PRP2019-03-11T09:57:36+11:00

PRP/SCP
What is it? 

Regenexx SCP is a concentrated, purified form of Platelet Rich Plasma (PRP) that is made by hand. This process is undertaken by a specially trained Technician who has been inducted via Regenexx head office. Each dose is individually tailored to each patient, taking into account their age and the target tissue treated.

Regenexx-SCP contains many more platelets than other commercially available forms of PRP made using kits or automated machines and is free of red or white blood cell contamination.

The patient procedure is the same as for PRP, but more blood is required. When it is being processed a technician performs every step ensuring the PRP mixture is as pure and free of contaminants as possible.

PRP has been shown to help relieve pain by assisting the healing process of musculoskeletal tissues. This treatment is used for many common injuries and degenerative conditions including ankle sprains, tendinitis, common ligament sprains, rotator cuff tears, and even tennis elbow. It can help reduce pain due to osteoarthritis, and assists with healing of injuries to the knee, shoulder and hip.

PRP has also been shown in independent journals to delay the progression of early stage osteoarthritis and relieve the symptoms for up to 6 months. Higher concentrations of PRP appear to have more beneficial effects.

Most commercial methods of preparing PRP can concentrate platelets to about 4 to 5 times the level found in whole blood whilst the Regenexx SCP process can easily concentrate to 16 to 20 times the level found in whole blood if needed. Also, because each dose is made by hand in a laboratory there is no contamination with red or white blood cells, both of which can stimulate damaging inflammation when released into a joint.

How much time does it take?

Regenexx SCP takes about an hour to produce once the blood has been drawn. It can be injected back into the area of need as soon as it is ready, or stored for injection later in the day.

It is advisable not to do too much activity for the rest of the day but patients can drive to and from the appointment and attend to their own care.

Patients can resume their normal sporting activities within the next few days with maximal pain relief appearing after 10 days in joints and a few weeks in soft tissue injuries.

Will it help me?

Regenexx SCP can help many people with joint pain, ligament strains and minor muscle or ligament tears. It can reduce the pain associated with repetitive minor injuries and accelerate healing allowing better performance, and can reduce or stop the need to take anti-inflammatories or pain killers. It forms part of a total treatment program including activity modification and a good diet.

A summary of PRP studies and its uses for medical professionals

In the last 5 years there has been a lot of research into the effects of PRP in both joint and soft tissue injuries, and PRP has been shown to be an effective treatment for early osteoarthritis of the knee, hip, and ankle. It has also been shown to be beneficial in tendon and ligament injuries to the rotator cuff, biceps tendon, common extensor origin, ulnar collateral ligament of the elbow, and refractory cases of patella tendinitis (jumper’s knee).

Knee osteoarthritis – Can osteoarthritis progression be stopped?

In a remarkable study from 2013, 22 patients with knee osteoarthritis of up to grade II on the Kellgren Lawrence scale were given 1 injection of PRP. All patients were assessed with an MRI 12 months later and 73% showed no further loss of articular cartilage in any compartment(1). This is despite it being generally accepted that most patients with symptomatic osteoarthritis loose between 3% (in the lateral compartment) and 5% (in the medial compartment) each year(2). In the study, the patients’ pain scores decreased, and functional and clinical score increased at 6 and 12 months after the one injection.

PRP injections have been shown to reduce knee pain and improve quality of life in knee osteoarthritis for 12 months after injection(3,4). Short term improvements were superior to injections of cortisone at 2 months for reduction in pain, improvement in quality of life, and ease of activities of daily living(5), and long term improvements were superior to injections of hyaluronic acid at both 6 months(6), and 12 months(3,6).

When compared to 6 weeks of Paracetamol 500mg q8h, PRP showed a greater reduction in pain at 6 weeks, sustained improvement in knee function at 24 weeks, and improvements in quality of life not seen in the Paracetamol group at either 6 or 24 weeks(7).

So, as the table below shows, if patients are just after a cheap fix that will not stop the progression of arthritis, or might actually weaken the cartilage further, they can continue taking Paracetamol or have an injection of Cortisone. But if they are after a treatment that is superior to Hyaluronic acid, and that lasts longer, they should consider an injection of PRP.

Efficacy period & strength Adverse effect risk Cost (1 knee / 2 knees)
PRP/SCP 12 months / high Low $900 / $1250
Hyaluronic Acid 6 months / high Low $710 / $1310
Cortisone inj. 2-6 weeks / high High $100 / $240
Paracetamol Hours / low Moderate $10

Ankle osteoarthritis

In ankle osteoarthritis PRP injection has been shown to be safe(8) and reduce pain and improve function in both the short term (3 months)(8), and the long term (16 months)(9). The second study also showed that the application of PRP after ankle arthroscopy with microfracture improved functional scores over surgery alone at 16 months, and this effect was superior to the application of hyaluronic acid after surgery(10).

