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Tuesday, January 10, 2012

The Benefits of Platelet Rich Plasma (PRP)

Platelet Rich Plasma (PRP) treatment has been used in modern medicine since the 1990s. It was originally used to facilitate wound healing in humans after oral surgery. Platelet-rich plasma is a blood product that has a high concentration of platelets, growth factors and cytokines that enhance healing of bone and soft tissue. 

In human medicine, PRP has been implemented in the treatment of nerve injuries, tendinitis, osteoarthritis, bone repairs, plastic surgery, and oral surgery. In horses, veterinarians are using PRP for the treatment of tendon/ligament injuries and osteoarthritis. 

The following images are from 2 different cases in which treating with PRP made a significant difference in the quality of tendon repair. In the first case, a 6 year old Saddlebred mare presented for acute lameness at a show that was associated with soft tissue swelling over the flexor tendons. Ultrasound of the limb noted significant swelling of the superficial digital flexor tendon (SDF) and a core-like lesion (Figure 1) that appears as a black circular structure within the SDF tendon. This lesion extended 4-5cm in length. These findings were consistent with moderate to severe tendinitis of the SDF tendon.

Figure 1
The tendon was treated with approximately 10cc of PRP product by injecting the core lesion via ultrasound guidance. The area of interest was treated in multiple sites. In addition, the mare was treated with forced rest, daily ice therapy and extra-corporeal shockwave treatment (3X). The tendon was re-ultrasounded 6 weeks post PRP injection (Figure 2). The core-like lesion was filled in and the over-all cross sectional area (CSA) of the tendon was significantly reduced.

Figure 2
The second case was a 14 year old Fresian gelding that presented for a chronic (2-4 months) history of forelimb lameness. The lameness blocked out to the proximal metacarpal region which is just below the carpus (knee). The ultrasound exam of this area noted an enlarged SDF tendon with a CSA that was over 3X the normal size (Figure 3) . In addition, there was evidence of fiber disruption and edema present within the tendon. The area of interest was treated with approximately 10cc of PRP product that was injected at multiple sites. In addition, the gelding was treated with forced rest, ice therapy, and extra-corporeal shockwave treatment.
Figure 3
The SDF tendon was re-ultrasounded 4 weeks after PRP and the CSA of the tendon was greatly reduced (Figure 4). There appeared to be better fiber alignment and the gelding's lameness was greatly improved.

Figure 4
Both of these cases are good examples of the benefits of PRP treatment. However, it is important to note that forced rest and a controlled rehabilitation program are critical components to a successful outcome. Current PRP technology allows for on-site treatment and there are a variety of products available to the veterinarian for the production of PRP. The quality of product is directly correlated to the high concentration of platelets and the low concentration of white cells. More recently, practitioners are using PRP treatments in horses that have arthritis as a healthy alternative to cortisone treatment.

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