The BIOS Orthopedic Institute

Alberto J. Panero, D.O.

Regenerative Orthopedics Specialist & Sports Medicine Specialist located in Sacramento, CA

Platelet rich plasma therapy is used in regenerative orthopedics to stimulate your body’s own tissue healing process. The BIOS Orthopedic Institute in Sacramento, California, uses platelet rich therapy for many purposes, including, decreasing pain and inflammation around tendons and inside arthritic joints. Consult with Dr. Alberto J. Panero to see if this therapy is for you.

What is platelet rich plasma?

Platelet Rich Plasma is defined as platelets concentrated at a greater than physiologic level suspended in a plasma medium. In addition to decreasing pain and inflammation around tendons and inside arthritic joints, it can also be injected into the actual tendon, ligament, muscle or affected soft tissue to promote healing.

How Does Platelet Rich Plasma (PRP) Work?

Think about what happens when you cut your finger. During the initial stage, platelets migrate to the area and form a fibrin clot. This clot achieves hemostasis and the bleeding stops. As the platelets clot they degranulate and release a milieu of growth factors and cytokines that activate the body’s innate healing response. Over the next days to weeks these growth factors change the microenvironment of the wound, reducing negative inflammatory proteins, and creating a healthier, positive microenvironment that’s conducive to healing. They also recruit the migration of stem cells and activate downstream processes that result in tissue proliferation and maturation. As result, the cut scabs over, the scab subsequently falls, and new tissue grows and heals the wound.
Using these principles, PRP optimizes healing of new injuries and kick-starts the healing cascade on chronic injuries that have not properly healed.

Is all PRP created equal?

NO, all PRP is not created equal. In fact, PRP must be tailored to each individual patient and their diagnosis. An experienced physician can manipulate the ratios of platelets, white blood cells, and red blood cells, by calculating the amount of blood that is taken versus the speed and time that the blood is centrifuged for. Specialized extraction methods can then be used to further concentrate or dilute the preparation to the desired PRP ratios.

In general terms, PRP can be divided into two groups, leukocyte (white blood cell) RICH or leukocyte (white blood cell) POOR. Leukocytes at times can be inflammatory, and in the setting of a chronic tendon injury, such as tendinopathy, the evidence suggests that this inflammatory response yields a better outcome. Thus, a leukocyte RICH – PRP preparation can be used. The opposite is true in the setting of joint arthritis, there is already inflammation in the joint and adding leukocytes can have a detrimental effect. Hence, in arthritis, a leukocyte POOR – PRP preparation is used.

What Conditions can be treated with PRP?

– ARTHRITIS
– TENDON INJUREISTENDINOAPTHY
– LIGAMENT INJURIES
– MUSCULAR INJURIES
– SPINE INJURIES.

What happens the day of the procedure?

Your blood is drawn into a PRP collection syringe. The blood is transferred to the centrifuge system. This process takes approximately 5-20 minutes and it is done in-office, same day of the procedure.

Once the centrifugation is done, the concentrated platelets and plasma are manually extracted from the blood into the injection syringe. The PRP is then precisely guided to the site of injury by either ultrasound, fluoroscopy, or needle arthroscopy, under sterile technique.

Although one injection can be very helpful, studies support the use a series of 3 injections given one week apart in various settings. The injections can be relatively painless or quite painful, depending on the location and type of procedure that is being performed with the PRP. Depending on the area injected, the doctor may administer a regional anesthesia to decrease the pain from the injection itself. We will take as many precautions to make the experience as comfortable as possible.

What can I expect after the procedure?

You go home the same day of your procedure. Depending on the area injected, you may have to wear a brace and/or use crutches for a short time. The injection area will be sore for about 1-2 weeks. Depending on the are being treated and your pain tolerance, you may need pain medication the first few days. Your post-procedure regimen will include physical therapy, 2 X week, for at least 4-6 weeks. We see you for follow up around the 3 week, 6-8 week, and 3-4 month marks. We are always available however if any questions or issues may arise.

Dr. Panero is extremely professional and takes the time to explain in detail his diagnosis and opinion. He is also willing to listen to your concerns and needs.(Some orthopedic doctors I’ve meet with have not been as open minded.) I really like his approach to rehab and regeneration. It is refreshing to not have a Dr. want to immediately operate or medicate you. Nice courteous staff, reasonable wait time and the office is very accessible with a parking garage. Parking fee, I paid $1 for 30 mins, cash only.

Ronald Z.

I really appreciate Dr. Panero’s skill and expertise, as well as his focus, deep active listening, and clear communication about next steps. Thank you so much!

Susan C.

I was very happy with Dr. Panero. He took his time to listen to me and evaluate me. Then he went over all my options and answered all my questions. I am very glad I was referred to him!

David M.

Dr. Panero is an amazing physician who truly cares about the wellbeing of his patients. His entire team is dedicated, thorough, and professional who makes sure all appointments go smoothly even with the ongoing pandemic. Dr. Panero recommended PRP for my elbow tendinitis and truly advocated for me to get the treatment I needed to improve my chronic pain. I am so grateful to be one of Dr. Panero’s patients!

Rena S.

Very personable and knowledgeable presenting options for the problem and then going forward from the choice made. I would definitely recommend him to friends and family! Office staff is fabulous as well.

Jim M.