Dr. Bob Underwood (Host): Have you ever had a nagging joint injury that starts to be a hindrance to getting back to your normal level of activity? It might be persistent pain, swelling or difficulty with certain movements in a tendon or a ligament, and you're eager to get back to your active self. Well, today we are lucky enough to have Dr. Wisler Saint-Vil, a sports medicine doctor from Memorial Health System Ohio, to talk to us about the potential treatment option of platelet-rich plasma therapy.

Host: This is Memorial Health Radio with Memorial Health System Ohio. And I'm your host, Dr. Bob Underwood. Dr. Saint-Vil, hello and welcome to the program.

Dr. Wisler Saint-Vil: Hello. Thank you for having me.

Host: Yeah, absolutely. I want to start with saying, I'm a physician and I have to say that before preparing for our talk today, I was relatively unfamiliar with platelet-rich plasma therapy. Can we start today by explaining what platelet-rich plasma therapy is and how does it work in the field of sports medicine?

Dr. Wisler Saint-Vil: Yes. I'm not surprised that you are not familiar with platelet-rich plasma because platelet-rich plasma, for short, we call it PRP, it is a very newly developed therapy to treat sports injuries, soft tissues injuries and also to treat overuse injuries and we even use it to treat osteoarthritis and much more.

Host: That's fascinating. You know, we think about it in sports medicine, but arthritis as well. I mean, that's fascinating. What types of injuries or conditions do you commonly treat with PRP? And what are the potential benefits for patients who seek this particular kind of treatment?

Dr. Wisler Saint-Vil: So, with PRP, we can treat tendon injuries like tendinosis or even tendinopathy. We also can treat ligament injury and even meniscus injuries. All those kind of things that can be treated with PRP. And patients treated with PRP, they have tons of benefits because PRP is a product that comes from patient's own blood. We draw a patient's blood and we get the PRP from it. The patient's blood has four different component on it or the main components: the plasma, the platelet, the red blood cells and the white blood cells.

So, what we do, the blood is drawn. We add anticoagulant to it. Then, we use a centrifuge to prep the PRP and to remove the red blood cells and, in many cases, to also remove the white blood cells. Once we remove the red blood cells and the white blood cells, we end up with a rich source of bioactive compounds that are almost impossible to synthesize. So, we inject the PRP to the place or to the tendon or to the joint where we're treating the condition. And the PRP is supposed to go there and help to regenerate the soft tissue in some cases or decrease the inflammation and give patients lots of relief from pain and it is extremely safe because it's from the patient's own blood.

Host: I just think that that's amazing and fascinating. I really do. So, would this be used to avert or in lieu of surgery in any circumstances?

Dr. Wisler Saint-Vil: Yes. In many circumstances, for example, we use it for plantar fasciitis. In some cases, in people who have plantar fasciitis who don't respond well to conservative treatment, the doctor might have surgery as an option. But actually, PRP can help those people with plantar fasciitis to decrease the inflammation and promote healing of the plantar fascia. It is the same case also for tendon injuries. So, as you know, tendons, they have really poor blood supply. So when you have a partial tear or when you have a chronic condition of the tendon, we call tendinosis, you have scar tissue building up in the tendon. It makes it almost impossible for the tendon to heal without any help. And before, we used to do, or we still do that, steroid injections. But actually, steroid injection can help when you have an acute issue, when you're dealing with an acute issues like a tendonitis, which is an acute inflammation of the tendon. But when you're dealing with a chronic issue like tendonosis, the injection doesn't really help. So, we go and inject the PRP then that can help instead of a traditional surgery to go and clean the tendon. And most of the time, patients don't respond well, to the surgery. So, PRP is key, because the success rate is very high and it's minimally invasive. The risk for allergies doesn't exist because it's from the patient's blood. So, it is safe and it can prevent patients from those additional surgery where the outcome is not sure and the recovery is very long.

Host: Yeah. That just sounds like such a great benefit to have that level of alternative for patients in this. So, how long would it take? Say you have my initial consultation, I'm coming in to talk to you, and we decide that that's the therapy. You've already kind of talked about the step process of centrifuging the blood and developing the plasma. About how long does it take from the time I see you the first time until I'm recovered from the treatment?

