Platelet - Rich Plasma (PRP) is a product derived from whole blood via density centrifugation. It contains a high concentration of platelets and growth factors which are thought to aid the healing process by promoting cell growth. Not all PRP products are the same, they differ on their platelet concentration levels, inclusion/exclusion of white blood cells and whether the platelets have been actived to release biofactors before injection, or not. PRP is used as an adjunct to surgery with the aim of providing a high concentration of autologous growth factors to promote cell growth. There are also clinics that offer PRP injected directly into the site of injury in order to promote healing. PRP has been used in sports medicine for over a decade to treat articular and fibrous (meniscal tears) cartilage injuries, tendon and ligament injuries.
Stem Cell Therapies
Therapies and techniques are being developed using different types of stem cell. Stem cells are capabable of differentiating into different types of cell in the body. For example, in the case of cartilage repair, stem cells differentiate into chondroblasts, actively producing the substance chondrin, which is the primary substance in cartilage, to build and repair the tissue. Mesenchymal Stem Cells (MSCs) are derived from adult tissue, mostly bone marrow or blood. Although no stem cell therapies have been approved for use in sports medicine to date, several therapies and techniques are being developed using different types of stem cell. For instance, companies are working on technology platforms that to harvest stem cells from a patient's blood or bone marrow, process these cells and reinject them into the patient, delivering a therapeutic dose of autologous stem cells and proteins at the bedside. Therapies are also in clinical trials which involve the injection of the patient's own stem cells directly into the site of injury with the aim of speeding up the healing process. In addition, the IMPACT and AMIC methods of cartilage repair utlilise MSCs and some osteochondral scaffolds are seeded with stem cells to enhance cartilage repair. The 'bio-mediated gene delivery' technique being developed is based on the premise of delivering genetically altered stem cells seeded onto a synthetic scaffold to the injury site to promote cartilage repair. For an overview see EuroStemCell's summary of stem cell therapies in sports medicine.
Actovegin is a protein free ultrafiltrate of calf’s blood. It is reported to promote acceleration of muscle fibre synthesis in damaged muscle and de-toning of the hypertonic muscle bundle. It may have an effect in encouraging granulation tissue and new blood vessel formation. It is used medically to treat muscle strains. It is sometimes administered with an injection of Traumeel – a homeopathic formulation, alleged to suppress the release of inflammatory mediators and stimulate the release of anti-inflammatory cytokines.
Several hyaluronic acid injectable products are available, regulated as mechanical lubricants in the treatment of osteoarthritis. Although their exact role is yet to be defined, once injected, it is thought that the substance probably acts as a shock absorber, lubricant & space-filler working by coating the unstable joint to seal it off. Viscosupplementation is being investigated for use following surgery for several knee conditions, including ACL tears or ruptures, cartilage damage/OA of the knee, and meniscal tears.
Prolotherapy involves sclerosant injections to ligaments. It is suggested that it may strengthen / tighten ligaments by provoking an inflammatory repair response, which incites the formation of new collagen fibres. Is reportedly a popular treatment amongst athletes for ligament injuries. It is sometimes combined with mesotherapy – a technique that involves injecting small quantities of pharmaceutical, homeopathic medications, plant extracts, vitamins and other ingredients just below the surface of the skin. Components of some of these homeopathic preparations include antioxidants and vitamins, which, it is claimed, are able to trigger a regenerative response.
Prolozone therapy
Prolozone therapy is a combination of Prolotherapy and ozone therapy. Oxygen (in the form of ozone), along with other “collagen producing substances”, is injected into the injury area, the theory being that the oxygen increases circulation to the area stimulating the fibroblastic joint repairing abilities. Advocates claim that the therapy not only eliminates pain, but also results in cartilage regeneration.
Autologous whole blood products
Autologous whole blood/ or blood products are injected into the site of injury to speed up healing and repair of the affected area and quicken recovery time. Target areas are usually those where treatment options are limited due to lack of blood flow. Autologous blood products are, reportedly being used by elite athletes across the globe to speed up recovery times.