Sunday, April 18, 2010

Ultrasound and Platelet Rich Plasma

Ultrasound of a Partial Elbow Extensor Tendon Tear

Ultrasound is a powerful non-invasive tool to evaluate soft tissue.  It can be especially helpful when imaging tendons.   Platelet rich plasma has been used extensively in tendinopathy and I believe ultrasound could provide an objective endpoint for future studies.  The size of the lesion could be measured before and after treatment.  Calculation of reduction of the pathologic hypoechogenic area could then be made.  We are beginning to evaluate a variety of ways to use ultrasound and would welcome any questions, comments or suggestions. 

Saturday, April 03, 2010

Mishra Platelet Rich Plasma Classification

Not all platelet rich plasma (PRP) is the same.  In order to be able to compare PRP, I am proposing a new classification system based on the presence or absence of white blood cells, activation status and platelet concentration.  Activation implies the use of thrombin and or calcium to cause the platelets to gel and release their bioactive molecules.  No activation implies in vivo activation by collagen. 

Platelet Concentration:   
A = 5 x baseline or higher
B =  Less than 5 x baseline

Type          White Blood Cells              Activation    

Type 1:       Increased WBCs                  Unactivated

Type 2:       Increased  WBCs                 Activated

Type 3:       Few/None WBCs                 Unactivated

Type 4:       Few/None WBCs                 Activated

Type 1A PRP:    Formulation with increased WBCs, 5.5x baseline platelets injected in an unactivated fashion.

The system is meant to be simple for now.  Clearly, there are other components to PRP including anticoagulation and buffering.  Importantly, new formulations may arise but for now we need a simple reproducible structure to discuss the different types of PRP.  I hope this represents a start.

Total Tendon
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