REVIVAL PRP® for Pain
SIZE: 11ml and 22ml tubes
INDICATIONS: Indicated for the acceleration of bone and tissue healing
DIRECTIONS: Intended for use only by physicians. Please refer to instruction sheet.
WHAT IS REVIVAL PRP®?
REVIVAL PRP® is an Advanced Separator Gel-based, easy to use, sterile system that is used to prepare PRP in a safe and effective manner to maximize the benefits of PRP therapy.
PRP is used in various medical applications including tissue enhancement, treatment of tissue and cell regeneration, rejuvenation, reconstruction and for general healing and repair in various fields of medicine.
PRP is indicated for the acceleration of bone and tissue healing in the following areas:
- Chronic Wounds
- General Surgery
- Post operation wounds
- Sports Medicine
- Biological Glue
- Esthetics & Cosmetic surgery
- Scalp cure & hair treatment
- Dental & Periodontal
Revival PRP®‘s Advanced Separator Gel ensures that the physician obtains an optimal concentration of platelets containing growth factors, cytokines and chemokines which are all crucial in providing the anti-inflammatory properties of the plasma. This helps to repair and regenerate connective tissues, stimulate cells, reduce inflammation, relieve pain, and reduce scar tissue formation.
HOW IS REVIVAL PRP® DIFFERENT?
An accessories pack may be purchased with the REVIVAL PRP® system which may include:
- Blood collection set
- Gauze pads
- Fabric Plasters
- Alcohol Pads
- Tube holder
- 22, 25 and 30 Gauge Needles
ABOUT OSTEOARTHRITIS AND TENDINOPATHY
What is Osteoarthritis?
Osteoarthritis (OA) is often called the “wear and tear” of joints. This joint disease is the most common form of arthritis, mostly affecting cartilage. Cartilage is the cushion between the joints, which allows bones to smoothly glide over each other, while also absorbing shock from everyday movements such as walking or jogging.
With osteoarthritis, this cartilage breaks down, causing friction between the bones. This reduces motion of the joint, causing immense pain and swelling. Over a long period, these unprotected bones may be susceptible to abnormal growth and breakage, causing further damage.
Synovial fluid is responsible for the lubrication and shock-absorbing actions inside joints. It acts as a cushion between the bones. The degeneration of the synovial fluid (due to age or injuries) plays an important role in osteoarthritic progression. Osteoarthritis is most common in the knees, hips, shoulders, hands, fingers, and the spine. Although osteoarthritis can occur in people of all ages, it is most apparent in the elderly population. Risk factors include previous joint injuries, genetics (familial history), overuse of joints, obesity, and weak muscles.
Diagnosis and Treatment
Osteoarthritis can occur at any joint. Early warnings signs of joint degeneration can include joint stiffness and swelling. Although no single test can fully diagnose osteoarthritis, most physicians rely on medical history and conduct x-rays and physical checkups. If you are interested in determining the condition of your joints, please click here to take our self-assessment test(s). These series of questions will provide more information and can serve as a monitoring tool of your condition. Our tests include knee (Lequesne, WOMAC), hip (Lequesne, WOMAC), and shoulder (SPADI).
To date, there are no cures for osteoarthritis. However, certain measures can be taken to improve osteoarthritic conditions, for example, regular exercises, weight management, pain-relief medications, joint therapies and surgery. Since there is no known cure for osteoarthritis, the treatment strategy is focused on reducing pain, maintaining and/or improving joint mobility while limiting functional impairment.
General Non-Pharmacological Therapies Include:
Drug Therapies Include:
Administration of Hyaluronic Acid into the intra-articular space plays an important role in osteoarthritis therapies. It restores the physiological characteristics of the synovial fluid, reduces pain and inflammation, and provides lubrication, while increasing the movement of joints. The effects of Hyaluronic Acid injections generally last for more than six months.
Osteoarthritis treatments should also address the structural damages of cartilage and provide “structure-modifying effects”. A nascent field called regenerative medicine is focusing on the use of stem cells, growth factors and synthetic tissues to provide, repair, replace or restore structural and functional damage caused by ageing and/or disease. The key aspect of regenerative medicine is the use of elements from our own body (autologous) to harness its own healing and regenerative power. Among these treatments one stands over others due to its proved safety and efficacy: the use of Platelet-Rich Plasma or PRP. PRP therapy’s natural healing process intensifies the body’s efforts by delivering a higher concentration of platelets.
What is a Tendinopathy?
Tendinopathies are chronic tendon injuries generally accompanied by inflammation. They usually occur when repetitive motion, stress or repeat injuries irritate a tendon over time. The result is pain and swelling of the tendons around a joint such as the ankle, elbow or shoulder. Tendons become less flexible with age, therefore tendinopathies are more common as people get older.
