Knee Pain? There’s Something Better Than Steroids to Inject!

Better Treatment For Chronic Knee Pain:
Your Own Platelet Rich Plasma

Painful joints can seriously interfere with your life.  If your shoulder, elbow or knee is in constant pain, you may be less mobile, less likely to exercise and have a harder time doing many of the things you enjoy.  Sometimes, these conditions may be due to something very severe and surgery is required to fix them.  However, that is actually the minority of cases.  Most of the time, less invasive methods of treatment are sufficient to relieve pain and restore function of a joint

Determining what the most appropriate plan of care begins with a thorough evaluation.  All of the following factors must be taken into account:

• How/When did the pain begin? Did it develop slowly over time, or did it start suddenly with an accident or sports injury?
• How severe is the pain or injury? Is it manageable, or does it prevent you from using the affected area completely?
• Are there other areas surrounding the injury that are part of the problem? Are muscle spasms, gait, posture or other body mechanical problems contributing to the joint of concern?
• What other medical problems are you experiencing? There are many systemic issues which will contribute to joint problems which must be diagnosed and addressed to be sure that joint problems will also improve.
• What other procedures, supplements or therapies have already been done? Have any of them made a difference?

We will also do a thorough physical exam to be sure we can identify all the sources of joint issues.  All parts of the body are connected in some way.  If someone has knee pain, and you don’t examine the whole leg, feet, pelvis and back- one could easily miss another factor which is contributing to the symptoms experienced at the knee.  Finally, depending on the findings, further radiological studies like X-Rays, CT Scans or MRI’s may be done to get a better idea of any issues present within the joint and surrounding tissues. After this, we can decide if it is necessary to refer a patient for a consult with an Orthopedic Surgeon if there are findings which suggest surgical procedures would be the most appropriate way to address the problem.

There are a wide array of non-surgical approaches to address joint pain.  These include the following:

• Physical Therapy and Stretching Exercises
• Yoga
• Weight loss (if you are overweight)
• Topical Rubs/Balms to reduce pain and inflammation
• Supplements and herbs to support joint health and reduce inflammation
• Acupuncture
• Injection Therapies

The best approach to joint pain is to do a bit of everything!  All these therapies work together to improve outcomes.  The exact approach to each of them truly depends on the individual patient’s situation and what issues are causing their joint pain.  However, for the last item, there is one clear winner.

Physicians may use a wide variety of substances to inject in/around joints to relieve pain, reduce inflammation and stimulate healing.  A recent meta-analysis (a meta-analysis is a special type of study that combines the results of many different studies on the same topic into a single paper) of injection procedures for knee pain demonstrated that Platelet Rich Plasma (PRP) injection had better long term results than steroids, hyaluronic acid or placebo^[i].  The authors also noted that PRP’s benefits were greatest in the long term (6 and 12 months after the procedure) and there was no increase in the number of complications compared to any of the other therapies.

So, what is PRP?  Platelet Rich Plasma is obtained from the patient’s own blood!  We draw about 10 cc of blood into a special tube which contains a small amount of anti-coagulant to prevent the blood from clotting and a special filter inside.  The blood is then spun in a centrifuge at a specific speed so that all of the red blood cells fall down to the bottom of the tube and plasma (the liquid, yellow part of blood) and platelets remain on top.  We then gently rock the tube back and forth to get the platelets into suspension in the plasma, then draw it up into syringes to re-inject wherever it is needed.  The PRP contains many beneficial substances which are anti-inflammatory and promote healing^[ii].  Platelets secrete a compound called Platelet Derived Growth Factor (PDGF).  PDGF works by stimulating your body’s own stem cells to become active in the area and promote regeneration of damaged tissues.  So, while PRP is not a true stem cell treatment, part of the way it works is through stem cells which exist inside of every person, all the time.  This is part of what makes it so safe: you are unlocking your own potential for healing!

The PRP procedure itself is quite simple.  Plan to be in the office for about an hour and always come to the appointment well hydrated! Drink lots of water (at least 2 liters) the day before and the day of the procedure to be sure we will be able to draw you blood easily when you come in.  The steps of the procedure are as follows:

• Your blood is drawn into a special tube used to separate PRP.
• Your blood is spun and the PRP is separated from the red blood cells
• The platelets are re-suspended in the plasma by gently inverting the tube
• The PRP is drawn into syringes to be used for re-injection.
• Anesthesia is injected into any sensitive areas as needed to prepare for the injection
• The PRP is injected into the joint and any surrounding areas (muscles, tendons, acupuncture/trigger points) which are affected.
• You rest for a few minutes after the injections and are able to leave the clinic on your own.
  
  

Most patients do very well with PRP injections and the pain during procedures is mild to moderate.  Some patients may have a mild ‘flare’ of symptoms immediately after the procedure which usually improves within a few days.  For recent or acute injuries, a single procedure may be sufficient.  For long standing (>6 months) or more severe injuries, several procedures may be needed.  Repeat injection procedures are usually spaced out by at least 4-6 weeks.  The doctor will discuss the most appropriate approach and treatment schedule for you based on your history.  Because we are using your own PRP, repeat injections are very safe and there is no way to ‘overdose’ on PRP.

PRP procedures are safe and effective for many conditions.  A brief consultation and counseling session with a doctor will be able to determine if you are a good candidate for the procedure.  An important step to note about preparing for a PRP procedure is to stop all non-steroidal anti-inflammatory drugs (ibuprofen, naproxen, aspirin, acetaminophen, etc) 1 week before the procedure and avoid them for 1 week after the procedure. These drugs inactivate the platelets and can make the procedure less effective.  There are many alternatives to help manage pain before and after the procedure if needed.  Call us any time to schedule your consultation to see if PRP is a good solution for your joint pain!

REFERENCES

[i] Filardo G, Previtali D, Napoli F, Candrian C, Zaffagnini S, Grassi A. PRP Injections for the Treatment of Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials. Cartilage. 2021 Dec;13(1_suppl):364S-375S. doi: 10.1177/1947603520931170. Epub

[ii] Everts P, Onishi K, Jayaram P, Lana JF, Mautner K. Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020. Int J Mol Sci. 2020 Oct 21;21(20):7794. doi: 10.3390/ijms21207794. PMID: 33096812; PMCID: PMC7589810.