What is Platelet Rich Plasma (PRP)?
Platelet rich plasma (PRP) is the injection of concentrated platelets and growth factors, collected from your blood during an in-ofﬁce procedure, into an area of injury or arthritis. The growth factor concentrate signals local progenitor cells to replace the injured area with healthy tissue. PRP is considered to be more effective than dextrose prolotherapy and has gained popularity over the last decade through highly publicized testimonials from numerous professional athletes.
BOUNDLESS is a leading provider of PRP injections in San Diego.
What makes our PRP different?
Recent publications support our observation that most commercial PRP systems are inefficient and inconsistent at producing PRP of sufficient concentration and quality for optimum healing. At BOUNDLESS, we have optimized a process of producing highly concentrated, custom-made PRP in our in-house GMP-quality lab. We offer personalized PRP preparation options depending on your healing needs, from a “pure,” clear, and largely anti-inﬂammatory preparation, to a stem cell and macrophage-rich hand-made preparation when needed.
What does a typical treatment entail?
An office visit for a PRP treatment lasts about 90 minutes. Your blood is drawn and prepared in our in-house lab while you wait. The injured or arthritic area is then injected with the custom-made PRP mixture under ultrasound or fluoroscopic guidance. Each treatment may consist of one or several injections, guided by physical examination, prolotherapy traditions, and the latest research, to maximize the healing and stabilization of your tendon, ligament, or joint.
How many treatments treatments are needed?
Typically 1-3 rounds of treatments spaced 1 -3 months apart are needed for optimum results.
Our patients value their experience...
You’ve been going out of your way to help me–and I want to thank you.
Thank you just isn’t enough. You have no idea of the difference you have made in my life. I’ve gone from totally discouraged and completely worn down from chronic pain to optimistic, excited, and happy. YOU have made that difference in me.
I love your spirit and am grateful that [my partner] has you as his doctor. You are a caring guide on his path of learning to manage his pain.
Why do you think I am back? You are HONEST and I like you–and surgery is the last option.
There are not adequate words to thank you for what I feel in my heart, my mind, and my body. I have my life back! Each day is so very special. How do you find the words to begin to thank you for that? I could not have been more pleased with your personal sensitivity.
Is all PRP the same?
No – there is a wide variety of PRP preparations and this accounts, in part, in the conﬂicting study results. There are a number of commercial systems that produce easy to produce, turn-key PRP of various quality – some produce a mixture high not just in platelets, but also in white and red cells (which looks red, or bloody and results in higher inﬂammation levels and pain) and others that produce a much clearer solution which is low in white and red cells, and, unfortunately, also in platelets. At Boundless we are unique in the community in offering PRP using several commercial systems as well as custom hand-made preparations produced in our lab, shown to surpass most commercial systems in platelet recovery and selection. This allows us to offer our patients personalized PRP options depending on their healing needs, from a “pure”, clear and largely antiinﬂammatory preparation, to a stem cell and macrophage-rich preparation when needed. We also offer platelet lysate, containing growth factors without platelets, for those cases where minimum inﬂammation is necessary, such as around nerves and in the epidural space.
What are the risks and side effects of PRP treatment?
The risks associated with PRP are extremely rare, typically limited to infections and needle-related injuries according to the literature. Since a portion of your own blood is used, the treatment is one of the most natural, without risks of allergy/adverse reaction common to injected medications, or risks of anesthesia and surgery. PRP is associated with a temporary, self-limited
pain ﬂare, lasting typically a few days to 2 weeks, related to its mechanism of action, your own healing/inﬂammation system. The purer, less inﬂammatory PRP preparations are associated with a lower/shorter pain ﬂare.
How does PRP compare with cortisone injections and surgery?
Cortisone injections have shown to provide temporary relief of pain and inﬂammation at the cost of tissue weakness and destruction if overused. They are appropriate in cases of severe, functionally limiting pain and inﬂammation and, if used sparingly and combined with physical therapy and strengthening, can result in overall beneﬁt. PRP, however, results in direct healing and strengthening of tendons and ligaments and outperforms cortisone in long-term studies of tendinopathy (tennis elbow) and arthritis (knee arthritis studies). Surgery is, for many patients, a last resort due to the risks of surgery and anesthesia, recovery time, cost, and extent of intervention/irreversibility. While there are cases where surgery is necessary, PRP can frequently prevent or delay surgery in cases of partial tendon tears and tendinopathies, meniscal and labral tears, arthritic conditions, and soft tissue injuries. In choosing PRP, you are not burning your bridges – for those patients who do not improve with PRP, surgery remains an option.
