Platelet-rich plasma: what can be treated with PRP injections?
Still too little used, platelet-rich plasma injections rely on the body’s own ability to heal itself, without external chemical intervention. Deployed little by little in different areas, they are beginning to make people talk about them. What are we treating with PRP? What are the results ?
The use of blood as therapy is not new, as evidenced by the famous bloodletting already advocated by Hippocrates and Galen in the 12th century, and more recently, of course, blood transfusions. Less known, “PRP injection, an acronym for platelet-rich plasma (or concentrates of autologous platelets), is part of the same register, that of regenerative medicine” notes Dr Nicolas Barizien, sports doctor.
For about 25 years, we have known that blood platelets are made up of granules that contain healing and tissue repair factors, as well as other molecules that have anti-inflammatory and analgesic properties. “It is these healing factors that explain why the wound stops bleeding when you cut yourself and that will promote the healing of the cut. details the specialist.
How is plasma collected?
Whole blood contains only 4% of platelets (against 93% of red blood cells), which must be extracted to benefit from their virtues. At his office, the doctor takes 8 to 15 ml of blood (the equivalent of three blood collection tubes) using a single-use, sterile kit. The blood collected in a special vial is then placed in a centrifuge. Five minutes later, the different elements of the blood are separated.
Plasma is thus obtained, a yellowish liquid which floats and which contains platelets. It is this plasma which will then be injected with a syringe, directly at the place where it must act (joint, mucosa, etc.).
A proposed treatment in case of osteoarthritis
Prohibited in France in acts for aesthetic purposes, this technique is now essentially used in dental implantology and rheumatology. In the first case, it facilitates the installation of a pivot or a prosthesis on a damaged bone and accelerates the production of tissue at the root of the tooth.
Plasma enriched with platelets is also part of the treatments offered in the event of osteoarthritis (knee, hip, thumb). PRP does not regenerate or rebuild cartilage, but it helps to control pain and therefore to move more easily, especially since it would also help to increase the natural production of hyaluronic acid inside the body. the arthritic joint. “The latest publications show that in osteoarthritis, PRP is just as effective as hyaluronic acid and the combination of the two offers better results “emphasizes the doctor.
It promotes healing in case of tendonitis
In rheumatology, the injection of PRP, with a syringe under ultrasound control, also promotes scarring and healing of fissures in the event of chronic tendinitis (shoulder, Achilles tendon) or even bursitis (chronic inflammation of the bursa of the hip, shoulder, etc.).
“Once injected into the joint envelope, into the intratendinous fissures, these platelets will degranulate, that is to say release the healing and tissue repair factors to act as a biological glue”details Dr. Nicolas Barizien.
More surprising and still confidential, although promising, this treatment can also be used successfully in the treatment of anosmia (loss of smell) or parosmia (distortion of smells and taste) following Covid for example. “With a single injection, I have 81% improvement 3 months later” assures Pr Jérôme Lechien, ENT at the EpiCURA hospital (Mons) and at the Foch hospital (Suresnes). “200 people have already benefited from these injections under the olfactory mucosa, which is thus repaired”.
However, this technique cannot be generalized to all forms of anosmia. When it is for example due to the presence of a polyp (polyposis), the injection of PRP could on the contrary promote the growth of the polyps and therefore aggravate the disorders of smell.
PRP: how many injections are needed?
The number of injections varies according to the pathology and practices. The French Society of Sports Traumatology should also publish recommendations for good practice in the course of 2023. For his part, Dr Barizien administers a first injection, then takes stock 3 months later.
Unlike some drugs, this technique has no side effects. At most, it is not recommended for pregnant women and for people treated with antiplatelet agents (cardiac anticoagulants), because their platelets are of poor quality, so the treatment would not be effective. The other limitation of this technique is related to the syringe rather than the PRP: “It is difficult to make this injection near the spine in case of osteoarthritis, because the gesture is complicated and therefore risky ” warns our expert.
PRP: what results?
You can leave the doctor’s office half an hour later and resume your usual activities, with the exception of sports. “It will be necessary to wait about 2 weeks to allow time for the tissues to heal, then plan 8 to 10 sessions (2 per week) of rehabilitation to guide tissue healing, says the doctor. Sometimes, the person also wears a splint for 1 to 2 weeks, in order to relieve their treated joint.
The improvement is not immediate (it takes a few weeks) and it generally lasts six to twelve months, then the injection will have to be repeated.
PRP: how much does it cost?
Depending on the volume injected and the location, each injection costs between 200 and 400 euros, not covered by health insurance. “This treatment will probably never be reimbursed, but we can hope for the drop in the price of consumables (syringe, vial) which would be passed on to patients.”
Technological advances in centrifugation could also make it possible to extract a greater quantity of platelets and platelets of better quality, so that they release more growth factors. The frequency of injections could then be reduced.
Our expert: Dr Nicolas Barizien, head of the physical medicine and functional rehabilitation department at the Foch hospital (Suresnes, 92)