Tendinopathies are responsible for up to 30% of sports doctor consultations and other musculoskeletal health providers. This conditions is most often seen in tendons of athletes either before or after an injury, but is becoming more prevalent in non-athletes and sedentary populations. Among the risk factors associated with tendinopathies are the age, occupation, obesity and the practice of high impact sports or activities.
Although tendinitis can be caused by a sudden injury, the condition is much more likely to stem from the repetition of a particular movement over time.
Diagnosis and Treatment
Tendinitis can usually be diagnosed during the physical exam alone. Your doctor may order X-rays or other imaging tests if he or she needs to rule out other conditions that may be causing your signs and symptoms
The goals of tendinitis treatment are to relieve your pain and reduce inflammation. Often, taking care of tendinitis on your own — including rest, ice and over-the-counter pain relievers — may be all the treatment that you need.
For tendinitis, your doctor may recommend these medications:
Taking aspirin, naproxen sodium or ibuprofen may relieve discomfort associated with tendinitis.
Topical creams with anti-inflammatory medication — popular in Europe and becoming increasingly available in the United States —also may be effective in relieving pain without the potential side effects of taking anti-inflammatory medications by mouth.
Sometimes your doctor may inject a corticosteroid medication around a tendon to relieve tendinitis. Injections of cortisone reduce inflammation and can help ease pain. Corticosteroids are not recommended for chronic tendinitis (lasting over three months), as repeated injections may weaken a tendon and increase your risk of rupturing the tendon.
Platelet-rich Plasma (PRP)
PRP treatment involves taking a sample of your own blood and spinning the blood to separate out the platelets and healing factors. The solution is then re-injected into the area of chronic tendon irritation.
PRP injection in the region of chronic tendon irritation has been shown to be beneficial for many chronic tendon conditions.
You might benefit from a program of specific exercise designed to stretch and strengthen the affected muscle-tendon unit. For instance, eccentric strengthening — which emphasizes contraction of a muscle while it’s lengthening — has been shown to be effective in treating chronic tendon inflammation.
Surgery and Other Procedures
Depending on the severity of your tendon injury, surgical repair may be needed, especially if the tendon has torn away from the bone.
For chronic tendon inflammation, focused aspiration of scar tissue (FAST) is a minimally invasive treatment option using ultrasound guidance and very small instruments designed to remove tendon scar tissue without disturbing the surrounding healthy tendon tissue.
FAST achieves the same goal as open surgery but is performed under local anesthesia in a nonsurgical setting. Most people return to normal activities within one to two months.
To treat tendinitis at home, R.I.C.E. is the acronym to remember — rest, ice, compression and elevation. This treatment can help speed your recovery and help prevent further problems.
Rest – Avoid activities that increase the pain or swelling. Don’t try to work or play through the pain. Rest is essential to tissue healing. But it doesn’t mean complete bed rest. You can do other activities and exercises that don’t stress the injured tendon. Swimming and water exercise may be well-tolerated.
Ice – To decrease pain, muscle spasm and swelling, apply ice to the injured area for up to 20 minutes several times a day. Ice packs, ice massage or slush baths with ice and water all can help. For an ice massage, freeze a plastic foam cup full of water so that you can hold the cup while applying the ice directly to the skin.
Compression – Because swelling can result in loss of motion in an injured joint, compress the area until the swelling has ceased. Wraps or compressive elastic bandages are best.
Elevation – If tendinitis affects your knee, raise the affected leg above the level of your heart to reduce swelling.
Although rest is a key part of treating tendinitis, prolonged inactivity can cause stiffness in your joints. After a few days of completely resting the injured area, gently move it through its full range of motion to maintain joint flexibility.
WHAT IS PRP?
Platelet Rich Plasma (PRP) is a concentration of platelets derived from the patient’s own blood that is above the baseline level and contains several growth factors which stimulate healing. Platelets are the key components of PRP. They are small anuclear fragments of cytoplasm produced by megakaryocytes in the bone marrow. Platelets affect primary haemostasis, the innate immune response and inflammation, host defences against microorganisms, wound healing and malignancy.
The most basic method to prepare PRP is through centrifugation. This can be either a one-step or two-step process. The patient’s blood is drawn and centrifuged at varying speeds until it is separated into 3 layers: Platelet Poor Plasma (PPP), Buffy Coat/Platelet Rich Plasma (PRP) and red blood cells.
To truly concentrate platelets from autologous blood, a double centrifugation technique is used. The first spin (called the hard spin) separates RBCs from the plasma, which contain the platelets, WBCs and the clotting factors.
The second spin (called the soft spin) finely separates the platelets and WBCs together with a few RBCs from plasma. This soft spin produces a richer PRP concentration and separates it from the platelet poor plasma.
Depending on the application, only one spin may be performed to obtain a lower platelet concentration as a higher PRP concentration may prove to be unfavourable.
