What are Orthobiologics?
Biologic substances that are derived from your own blood or tissue cells and used to enhance structural healing, regeneration and repair of tendons and reduce inflammation and pain associated with rotator cuff tears and glenohumeral (shoulder) arthritis.
Platelet rich plasma (PRP) injections are the most used orthobiologic with the strongest evidence in the medical literature including randomized controlled trials.
What is PRP?
Plasma is the liquid component of blood. There are also three solid components including red cells that carry oxygen, white cells that fight infection, and platelets that help with clotting, deliver growth factors, and modify inflammation at sites of injury. A normal sample of whole blood contains a platelet concentration of only 6%. The platelet concentration of enriched plasma (autologous conditioned plasma or ACP) can exceed 90% and contain 5 to 10 times the concentration of growth factors found in normal whole blood.
What growth factors are found in platelets?
⍺-granules in platelets contain numerous growth factors such as PDGF, TGF-β, VEGF, IGF-1, EGF, and HGF. These growth factors improve fibroblast migration, tenocyte proliferation, type I collage deposition, tendon-bone interface maturation, early vascularization, and modulation (reduction) of inflammation.
What Conditions are Treated with PRP Injections?
- Rotator cuff tendinopathy and tendinitis (wear and tear) and partial thickness rotator cuff tears
- Early to moderate glenohumeral (shoulder) arthritis
When are PRP Injections Recommended?
- Prior to surgery as a non-operative treatment option in addition to ice, heat, rest, NSAIDs (ibuprofen), Tylenol, and physical therapy
- Prior to surgery as a non-operative treatment alternativeto cortisone injections in patients who are not a candidate for or ready to proceed with arthroscopic rotator cuff repair or shoulder replacement
- During surgery to improve and enhance the healing potential with arthroscopic rotator cuff repair
Who is a candidate?
- Any patient greater than 18 years of age
- Traumatic shoulder injuries
- Degenerative shoulder conditions
- Throwing athletes
- Swinging athletes (golf, tennis, pickeball)
- Worker’s compensation
PRP injections are not recommended if you have:
- Active infection
- Active cancer
- Bleeding disorders such as thrombocytopenia
Where are PRP injections performed?
Dr. Gasbarro performs these injections at an ambulatory surgery center in Towson on Monday mornings. The SurgCenter of Towson, an affiliate of Mercy Medical Center, is located at 1609 East Joppa Road.
What occurs after arriving at the SurgCenter of Towson?
You will be greeted in the main lobby and check-in for the procedure. A pre-operative nurse will bring you to the pre-procedure area, confirm your name, date of birth, and procedure site. Dr. Gasbarro will meet with you, obtain consent for the procedure and review any questions. You do NOT need to change into a gown or fast the night before the procedure. The nurse will then obtain a blood draw (15 mL) from your arm, and this will be placed into a centrifuge for 5 minutes to derive the ACP used for your PRP injection. Next, you are brought into a dedicated procedure room. Dr. Gasbarro will again confirm the injection site and then sterilize your shoulder. Like a cortisone injection, a needle is used to inject your shoulder and a dressing is applied. You are then brought to the post-procedure area and observed for 15 minutes. You will be given food and water as the nursing staff reviews post-injection instructions.
What is the typical recovery?
Most patients should expect soreness over the first 48 to 72 hours. Rest, ice, and Tylenol are recommended initially. Please avoid NSAIDs (ibuprofen) or aspirin (unless previously prescribed) as these medications may block the effect of the injection. Heavy exercise and sports activities should be avoided for the first week after the procedure. You will see Dr. Gasbarro 10-14 days after the injection and start formal physical therapy. If you have elected for series of 2 or 3 injections scheduled 2 weeks apart, physical therapy will begin after the last injection is given. Pain relief and improved function usually occur over the course of 6-8 weeks.
What are the potential risks?
Risks and complications are very minimal but include:
- Pain at the injection site
- Infection
What is the cost?
In the United States, nearly all commercial insurances plan, Medicare and Medicaid do not cover and pay for the cost of PRP injections. As such, patients are responsible for an out-of-pocket fee for the procedure. Some worker’s compensation carriers do pay for the injection. Pricing is based on a fair market analysis of all hospitals in the Baltimore metropolitan area. The current cost for a single PRP injection is $1,250.
Frequently asked questions
- Do you recommend other orthobiologic treatments such as stem cell therapy for the shoulder?
- Not currently. Adult “stem cells” derived from bone marrow (BMAC) or adipose (fat cells) are actually mesenchymal stromal cells which do not differentiate into tendon or cartilage. The biologic effect of these cells is through paracrine signaling of the entire cellular milieu. Pre-clinical and early clinical data are available through small cohort studies but evidence for use in shoulder conditions is limited.
- Do you recommend therapeutic peptides such as BPC-157 for the shoulder?
- Not currently. Widespread enthusiasm through promotion on social media for body protection compound-157 (BPC-157) has outpaced clinical evidence. Animal studies have shown improved tissue regeneration when exposed to this synthetic 15-amino acid peptide derived from gastric juice. There is no high-quality clinical evidence to date, however.
Disclaimer
All PRP injections are autologous and performed on the same day and compliant with FDA regulatory guidelines, including IND/BLA, RMAT, and Sections 351 and 361 HCT/P.
