Growth Factors

There has been a recent surge in interest in the use of growth factors to promote natural healing of bone and soft tissue injuries. A variety of products have been developed to help stimulate biologic factors and promote healing. Platelet rich plasma (PRP) has received a lot of publicity recently. Platelets contain proteins, cytokines and other biologic factors that promote healing. PRP is produced by centrifuging a sample of anti-coagulated blood taken from the patient. It therefore has a 3 to 5 fold increase in the concentration of growth factors. The PRP is then clotted before it is used. About 30 to 60mls of blood will produce 3 to 6mls of platelet aggregate.

Some patients will get an immediate inflammatory reaction to the injection with pain and swelling. Patients can use ice and elevation to control the pain. Non steroidal anti-inflammatory drugs are not given for 2 weeks after the injection as they reduce the effectiveness of the treatment. PRP depends on the inflammatory healing cascade.

The indications for treatment have not yet been clearly established. It is showing some good results in patellar tendinopathy, Achilles tendinopathy, tennis elbow and even acute muscle tears. The exact indications and the technique of injection have yet to be defined. It is however an exciting development where the patient’s own blood is used to treat the condition with no risk from drugs or outside agents. There is no doubt that it is in the field of biologics where the next developments in the treatment of orthopaedic injuries is happening. We have to be careful with any new treatment as there have been false dawns in the best. I am also a little wary of any treatment that is the cure-all for all diseases. However platelet rich plasma makes sound scientific sense, is a very safe procedure and appears to work. We await the specific double blind trials that will define its role.

Breandán Long