The platelets undergo degranulation to release Growth Factors (GFs) with healing properties. The plasma contains cytokines, thrombin, and other GFs with inherent biological and adhesive properties.
Platelet content is also affected by the donor’s gender, with females having a higher concentration than males. GF content however, is not influenced by age or gender. GFs are released after exogenous or endogenous activation. PRP is commonly activated by calcium chloride, thrombin, chitosan and/or batroxobin. Calcium chloride and thrombin are the most common methods of PRP activation.
Growth Factors Present in Platelets and their Function
Transforming Growth Factor-beta
Basic Fibroblast Growth Factor
Platelet Derived Growth Factor
Epidermal Growth Factor
Vascular Endothelial Growth Factor
Connective Tissue Growth Factor
APPLICATIONS OF PRP IN DIFFERENT THERAPEUTIC AREAS
PRP has many different applications over a wide range of therapeutic areas such as Sports and Orthopedics, Dental, Cosmetic Surgery, Esthetics and Dermatology, General Surgery , Chronic Wounds, Ophthalmology, Veterinary
Athletes of all competition levels are early adopters of novel treatment methods. They are driven to find less invasive methods of injury management and faster means of returning to their sports.
Ligament, muscle and tendon tears are often slow to heal due to inadequate blood supply to these areas. Although PRP can be injected on any muscle or tendon. The following areas are the most common sites:
- Shoulder (rotator cuff)
- Elbow (Lateral or medial Epicondylitis; aka tennis or golfer’s elbow)
- Knee (patellar tendon; aka Jumper’s knee)
- Ankle (Achilles Tendon)
PRP can also be used during surgery to augment healing for ACL reconstruction and rotator cuff repair.
Connective tissues such as ligaments and tendons heal by filling in with scar tissue, which in turn, doesn’t support the pressure of large loads effectively and increases the risk of re-injury. Chronic tendon injuries are related to degeneration of the tendon tissue. Traditional forms of therapy do not necessarily improve the tendon’s ability to create new tissue and heal in the same way PRP does.
Platelets release bioactive proteins and growth factors which enhance tissue regeneration and healing. New tendon cells called tenocytes start to develop in the treated area. Cartilage cells called chondrocytes form when PRP is injected into damaged cartilage. There is also an increase in the number of growth factors in the treated area as well as a build-up of Type 1 collagen fibers, which constitute the base structure of tendon tissue. PRP has been demonstrated to shorten recovery time, decrease pain and improve performance in the injured area
- Many high-profile athletes are also taking advantage of the benefits that PRP offers:
- Kobe Bryant of the LA Lakers received more than three treatments on his knee in the past few years and was able to make a full comeback after serious injury
- Alex Rodrigues of the New York Yankees received multiple PRP treatments for both his left shoulder and right knee
- Peyton Manning (quarterback of the Denver Broncos) had several treatments to help repair ligaments, tissues and alleviate pain in his neck
- Tiger Woods received PRP treatments for his Achilles tendon and both knees after a knee surgery to repair injury.
(News coverage of PRP usage in athletes)
(Pittsburgh Steelers athletes use PRP as an innovative injury treatment)
Some common orthopedic indications for which PRP is used are listed below:
- Tendinopathies (refers to a degenerative condition of tendons characterized by the chronic loss of collagen, stability, strength and tissue integrity possibly caused by natural aging, injury, repetitive stress, and/or neural, vascular and hormonal inputs)
- Ligament Sprains
- Muscle Strains
- Joints (i.e. osteoarthritis; a chronic degenerative disease of hyaline cartilage)
PRP can be effective for many cases of osteoarthritis as repairing the damage has posed a great challenge due to its regenerative limitations. Platelets and other elements within the blood help tendons and ligaments heal by stimulating a repair and growth response that accelerates the process of developing new tissue. However, the tendons and ligaments do not receive a rich blood supply containing these factors which is why they often take a significant amount of time to heal. PRP stimulates healing of cartilage and reduces pain and disability by delivering these factors directly to the site of injury. Areas of treatment can include knee, hip, shoulder and ankle.
With age, the cartilage lining the joints can shrink and wear thin causing friction between the bones. Bone spurs and inflammation can gradually enlarge the joint leading to the pain and dysfunction of arthritis.
Damages to the cartilage have been treated by cortisone and HA injections, micro fracture, debridement and grafting procedures. The results obtained by these techniques are so far unsatisfactory and in most cases, result in the formation of fibrous connective tissue with minimal mechanical strength at the affected area.
Not only does PRP stimulate cellular activity and the process of regeneration and repair, it also improves bone and cartilage recovery, as well as reduce inflammation and pain which could potentially inhibit the deteriorating effects of age and slow the progression of arthritis.