How soon can I go back to my regular activities?
Typically gentle range of motion and normal daily activities are resumed the ﬁrst day after PRP treatment as tolerated. As the initial pain ﬂare/inﬂammation resolves, patients resume an exercise program designed to optimize their healing, frequently under the guidance of a physical therapist. Gradual return to sports is encouraged, keeping in mind that those activities that resulted in the initial injury, if restarted too quickly, will re-injure the area and result in failure of treatment. Patients are counseled in pacing and advised to avoid those activities that result in a pain ﬂare of more than 2 points on a scale of 1-10.
Will my insurance cover PRP therapy?
As with other regenerative procedures, medicare and most insurance companies consider PRP to be experimental despite the thousands of studies in the literature today. Some companies have begun to reimburse the procedure, but these are currently in the minority. At Boundless, we collect for the procedure at the time of treatment, but, as a courtesy to our patients, do send the billing codes to the insurance. If the insurance company is one of the few that does reimburse the procedure, the patient’s money will be refunded.
Intra-articular injection in the knee of adipose derived stromal cells (stromal vascular fraction) and platelet rich plasma for osteoarthritis
Full Text, 2017 (Jun. 19); Bansal, et. al.
Dr. Bunyak notes this text from the conclusion, “SVF combined with PRP has a great potential as a therapeutic agent in regenerative medicine especially in orthopedic conditions. The high numbers of MSCs in SVF make it a suitable source for cellular medicine. Preliminary studies suggest that it is a safe and effective method for treating osteoarthritis. Both qualitative and quantitative measurements showed statistically significant improvements during the follow up period of 2 years.”
Optimization of pure platelet-rich plasma preparation: A comparative study of pure platelet-rich plasma obtained using different centrifugal conditions in a single-donor model
Full Text, 2017 (Jul. 9); Yin, et. al.
Dr. Bunyak notes this text from the conclusion, “In conclusion, while P-PRP obtained using different centrifugal conditions had similar erythrocyte, leukocyte and pro-inflammatory cytokine concentrations, centrifugation at (specific spin speeds) successively captured and concentrated platelets and growth factors more efficiently with preservation of platelet function compared with other conditions. “
Benefits of different postoperative treatments in patients undergoing knee arthroscopic debridement
Full Text, 2017 (Sep. 25); Vasavilbaso, et. al.
Dr. Bunyak notes, “HA (hyaluronic acid injections) and PRP (platelet-rich plasma therapy) both help with post-arthroscopy pain and function for arthritis and meniscal tears. In this study, the HA offered more benefit than PRP, and this benefit lasted 18 months.”
The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis
Full Text, 2018 (Jan. 4); Rahimzadeh, et. al.
Dr. Bunyak notes this text from the Conclusion, “Results of the present study suggested a significant decrease in the overall WOMAC score of patients who undergo either PRP therapy or PRL (prolotherapy). This positive change in the overall WOMAC score led to an improvement in the quality of life of patients with knee OA shortly after the first injection. PRP injection is more effective than PRL in the treatment of knee OA.”
Effects of bone marrow aspirate concentrate and platelet-rich plasma on patients with partial tear of the rotator cuff tendon
Full Text, 2018 (Jan. 3); Kim, et. al.
Dr. Bunyak notes, “BMAC-PRP (bone marrow aspirate concentrate therapy combined with PRP) improved pain and shoulder function in patients with partial tear of the rotator cuff tendon.”
Management of rotator cuff injuries in the elite athlete
2018 (Jan. 13); Weiss, et. al.
Dr. Bunyak notes, “Conservative management of rotator cuff injuries continues to be the “gold standard” in the elite athlete. This includes a comprehensive rehabilitation program, anti-inflammatories, and corticosteroid injections. Newer treatment techniques such as intramuscular dry needling and the use of biologics such as platelet-rich plasma and stem cells demonstrate early promising results; however, these modalities require further investigation to determine their effectiveness.”
Platelets rich plasma versus minoxidil 5% in treatment of alopecia areata: A trichoscopic evaluation
(El Taieb, Ibrahim, et. al., Dermatologic Therapy, 1-2/2017)
From the abstract: “Platelet rich plasma is more effective in the treatment of alopecia areata than topical minoxidil 5%.”