This short video clip shows the subacromial space after a successful rotator cuff repair done for a 2cm complete tear in the tendon. The tendon is completely healed and the sutures are not even visible because the tendon and bursal tissues grow right around and over them. 2 years after surgery, using this arthroscopic surgery technique, 93% of the time this is the result we get...proven by MRI scans or ultrasound scans! We are now researching how to match these excellent rotator cuff repair results in larger tears and more chronic tears by adding orthobiologics like PRP (Platelet rich plasma) or stem cells (bone marrow concentrate) or microfat (adipose)
Can I still do a Platelet rich plasma ( PRP) procedure if my patient is on Plavix?
Spoiler alert is that we don't really know the affect of Plavix on PRP production or clinical outcomes....BUT I do have some ideas based on the biology.
#1 Plavix works by blocking platelet aggregation by binding to a surface receptor on the platelet.
#2 Plavix does NOT work by changing the contents of the platelets or the number of platelets....but rather by decreasing platelet release.
#3 We use platelets in PRP because they release their contents and not because we want them to aggregate and clot.
Orthopedic Clinicians often assume that older patients don't do as well with surgery or even with regenerative medicine procedures. There may be some biological truth to that BUT we have ways to mitigate the effects of aging...and it really isn't that hard. We can still do PRP (platelet rich plasma) procedures and bone marrow concentrate procedures and adipose procedures and expect good outcomes for the proper indications.
We have tested many #PRP kits and protocols over the years to see see how they perform in a real world situation. We can standardize the blood draw and compare the PRP output from any kit...and we have now tested about 8 of the more common ones available in the USA. Last week we were able to test The Arthrex ACP Max PRP system. We had some key orthobiologic gurus from Arthrex present to walk us thru the system and interpret the results. Here is what we found:
With mounting registry data, we are able to tell patients and their families about how long a PRP injection might help with their SLAP lesion symptoms. We are trying to decrease their pain and improve their function. But surgery is still the gold standard for anyone who still has pain or dysfunction with a type 2 SLAP lesion.
Cells get trapped in the lung as the vascular tree gets smaller. This "first pass" effect is not a new discovery....it is known human biology for at least 35 - 40 years if not longer. With regards to any cellular therapy.....there have been lots of publications documenting the 95+ % first pass effect in which cells injected IV are trapped in the lungs....they don't make it back to your knee....they don't go to your spine....they stay in your lungs....so if you have a lung problem that really is the only reason to pay for an IV stem cell injection (once there is evidence that it a good treatment...) Anyone selling IV stem cells in regenerative medicine is a fraud at this point.
We test and know the dose of every PRP injection we do. All patients, Every day!
We have invested in an in-office hematology machine...about a $12,000 piece of equipment...because it is the standard of care for analyzing blood samples and determining the Platelet Rich Plasma doses we are giving to patients. We want to know the dose of the drug that is effective and patients paying for these procedures deserve to know the dose they are paying for. Simple!
Yet less than 5% of doctors doing these procedures have a hematology machine on-site to get these answers where the procedure is happening.
* What is the average price for a knee #PRP injection at the top 25 US Hospitals?*
The average is $800 per injection.
But how many platelets are in that injection? We have an average price but we don't know how many platelets that is buying. As a result the conclusion misses out on some critical price factors that must be considered by doctors and patients alike when choosing PRP companies, following dosing protocols, and pricing the PRP for patients.
Let me explain.
Single Price does not equal the total cost to the patient.
Would you rather have 3 injections for $800 each or 1 injection for $1800 if the results were the same? Right.
We decided to see how much PRP the Biobrace 5mm by 250mm implant would absorb before saturation.
The answer? 342% of its weight!