Case Study #1- Abraham M.
Today’s society sees more joint issues than before. This is due to the fact that we are a more active
society and we are living longer. There is more trauma from work, sports and general life activities.
People enjoy their active lifestyle for multiple reasons, including physical and emotional well being.
When a person is injured and the healing process doesn’t finish, joints remain painful and dysfunction
ensues. Some patients experience depression and anger. This case study demonstrates how Platelet
Rich Plasma is a potent, safe, and natural therapy to restart thehealing process in injured joints and help
people return to their prior active lifestyle.
Abraham was an 18 y/o male who came to me on January 19, 2010 for an initial consultation for PRP for
his right knee. He had originally injured the knee on November 7th, 2009. The injury occurred during a
soccer game when he planted his foot and turned without the lower leg moving. He developed
considerable pain and swelling in the knee and had to stop playing. He saw an orthopedic surgeon who
obtained an MRI on November 30th of the knee which showed the medial collateral ligament having a
grade 1 sprain without full thickness tear. There was bone contusion of the lateral femoral condyle and
effusion of the lateral knee joint. The radiologist also read a possible partial tear of the anterior cruciate
ligament to be correlated with physical exam. The MRI also mentioned a posterior horn tear and body
tear of the lateral meniscus. The orthopedic surgeon recommended arthroscopy. The patient’s mother
did more research and found that PRP might help sprains and came for an opinion regarding its use.
On initial exam in my office, the right knee was tender along the MCL and medial anterior joint line. The
knee had diffuse effusion. The lateral joint line was not tender to palpation. He had considerable
gapping of the medial joint with valgus and negative drawer line.
The risks and benefits were discussed with the patient and he opted to have the PRP done. For this
treatment, I used a large 60cc Harvest SmartPrep kit. I felt the larger amount of PRP obtained from this
amount of blood would be better for treating themultiple areas of the knee that needed treated. I
anesthetized the MCL, the anteromedial joint line, the anterolateral joint line, the lateral joint space into
the anterior cruciate ligament and the medial joint space into the ACL and the tibia plateau. I used
about 20cc of 50-50 mix of lidocaine and marcaine. I then injected the PRP into the above areas using a
peppering technique of the ligaments and tendons around the knee and within the knee. The patient
tolerated the procedure well and was given home care instructions with some vicodin. He was asked
not to do any exercise, such as running and turning.
For follow-up, I called the patient the next day to see if he had any discomfort from the injections. He
stated he felt fine and had very little discomfort. I had him return in 4 weeks to check his knee function
and see if he needed another PRP. On exam, he had no effusion. He had no tenderness. He had mild
gapping of the medial joint with valgus but much less than on initial exam and no pain with valgus. He
had normal flexion and extension. At this point, I had him resume regular activity with soccer and other
sports and notify me if any pain of instability develops. I also obtained an MRI on February 24th. I had it
compared to the prior MRI from November. The comparison revealed no more effusion. There was no
bone contusion. The ACL was thickened at its femerol insertion but appreared intact. The medial
collateral ligament was now normal. The posterior horn of the lateral meniscus still had evidence of a
tear. On further followup, I called Abraham on 5-13. He was playing soccer normally without any pain.
His knee was stable but he was still being cautious when cutting and turning. He did not experience any
swelling.
This case reperesents a typical result of Platelet Rich Plasma therapy. My experience is that 80% of
patients find improvement with injections of PRP. While this case involves the knee, I have found equal
success with virtually all other joints in the body. What is remarkable with this case is the fact that we
achieved resolution of the patient’s pain and documented healing of the MCL tears, the bone contusion,
and the joint effusions with MRI. Platelet Rich Plasma therapy holds the potential to help the millions of
patients with joint injuries whether from sports or aging to get back to a more active life.
Case #2- Shoulders and knees.
D.L. is a 50 year old male with a long history of bilateral shoulder pain. The pain was disabling and
stopped the patient from doing many activities and working around the house. He had done
strengthening for the shoulders but still had significant dysfunction and pain. His past medical history
was significant for being a retired Navy seal and has had the pain since active duty. One of his biggest
issues is when he folded his hands behind his head, his shoulders got locked up and he needed
assistance from his secretary to return his shoulders to a normal position.
DL underwent his initial PRP on the right shoulder on May 28. His shoulder was anesthetized and
injected with 10cc of PRP along the biceps tendons, anterolateral joint capsule, lateral joint capsule, and
posterior joint. His AC joint was also injected. He was rechecked 2 weeks later and was doing much
better. He opted to have the left shoulder injected on June 9. A similar injection technique was used.
He was rechecked on October 16. He stated that the shoulders had never felt better. He was much
more physically active and exercising daily. But the right shoulder could still use some treatment. He
felt pain with abduction and external rotation. Another PRP treatment was done at that visit.
DL had been in periodically since the last treatment. His shoulders give him no more pain. He can do
physical work at home and at work without the shoulders bothering him. He can fold his hands behind
his head and return to a normal position without assistance or pain.
His last visit was May 14. He was using less pain medicines and starting treatments for his knees.
On May 14, DL received a PRP treatment to his left knee. He had been having pain in the knees for
years. About 3 months prior, he had to stop running because of the pain and swelling in the knees. He
was only comfortable with walking.