Hip osteoarthritis

A 2016 study of hip osteoarthritis(11) comparing PRP injection with hyaluronic acid, or an injection of a combination of the two found that VAS pain scores were better in the PRP group at 2, 6, and 12 months after injection than the other 2 groups. The WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) was significantly better in the PRP group at 2 and 6 months.

Put simply, PRP can reduce the pain of arthritis and improve joint function in the joints of the lower limb more effectively than Cortisone or Hyaluronic Acid injections with the effect lasting for about 12 months.

Rotator cuff tears

Subacromial injections of PRP into partial rotator cuff tears reduced pain more effectively than cortisone when assessed 3 months later(12), and injections into interstitial (intrasubstance) tears lead to a reduction in pain and tear size when assessed 6 months later(13).

Interestingly, administering PRP in association with surgical rotator cuff repair significantly decreased patient’s pain at 1 week(14) and 1, 3, and 6 months post-surgery(15), allowing for faster rehabilitation. There was also an 85% reduction in the rate of re-tears in large cuff tears 2 years after surgery(15).

Elbow injuries

PRP has been shown to be an effective treatment in recalcitrant lateral epicondylitis(16) and refractory distal biceps tendinitis(17). An American study of 44 baseball players with a strain of the ulna collateral ligament of the elbow treated with PRP found 70% had a good or excellent outcome, with 4 of 6 professional athletes returning to professional sport without other treatment(18).

Ankle injuries

High ankle sprains, or strains of the syndesmosis are common in footballers and difficult to treat. A 2015 study of 16 elite athletes showed treatment of the syndesmosis with PRP returned athletes to play in 2/3 the time (40 days compared to 60 days) with less residual pain than standard treatment, and without the need for surgery(19).

PRP physiology

Many studies have looked at the physiological effects of PRP. Apart from over 30 growth factors, such as Platelet Derived Growth Factor, Vascular Endothelial Derived Growth Factor, and Insulin Like Growth Factor(20), there are over 300 proteins synthesized by platelets. These interact to produce a wide range of effects but key among them are:

  1. An increase in cartilage synthetic activity and decrease in cartilage catabolism(21,22)
  2. Down regulation of genes that degrade the cartilage matrix(23), and
  3. A decrease in the production of COX-2 (Celebrex is a Cox-2 inhibitor) and an increase in the production of Collagen type 2(22).

So there is good reason to have confidence that treatment with PRP in early osteoarthritis will help stop tissue degradation, reduce inflammation, and help cartilage remain healthy.

References

1 Clinical and MRI outcomes after platelet-rich plasma treatment for knee osteoarthritis. Halpern B, Chaudhury S, Rodeo SA, Hayter C, Bogner E, Potter HG, Nguyen J. Clin J Sport Med. 2013 May;23(3):238-9.

2 Knee cartilage loss in symptomatic knee osteoarthritis over 4.5 years. Anita E Wluka, Andrew Forbes, Yuanyuan Wang, Fahad Hanna, Graeme Jones and Flavia M Cicuttini. Arthritis Research & Therapy 2006, 8:R90

3 Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options. Duymus TM; Mutlu S; Dernek B; Komur B; Aydogmus S; Kesiktas FN. Knee Surgery, Sports Traumatology, Arthroscopy. 25(2):485-492, 2017 Feb. (Level 1 evidence)

4 The effects of repeated intra-articular PRP injections on clinical outcomes of early osteoarthritis of the knee. Gobbi A; Lad D; Karnatzikos G. Knee Surgery, Sports Traumatology, Arthroscopy. 23(8):2170-7, 2015 Aug. (Level 2 evidence)

5 Effect of single injection of platelet-rich plasma in comparison with corticosteroid on knee osteoarthritis: a double-blind randomized clinical trial. Forogh B; Mianehsaz E; Shoaee S; Ahadi T; Raissi GR; Sajadi S. Journal of Sports Medicine & Physical Fitness. 56(7-8):901-8, 2016 Jul-Aug.

6 Hyaluronic Acid Versus Platelet-Rich Plasma: A Prospective, Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for the Treatment of Knee Osteoarthritis. Cole BJ; Karas V; Hussey K; Pilz K; Fortier LA. American Journal of Sports Medicine. 45(2):339-346, 2017 02. (Level 1 evidence)

7 Leukocyte-poor platelet-rich plasma is more effective than the conventional therapy with acetaminophen for the treatment of early knee osteoarthritis. Simental-Mendia M; Vilchez-Cavazos JF; Pena-Martinez VM; Said-Fernandez S; Lara-Arias J; Martinez-Rodriguez HG. Archives of Orthopaedic & Trauma Surgery. 136(12):1723-1732, 2016 Dec.

