared).
- MRIs showed that that the degenerative process had not progressed in the majority of knees.
While knee cartilage did not seem to regenerate for patients, the fact that arthritis did not worsen may be significant. Evidence suggests that an average of 4 to 6% of cartilage disappears each year in arthritic joints.
So let’s review…
- What is PRP?
- Who does PRP work best for? Men or Women?
- How do we get the PRP from your blood?
- What are the side effects?
- What other health areas should be explored for hair loss?
- Are there additional therapies to assist PRP?
- What is PRP (Platelet Rich Plasma)?
Plasma is the liquid portion of your blood and is primarily composed of water, but is also includes proteins, nutrients, and other elements that can distribute throughout the body. PRP (Platelet Rich Plasma) is a sample of the patient’s own plasma that is concentrated with platelets (for clotting) and white blood cells (for fighting infection). PRP is obtained by drawing a small sample of blood from the patient and separating the red blood cells and plasma. This technology yields a high concentration of platelets and white blood cells that is 5-7 times greater than normal. The separation is done by spinning the blood sample in a special centrifuge to separate the elements before the injection.
PRP Therapy utilizes your body’s own bio-active proteins, also known as growth factors, to replace, repair, and regenerate tissue. PRP is used to deliver the growth factors directly to the site of treatment. When tissue injuries occur, platelets collect at the site of the injury and begin the clotting cycle. These activated platelets release numerous growth factors that are directly responsible for tissue regeneration. Proper preparations can help PRP secrete many growth factors (GFs) at high concentrations, including transforming growth factor-β, platelet-derived growth factor, insulin-like growth factor, vascular endothelial growth factor and epidermal growth factor.
So, by increasing the concentration of platelets, we can deliver a powerful mixture of growth factors directly to the injured tissue and dramatically enhance the body’s natural healing process. This treatment may result in a more rapid, efficient, and thorough restoration of the tissue to a healthy state.
Who is it best for? Men or Women?
PRP knee treatment is equally effective for both men and women.
PRP is not a permanent cure; PRP likely will need to be repeated 2-3 times per year.
What do we do?
PRP is obtained by drawing a small sample of your blood and separating the red blood cells and plasma. This technology yields a high concentration of platelets and white blood cells that is 5-7 times greater than normal. The separation is done by spinning the blood sample in a special centrifuge to separate the elements before the injection.
The PRP is then ‘activated’ to enhance the growth factor release, and is ready for injection!
What are the side effects?
PRP is very safe, very minimal side effects. You can expect some discomfort after the injections. Because PRP initially stimulates repair by inducing inflammation, some people who have a more significant response can experience more discomfort after the injection for 1-2 days. This is well-controlled typically with Tylenol and light icing if needed.
What other health areas should be explored for knee joint pain?
We will get the best results by treating underlying conditions, and/or adding other supportive nutrients or medications. This includes increasing collagen and other joint healing nutrients such as glucosamine, MSM, and hyaluronic acid, and vitamin C into your joint healing routine. I also recommend working with a physical therapist, chiropractor and/or functional fitness expert to strengthen the muscles around the knee and correct any misalignments.
Are there additional therapies to assist PRP?
If you really want to boost your PRP, we recommend that you complete two to three IV Vitamin infusions before your PRP to help nourish your blood. And if you really want to boost the effectiveness of the growth factors, we also can combine your PRP with ozone (talk about a great combination!!).
Questions about regenerative knee healing? We would love to create a personalized plan for you for your health and wellness journey! Please reach out if you have questions or want to share your story!
In love, health and light,
Dr. Angila Jaeggli, ND
Phone: (425) 835-0359
Sage Integrative Medicine Clinic, PLLC
110 James Street, Suite 103
Edmonds, WA 98020
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