Platelet Rich Plasma, Stem Cells, and Other Growth Factors

The healing effect of Prolotherapy is a graded, controlled reaction producing repair of the weak and damaged connective tissue with new healthy collagen. When properly applied, Prolotherapy does not induce scar formation. The bonds are stronger, healthier, and thicker than before treatment, and with each treatment continue to strengthen, until the healing is complete and the pain resolved. There are new, advanced versions of Prolotherapy which may in time prove to have specific effects that exceed the effects of standard Prolotherapy solutions. Since standard Prolotherapy solutions have been proven for over 75 years with millions of successful patient treatments, advanced solutions are not necessary for most conditions. However, moderate to severe tears of tendon, ligament, or cartilage within a joint may potentially require a stronger agent to achieve an optimal outcome. Examples of these include the following:

Human Growth Hormone (HGH) has been successfully injected into joints to induce growth of cartilage. HGH increases cartilage thickness and repair. The use of HGH is somewhat controversial however, due to the inappropriate systemic use of HGH in the professional athlete population to increase muscle mass and performance.

Platelet-Rich Plasma (PRP) is derived from the patient’s own blood and is placed in a centrifuge, to obtain a concentrated fluid rich in platelets and growth factors. This is then injected into the tendons and ligaments to stimulate growth and repair. A recent article in many nationwide newspapers including the New York Times (PRP New York Times) discusses this procedure and its outcome in professional athletes.

Mesenchymal Stem Cells (MSC’s) are derived from the patient’s own fat tissue and bone marrow. Techniques are being studied to take advantage of the powerful repair that stem cells can produce. The use of the patient’s own tissues eliminates the issues of allergic reaction, genetic tissue interchange, rejection of tissue transplantation, and unintended or unknown infectious agents that would be a potential risk using tissue derived from another person. The ethical consequences of using embryonic fetal cell tissues are also completely avoided.

Prolotherapy with newer growth-stimulating factors appears to have similar safety to date as standard Prolotherapy. The theoretical risks are similar but have proven to be quite rare: infection, nerve injury, bruising, air in the lung (pneumothorax) during a rib cage procedure, etc. Careful adherence to injection site sterility and precise needle technique generally appears to virtually eliminate these risks.

Since Prolotherapy with standard solutions routinely greatly benefits more than 80% of patients, advanced solutions are used mostly in more challenging situations, such as substantial cartilage loss, complex meniscus tears, labral tears, and deep osteochondral defects. The evidence suggests that we are entering a new realm of Prolotherapy in which additional factors will be discovered that improve upon the excellent results and low risk of Prolotherapy.