The treatment I did on his knee was a general treatment of the entire knee including the MCL, medial
joint line, medial patella, lateral joint line, LCL and some under the patella. This is very general
treatment using a larger PRP kit. Often, in cases such golfers knee, in which the medial side of the knee
is injured, I will use a smaller kit and concentrate on the medial components and get great results.
On June 4th, DL returned for PRP on the right knee. His left had no pain or swelling and he could be very
active on the knee without pain. We treated his right with a similar treatment and are waiting 6 weeks
to recheck the results.
Case #3-J.M.- Lumbar pain after surgery.
JM, a 69 year old female, had lumbar spine surgery the year before consulting me. She had chronic
back pain for years before the surgery and was still having bilateral lower back pain which radiated into
the buttocks. She was using chronic pain medicines because of the back pain and knee pain. Her
activity level was as high as possible with some swimming in other activities but she was still not
satisfied with her activity level since she was limited by the pain. She was only getting four hours of
sleep at night and awakening constantly. Her pain level was 7 -- 8.
On exam for her first visit she had central lower back scar consistent with her surgery. It extended from
the upper lumbar to the lower lumbar. She had bilateral iliolumbar ligament pain and sacroiliac pain. I
performed a platelet rich plasma treatment on her using about 10 1/2 cc of the PRP split between both
sides. I injected the bilateral iliolumbar ligaments and sacroiliac joints after anesthetizing her with
lidocaine and Marcaine. I was careful to stay lateral to the incision area and along the bone of the ileum
and into the sacroiliac joint.
She came back for recheck one month later and had noted that she immediately had awakened with no
back pain. She is able asleep a full night and get seven hours of sleep. Her pain was now down to level 2
-- 3. She had only recently started noticing some increasing pain. She was doing all of her prior
exercises with no pain difficulties. She was able to decrease her pain medicine consumption. At the
second visit we again performed a platelet rich plasma injection on the bilateral iliolumbar ligaments
and SI joints.
Follow-up survey about one month after the last injection showed the patient to have 90%
improvement. Her pain level was staying at a level 3. She is able to sleep, walk , sit, and stand which
she was not able to do comfortably before. She was very satisfied with the treatments and
recommending them to anybody she could.
Case study#4-Low back and knees.
KW is an 80 year old male with bilateral lower back pain and bilateral knee pain. His lower back pain is
the result of an accident over 50 years ago while ferrying a B-17 across the U.S. He hit some turbulent
air in a storm and was thrown around while trying to secure some material. He injured his lower back
then and had had chronic pain since. When he walked 100 yards at his job from his office to the bus he
drove, he had to stop several times because of severe lower back pain radiating to the legs with
numbness in the legs, as well.
His knees had arthritis and he had the left one replaced several years ago. He was hoping the PRP
treatments for the right knee would give him relief and prevent a replacement.
The first PRP treatment, on Feb 18th, was to the bilateral lower back using a 60cc kit. I injected the
iliolumbar ligaments, the sacro-iliac joints, and the sacro-coccygeal ligaments. He did very well and had
little pain the next 2 days. KW followed up on Feb. 26th for the right knee. His lower back was much
better with a little soreness. We treated the medial right knee and saw the patient on April 1st. On April
1st, his main complaint was his lower back pain had regressed. He had been doing well, but in the last 3
weeks, he had increasing pain with walking. He was much better but was getting the leg pain again. On
April 1st, we treated his bilateral lower back again. He came back again on April 22 for the right knee.
The back was much improved. He was walking better and more active. We treated the right knee again
on the 22nd.
Patient returned for recheck on May 13th. At this point, the right knee was much better. He had very
little pain and much more stability. He stated that he wished this treatment was available years ago
before he had his knee replaced. He probably would have avoided a knee replacement. His lower back
was improved but still having some pain at the base. He could walk the 100 yards with a little tingling in
the right leg but not the amount of pain as before. He did not have to stop like before.
On May 13th, KW had another lower back PRP to see if he could get the remaining pain resolved. On
June 4th, we completed another right knee treatment. His right knee was over 50% better and he
wanted to see how much more improvement after this treatment he could achieve.
Overall, KW is very pleased with the PRP. He now is able to walk his dog without much pain. He is more
mobile and active and doesn’t need to think about pain with his movements. His decades of back pain is
dramatically reduced.
Case study # 5 Mary R.
This case is interesting because it shows the healing power of PRP. Mary R. is 70 year old Hispanic lady,
long time patient of mine, who has had diabetes for over 30 years and was placed on dialysis about
eight years ago. She came to me complaining of both of her knees bothering her in 2009.
Initially, I did prolotherapy for the left knee. She responded okay to the prolotherapy so I tried PRP on
her two weeks later. She had some medical issues in the intervening weeks and had another PRP done
on the left knee about two months later. At this point the left knee was doing very well and had very
little pain. She was able to walk on it much longer distances.
She then pursued the right knee. The right knee required 2 PRP injections with a subsequent
prolotherapy injection couple months after the last PRP injection. Patient did very well with the right
knee. And she was pain-free a couple weeks after the injections. The knees have remained relatively
pain-free and she is much more mobile. It is now six months after the last PRP injection in the right
knee. His approximately 10 months after the last PRP injection for the left knee.
Overall, she's very satisfied with therapies.
This case shows the effectiveness of PRP and the power of its ability to generate healing despite having
someone with significant chronic medical conditions.