8 Safety and Efficacy of Intra-articular Injection of Platelet-Rich Plasma in Patients With Ankle Osteoarthritis. Fukawa T; Yamaguchi S; Akatsu Y; Yamamoto Y; Akagi R; Sasho T. Foot & Ankle International. 38(6):596-604, 2017 Jun. (Level 4 evidence, case series)

9 Clinical outcomes of platelet rich plasma (PRP) as an adjunct to microfracture surgery in osteochondral lesions of the talus. Guney A; Akar M; Karaman I; Oner M; Guney B. Knee Surgery, Sports Traumatology, Arthroscopy. 23(8):2384-9, 2015 Aug. (Level 2 evidence)

10 Clinical Effects of Platelet-Rich Plasma and Hyaluronic Acid as an Additional Therapy for Talar Osteochondral Lesions Treated with Microfracture Surgery: A Prospective Randomized Clinical Trial. Gormeli G; Karakaplan M; Gormeli CA; Sarikaya B; Elmali N; Ersoy Y. Foot & Ankle International. 36(8):891-900, 2015 Aug. (Randomised controlled trial)

11 Ultrasound-Guided Injection of Platelet-Rich Plasma and Hyaluronic Acid, Separately and in Combination, for Hip Osteoarthritis: A Randomized Controlled Study. Dallari D; Stagni C; Rani N; Sabbioni G; Pelotti P; Torricelli P; Tschon M; Giavaresi G. American Journal of Sports Medicine. 44(3):664-71, 2016 Mar. (Level 1 evidence)

12 Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears. Shams A; El-Sayed M; Gamal O; Ewes W. European journal of orthopaedic surgery & traumatologie. 26(8):837-842, 2016 Dec. (Level 2 evidence)

13 In vivo clinical and radiological effects of platelet-rich plasma on interstitial supraspinatus lesion: Case series. Ladermann A; Zumstein MA; Kolo FC; Grosclaude M; Koglin L; Schwitzguebel AJ. Orthopaedics & traumatology, surgery & research. 102(8):977-982, 2016 Dec. (Level 2 evidence)

14 Platelet-rich plasma supplementation in arthroscopic repair of full-thickness rotator cuff tears: a randomized clinical trial. D’Ambrosi R; Palumbo F; Paronzini A; Ragone V; Facchini RM. Musculoskeletal Surgery. 100(Suppl 1):25-32, 2016 Dec. (Level 1 evidence)

15 Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized tear? A randomized controlled trial. Pandey V; Bandi A; Madi S; Agarwal L; Acharya KK; Maddukuri S; Sambhaji C; Willems WJ. Journal of Shoulder & Elbow Surgery. 25(8):1312-22, 2016 Aug. (Randomised controlled trial)

16 Leukocyte-poor platelet-rich plasma versus bupivacaine for recalcitrant lateral epicondylar tendinopathy. Behera P; Dhillon M; Aggarwal S; Marwaha N; Prakash M. Journal of Orthopaedic Surgery. 23(1):6-10, 2015 Apr. (Randomised controlled trial)

17 Single injection of platelet-rich plasma (PRP) for the treatment of refractory distal biceps tendonitis: long-term results of a prospective multicenter cohort study. Sanli I; Morgan B; van Tilborg F; Funk L; Gosens T. Knee Surgery, Sports Traumatology, Arthroscopy. 24(7):2308-12, 2016 Jul. (Level 3 evidence)

18 Platelet-Rich Plasma Can Be Used to Successfully Treat Elbow Ulnar Collateral Ligament Insufficiency in High-Level Throwers. Dines JS; Williams PN; ElAttrache N; Conte S; Tomczyk T; Osbahr DC; Dines DM; Bradley J; Ahmad CS. American Journal of Orthopedics (Chatham, Nj). 45(5):296-300, 2016 Jul-Aug.

19 Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial. Laver L; Carmont MR; McConkey MO; Palmanovich E; Yaacobi E; Mann G; Nyska M; Kots E. Knee Surgery, Sports Traumatology, Arthroscopy. 23(11):3383-92, 2015 Nov. (Level 2 evidence)

20 https://apexbiologix.com/growth-factors-in-platelets/

21 Platelet-rich plasma releasate inhibits inflammatory processes in osteoarthritic chondrocytes. van Buul GM; Koevoet WL; Kops N; Bos PK; Verhaar JA; Weinans H; Bernsen MR; van Osch GJ. American Journal of Sports Medicine. 39(11):2362-70, 2011 Nov.

22 Platelet rich plasma (PRP) induces chondroprotection via increasing autophagy, anti-inflammatory markers, and decreasing apoptosis in human osteoarthritic cartilage. Moussa M; Lajeunesse D; Hilal G; El Atat O; Haykal G; Serhal R; Chalhoub A; Khalil C; Alaaeddine N. Experimental Cell Research. 352(1):146-156, 2017 Mar 01.

23 The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Sundman EA; Cole BJ; Karas V; Della Valle C; Tetreault MW; Mohammed HO; Fortier LA. American Journal of Sports Medicine. 42(1):35-41, 2014 Jan.

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