Prolotherapy

How is Prolotherapy done?

A small amount of the patient’s blood is drawn (20-120 cc) into a syringe with a small amount of citrate (an anti-clotting agent)—then typically spun for about 15 minutes in a special centrifugation system that separates the platelets, blood and plasma. The plasma-poor layer is then drained off and the “buffy coat” plasma layer extracted, along with a small amount of plasma and red cells. In the surgical setting, PRP is activated by the surgeon mixing in calcium chloride and/or thrombin to make a gel-like graft and then placing it where he/she wants accelerated healing. Type I collagen has also been found to be effective in activating and creating a PRP graft. In 2006, M.M. Murray, et al, demonstrated a successful increase in healing of a central anterior cruciate ligament (ACL) defect in a canine ACL, using a collagen-platelet rich plasma matrix graft. In some musculoskeletal studies, a 10% solution of calcium chloride is added to the PRP just prior to injection or is injected simultaneously via another syringe into the area being injected with PRP.  Activation also occurs by exposure to tendon-derived collagen released by the injured tissue which is being treated. “Peppering” the tissue during injection with the needle tip can help ensure endogenous thrombin release needed for activation.

Growth Factors in PRP granules are released when platelets are activated.  After activation, secretion of growth factors begins within 10 minutes. The viability of the platelets and continued release of growth factors into the tissue continues for seven days. Meantime, the platelets stimulate the influx of macrophages, stem cells and other repair cells, as discussed previously. Micro-trauma created by the injection itself also stimulates influx of macrophages and growth factors as in the case of dextrose Prolotherapy. Once the platelets die (average life span 7-10 days), the macrophages continue wound healing regulation by secreting some of the same growth factors as the platelets did, as well as others. The amount of initial platelets present in the wound determines the rate of wound healing and explains why PRP used during a surgical procedure speeds recovery. This may be because PRP has a strong effect in the early phase of healing. Use of a “matrix,” such as adipose tissue or collagen fibers, to hold the PRP material has been used– especially in the case of a large defect.

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