Intra-articular injections are an innovative and non-invasive method for the treatment of pain and various symptoms. They are most commonly - but not exclusively - used in joints that are subjected to greater daily stress, such as knees and shoulders. Intra-articular injections include substances such as PRP (platelet-rich plasma), stem cells and cortisone. These are safe and relatively simple procedures, with minimal risks of complications or side effects.
The methodology of intra-articular injections is simple and painless. The substances are introduced directly into the joint space through a needle, providing relief and restoring mobility and functionality.
Intra-articular injections improve the outlook for patients suffering from orthopedic problems. They are a safe and effective option, allowing patients to enjoy a life free of pain and limitations.
One of the most important advantages of intra-articular injections is the immediate relief they provide to joint pain and inflammation. Patients perceive an improvement in mobility and comfort in their daily activities such as walking, bending and lifting heavy objects. Consequently, the patients' quality of life improves significantly.
In addition, intra-articular injections provide an alternative in cases where medication or other traditional treatments are not effective or cannot be applied due to pathological limitations.
It is important to note that intra-articular injections should be performed by experienced and qualified orthopedic surgeons.
PLATELET RICH PLASMA (PRP)
Much has been written in recent years about a preparation known as PRP - or Platelet Rich Plasma - and in particular about its potential effectiveness in the treatment of musculoskeletal injuries.
Many famous athletes have undergone cycles of PRP treatment for a variety of problems, including sprains, injuries and chronic tendinitis, conditions typically treated with drugs, physical therapy or even surgery. Some athletes even credit PRP with their quick recovery and return to sports.
Although this preparation has received extensive publicity, there are still some unanswered questions:
- What exactly is platelet-rich plasma (PRP)?
- How does it work?
- What is PRP?
- What are the indications for PRP treatment?
WHAT IS PLATELET-RICH PLASMA (PRP)?
Blood is made up of cells, such as red blood cells, white blood cells and platelets (the latter are considered cell fragments), which are suspended in a fluid called plasma. Platelets are best known for their role in blood clotting. However, they produce and secrete hundreds of proteins called growth factors, which are very important in the stages of tissue healing after trauma.
PRP consists of plasma with many more platelets than usual and therefore with a higher concentration of growth factors - 5 to 10 times the normal concentration. Platelet-rich plasma is an autologous blood fraction with a high platelet concentration and in order to prepare it, blood must first be drawn from the patient. The platelets are then separated from the other blood cells and their concentration is increased during a process called centrifugation.
HOW DOES PLATELET-RICH PLASMA (PRP) WORK?
Although it is not exactly clear how PRP works, laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process.
To speed up healing time PRP is used in two ways:
- PRP can be carefully injected into the irritated area. For example, in Achilles tendinitis, most commonly seen in runners and athletes, the combination of PRP and local anaesthetic can be injected directly into the inflamed tissue. Initially, pain may increase in the first week, and it may take weeks before the patient feels the beneficial effects of PRP.
- PRP can also be used to accelerate healing after surgery. For example, an athlete with a complete rupture of the Achilles tendon undergoes surgical repair of the tendon and intra-operative or post-operative injection of the preparation.
WHICH DISEASES CAN BE TREATED WITH PLATELET-RICH PLASMA (PRP)?
Currently, studies are being conducted to evaluate the effectiveness of PRP treatment. So far, the results of these studies are inconclusive, and vary depending on the case. Factors that may affect the effectiveness of PRP treatment include:
-The anatomical area of the body being treated.
-The overall health of the patient.
-Whether the injury is chronic or acute.
CHRONIC TENDINOPATHIES (TENDINITIS)
According to recent studies, PRP is particularly effective in treating chronic minor injuries to tendons, especially tennis elbow, a fairly common form of tendinitis. The use of PRP for other forms of tendinitis, such as Achilles or patellar tendon is promising. However, it is still difficult to draw conclusions regarding the effectiveness of PRP compared to traditional alternatives.
LIGAMENT AND MUSCLE INJURIES
Much of the publicity that PRP has received is due to the treatment of sports injuries and ligament and muscle injuries (sprains and strains). To date, PRP has been used to treat ligamentous knee injuries or quadriceps strains in professional athletes. However, there is no definitive scientific evidence that PRP treatment accelerates the healing process in these types of injuries.
Recently, PRP has been used during some surgeries to aid in post-operative healing. It was initially tried in shoulder surgery, particularly after repair of rotator cuff tears. However, results show little benefit after PRP use.
Surgical rehabilitation after anterior cruciate ligament rupture is another field in which the adjuvant use of PRP has been attempted. At present, the results in this case are also controversial.
OSTEOARTHRITIS OF THE HIP
Some studies have attempted to compare the efficacy of PRP with other formulations used for the conservative treatment of knee osteoarthritis. However, it is still too early to determine whether and to what extent PRP is more effective than current treatment methods.
To date, there have been few studies on the adjunctive use of PRP in fracture repair. So far it has not shown any benefit.
Platelet-rich plasma (PRP) therapy holds great promise. However, at present, the benefit to the patient is currently not documented in studies and in a scientific manner. Although PRP appears to be effective in the treatment of chronic elbow tendinitis (external epicondylitis), the medical community needs more scientific evidence before it can determine whether PRP therapy is truly effective in other conditions. Even though the effectiveness of PRP treatment is still questioned by many, the risks associated with its use are practically non-existent. There may be increased pain at the injection site but the incidence of other associated problems - such as infection, irritation of adjacent tissues and nerve injury - is no greater than that of other injectable preparations (e.g. cortisone).
Orthopaedic surgeons have focused their attention on mesenchymal stem cells. Unlike embryonic stem cells, mesenchymal stem cells are obtained from living adult tissues. In adults, mesenchymal stem cells are obtained from adipose tissue, usually from the patient's abdomen, or if combined with surgery (e.g. arthroscopy) from the marrow near the affected tissue. Laboratory isolation and culture of the stem cells is then performed.
To simplify the procedure, the treatment can be completed in one step: The donor site is the bone marrow, followed by immediate isolation of the stem cells. The procedure can be performed either under local anaesthesia or as part of the arthroscopic cleaning of the affected joint.
Autologous chondrocytes have been used successfully for the treatment of articular lesions for the last 10 years. Some clinical studies in knee osteoarthritis patients aged 16-49 years showed that up to 83% had significant improvement in joint mobility and gradual recovery of the lesion within five years. Further research and studies are expected in the future to ascertain and document their usefulness in orthopaedics.
Apart from the knee, the treatment is indicated for arthritis of the shoulder, hip and ankle, for cartilage tears and cartilage damage, for tendinitis and tendinopathies, for partial rupture of tendons in the shoulder, for muscle rupture and strain, partial tears of the cruciate ligaments or meniscus, partial tears of the Achilles or other tendons, aseptic necrosis of the femoral head in the hip in the early stages, and arthritic lesions in the spine.
The method is considered relatively safe and painless, as the biological material is derived from the patient himself, and the comparative advantages include the greater speed of reconstruction of the injured tissue, shorter recovery time and return to sporting activities, significant reduction in pain, and in many cases surgery is avoided. The treatment is usually completed with physiotherapy programmes.