Cutting edge technology or lunatic fringe? These are the boundaries that surround alternative treatments used in regenerative orthopaedics. Two such treatments include the use of platelet-rich plasma (PRP) and stem cell therapies. Although not historically considered ‘mainstream,’ these interventions are becoming increasingly popular for their potential to aid in healing and repair of the body.

For athletes, the field of regenerative medicine has been of particular interest. While conventional therapy for sports injuries often follows the RICE protocol (rest, ice, compression and elevation), there’s been growing interest in PRP therapy in order to improve soft tissue healing as well as lower recovery time.

What is platelet-rich plasma and stem cells?

Although blood is primarily liquid (plasma), it is also comprised of many small components including white blood cells, red blood cells and platelets. Platelets play a fundamental role in clotting blood, but they also contain proteins known as growth factors, which can trigger cell reproduction and stimulate tissue regeneration to support healing in the treated area.

Simply put, PRP is blood that contains a higher concentration of platelets and growth factors than normal. In fact, this high concentration can be five to 10 times greater – or richer – than usual.

To create PRP, a blood sample is taken from the patient, just like you would give blood for labs at your doctor’s office. The blood is then separated through centrifuge techniques in a way to concentrate the platelets and growth factors to yield platelet-rich plasma. In addition to the platelets, techniques also allow us to either use or discard the white blood cells captured as part of the blood draw and centrifuge separation. The condition being treated will influence whether we keep or discard the white blood cells.

Alternatively, stem cells are undifferentiated cells that can become many different types of cells including cartilage, muscle, nerve or other cells. They are harvested from the bone marrow as bone marrow aspirate or from adipose cells in the form of a mini liposuction technique. These cells are then mechanized and made ready for injection back into the body.

How are PRP and stem cell therapies useful in orthopaedics?

PRP and stem cell treatments are designed to boost the body’s own ability for healing. Although these interventions have been around for many years, PRP and stem cell interventions first gained attention because of their use by high level athletes – golfer Tiger Woods and Pittsburgh Steelers wide receiver Hines Ward to name a few – to speed up healing in joints, tendons and ligament injuries.

When dealing with injured, diseased tendons or joints, PRP increases the concentration of specific bioproteins or hormones, called growth factors, in that specific area to accelerate the healing process.

How do PRP and stem cell treatments work?

PRP and stem cell injections are used to treat a range of conditions including:

• Tendon or ligament injury (tear, sprain)
• Tendonitis
• Running injuries
• Trauma or impact injuries
• Arthritis or osteoarthritis
• Muscle strains
• Articular cartilage injury

After creating platelet-rich plasma from a patient’s blood sample, that solution is injected into the target area. In some cases, the injection can be completed by a physician feeling the appropriate body structures. In others, ultrasound guidance is helpful to allow the physician to make accurate delivery of the body’s healing products. This is very important in gaining the planned result for many patients.

These therapies are performed as a same day, office-based procedure with minimal downtime. Although success may ultimately depend on the site and severity and there is no “cure” for arthritis, we can often improve pain and function tremendously.

What are the benefits and downsides to these treatments?

Because PRP stimulates your body to rev up healing in the injured areas, your results won’t be immediate. However, your pain should begin to subside within a few days, with optimal results within weeks to months after your injection. Additional treatment benefits include:

• Increased healing potential
• Decreased pain
• Increased function
• Quicker recovery time
• Decreased time away from sport or daily activities
• Long-lasting relief from joint pain

PRP and stem cells taken from your body and reintroduced as an injection offer minimal risk for adverse reaction. As these are introduced as injections, they carry the same risk for infection that a standard injection would carry. Sterile techniques are used to prevent these complications.

Patients should keep in mind that PRP and stem cells are not a cure-all and may be best used in combination with other nonsurgical treatments and lifestyle changes. If you are considering treatment with PRP, be sure to check your eligibility with your health insurance carrier. Currently, only a select few insurance plans, such as workers’ compensation plans, provide partial reimbursement for these treatments. Treatment, therefore, is an out-of-pocket expense for the majority of patients.

Where to go for PRP treatments

At Wake Orthopaedics, our non-operative interventional orthopaedics team is on the frontier of cutting-edge technology including regenerative orthopaedics. Led by double board-certified physician Dr. Chad Greer, we offer many new technologies and treatments for orthopaedic conditions that include PRP and stem cell therapies. We are committed to aiding patients in safely navigating this vast area of untapped potential.

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About Chad Greer, MD

Dr. Chad Greer is a fellowship-trained primary care sports medicine physician, specializing in pediatric and adult non-surgical orthopaedics. This includes sports medicine for all ages, non-operative fracture care, arthritis, sports injuries, orthobiologics, concussion management and most musculoskeletal injuries.

He was the first physician to practice non-operative sports medicine in the orthopaedic setting in the Triangle area and brings over a decade of experience to WakeMed. He is specially trained in advanced regenerative orthopedics and fellowship-trained in ultrasound injection guidance.

Dr. Greer was born and raised near Winston-Salem, North Carolina. He completed his undergraduate degree at Clemson University in Clemson, South Carolina, studied alternative nutrition at Bastyr University in Kenmore, Washington, and later completed his master’s in nutrition at East Carolina University in Greenville, North Carolina. Dr. Greer completed his medical degree at Brody School of Medicine at East Carolina University and went on to complete a dual residency in Internal Medicine and Pediatrics at the Medical College of Virginia in Richmond, Virginia. Immediately following residency, Dr. Greer completed a Sports Medicine Fellowship at AnMed Health in Anderson, South Carolina. Dr. Greer has previously served as the NC State University team physician for wrestling and medical observer in football. Dr. Greer serves as sports medicine physician coverage for numerous high schools, as well as specialized soccer and rugby events.