Dr. Wisler Saint-Vil: That's a quick question. So, PRP does actually work like a steroid injection. Like a steroid injection when you inject steroids, it mostly is a combination of steroid and lidocaine. Patients tend to feel some relief right after the injection because of the effect of the lidocaine. But in the case of PRP, we don't inject lidocaine where we are injecting PRP because lidocaine can interfere with the PRP mechanism of action. So, they don't feel any relief right away. Actually, the first 24-48 hours after the PRP, they might feel a little bit more soreness because of the reactive inflammation that the PRP can cause in the area where we inject the PRP. The patient will feel some relief four to five days after the PRP injection. And the reason behind that is because PRP has two different kind of factors. PRP has growth factors and anti-inflammatory factors. The growth factors are the factors that help with regenerating the tissue help to promote regeneration of the soft tissue. That doesn't happen overnight. But the anti-inflammatory factors, they can kick off within days and provides significant relief with the Inflammation and the most patient will feel significant improvement by the time they see me in two weeks.

Host: Wow. That's really crazy to think about that in terms of that timeframe. You know, as a physician, I know that working with athletes and telling them that they need to be relatively inactive during a healing process, you know, they always want to get back in the game. And so, is that some counseling that you would give to any athletes that are getting this kind of therapy? Do they have to be inactive for a timeframe at least while this healing process is happening?

Dr. Wisler Saint-Vil: So, they don't really have to be inactive for a long period of time. As you know, it is a minimally invasive procedure. So during the first 24, 48 hours after the injection, I advise my patient not to do much. Like if I inject, for example, the common extensor tendon, the lateral elbow, if they are a tennis player, I will tell them not to play any tennis during that time. Or if I inject the gluteus medius tendon, the lateral hip, I will tell them not to kick or not to jump for 48 hours. And after that, they can resume the activities and pain will be their guide until they see me in two weeks.

Host: What a great benefit, again, as a physician and having patients in that kind of circumstance. Yeah, that's wonderful. So, how do I decide who's an ideal candidate for this kind of therapy?

Dr. Wisler Saint-Vil: So, first of all, it depends on what you're treating. If you're treating tendinopathy, first, it is better to use the PRP treatment if you're dealing with chronic tendinopathy, like tendinosis. Because if you're dealing with an acute inflammation of the tendon, those tend to get better within two to four weeks with just physical therapy and anti-inflammatory medication. So, there's no reason to go and inject PRP. But when you have someone with tendinopathy, who has failed conservative treatment with physical therapy, NSAIDs, even steroid injection, it is time to think about PRP. Because PRP, basically, it's very low risk and the patient will recover pretty fast. And the benefit from PRP is great. So, this is time that you will consider PRP instead of sending patient to see a surgeon to assess the patient, to see if patient might benefit of any additional surgical procedures.

Host: Sure. No, that total sense. And so as we wrap up today, is there anything else you'd like to add or discuss to our conversation?

Dr. Wisler Saint-Vil: What I want to say is, for many, PRP is a new kind of therapy. But I want to remind everyone that the concept is not new. The so-called autologous blood transfusion has been used in medicine for a long time, and it has some distinct benefit from allogenic blood transfusion, like improved safety profile, lack of allergic reaction and much more. That's the same thing for PRP as well. PRP is very safe. It is almost impossible for patient to be allergic to their own blood. And PRP can be used for many sports injuries, many overuse injuries like tendinopathy and also can be used for some neuropathy like carpal tunnel syndrome, Morton's neuroma and also can be used for osteoarthritis. And PRP for osteoarthritis, that is the only kind of injection that you can do actually that might slow down the process of osteoarthritis and, eventually, might prevent a patient from a big surgery. For example in the case of the knee osteoarthritis, if the PRP slows down the process of osteoarthritis, that may prevent patient from any replacement in the future. So, it is very important to know that about PRP.

Dr. Bob Underwood (Host): Wow. Thank you, Dr. Saint-Vil, for a very informative talk today. I did, and I think all of us really learned a lot. And that wraps up this episode of Memorial Health Radio with Memorial Health System Ohio. Head on over to our website, mhsystem.org/sportsmedicine for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all of the other Memorial Health System podcasts. I'm Dr. Bob Underwood. Thanks for listening.