The primary goal of PRP is to resolve pain through healing, therefore, it could prove to have lasting results. Initial improvement may be seen within a few weeks and gradually increase as healing progresses. Research studies and clinical practice have demonstrated PRP injections to be very effective at relieving pain and returning patients to their normal lives.
Ultrasound and MRI imaging have both shown definitive tissue repair after PRP therapy thereby confirming the healing process. The need for surgery can also be greatly reduced by treating injured tissues before the damage progresses to an irreversible condition.
PRP can be used to accelerate autologous grafts used for site preparations, sinus lifts, osteointegration, ridge augmentations, etc. An enhanced bone regeneration can be expected when PRP is used with mixtures of autologous bone and bone substitutes and with recombinant human growth factors such as recombinant BMP. PRP has also been shown to increase the quantity and quality of the host bone in areas of localized alveolar defects when used for guided bone regeneration.
Early results are promising that PRP placed in the preparation site of a dental implant will promote and accelerate osteointegration. This may be beneficial in the maxilla, in areas of previous failures, in type IV bone, in osteoporotic women, etc.
A clinical trial that observed 20 patients undergoing cosmetic surgery) demonstrated bleeding capillaries were effectively sealed within three minutes after application of PRP and PPP.
An added advantage was that the use of electrocautery could be minimized, therefore decreasing the risk of damage to adjacent nerves.
Platelet rich plasma contains the bioactive proteins which act as the catalyst for accelerating the wound healing process. With the increased level of growth factors present in PRP, the tissue maturation phase is accelerated and the overall healing process is significantly improved in terms of post-operative pain, swelling, infection and establishment of tissue texture, colour and contour. PRP’s cohesive nature and its hemostatic properties also allow for minimal bleeding.
Growth factors found in PRP permit accelerated tissue regeneration. It can be used to treat corneal lesions and dystrophy, superficial punctuate keratitis, severe dry eye-related ocular surface disorders, ocular GvHD, recurrent erosion syndrome, neurotrophic keratopathy, keratopathy with loss of epithelial-stromal tissue resulting from chemical or physical traumas, sicca syndrome and/or Sjögren’s syndrome.
It also provides nutritional factors necessary to maintain cellular feasibility in the epithelial repair process while reducing the risk of contamination and infection.
Platelet-rich Plasma: Intra-articular Knee Injections Produced Favourable Results on Degenerative Cartilage Lesions
(Click here to download full article)
Kon and colleagues in 2010 explored this novel approach to treat degenerative lesions of articular cartilage by treating 100 consecutive patients, affected by chronic degenerative condition of the knee, with PRP intra-articular injections. Patients were clinically prospectively evaluated before and at the end of the treatment, and at 6 and 12-month follow-up. IKDC, objective and subjective, and EQ VAS were used for clinical evaluation. A statistically significant improvement of all clinical scores was obtained from the basal evaluation to the end of the therapy and at 6–12 months follow-up.
The preliminary results of the study are encouraging and indicate that treatment with autologous PRP intra-articular injections is safe, and may be useful for the treatment of early degenerative articular pathology of the knee, aiming to reduce pain and improve knee function and quality of life.
Platelet-rich Plasma Prevents Blood Loss and Pain after Total Knee Arthroscopy
(Click here to download full article)
The purpose of this study was to determine whether platelet-rich plasma (PRP) might prevent blood loss and postoperative pain and expedite wound healing following total knee arthroplasty (TKA). Forty consecutive patients with knee arthritis who were matched for age, sex and body mass index (BMI) were randomly allocated to either receive or not receive PRP application over the wound, including capsule, medial and lateral recesses, during TKA. Postoperative haemoglobin, blood loss, blood transfusion, visual analogue scale (VAS) score, wound score, Knee Society Score (KSS) and Western Ontario and McMaster Osteoarthritis Index (WOMAC) score were recorded and evaluated.
The platelet-rich plasma and control groups comprised 17 and 23 patients, respectively. The PRP group recorded significantly less reduction in haemoglobin and need for blood transfusion (p =0.00 and p =0.001, respectively), experienced less pain (p =0.00) and required fewer narcotics than the control (p =0.00). There was significant difference in
range of motion (ROM) at three months (p =0.01), no significant difference in wound scores (p =0.311) and significant difference in KSS and WOMAC scores at 12 weeks (p =0.00, 0.00).
The use of Platelet-rich Plasma in Orthopedic Injuries
(Click here to download full article)
PRP has also been used in the Sports Medicine field with incredible results. Bittencourt and colleagues in 2014 published their findings based on the treatment of 203 patients with various tendinopathies (38 epicondylitis, 45 Achilles tendonitis, 25 patellar tendonitis, 12 hamstring origin (ischial tuberosity) tendonitis, 08 plantar fasciitis, 08 flexor carpi ulnarii tendonitis, 07 pes anserinus tendonitis, 04 biceps femoris tendonitis, 03 iliopsoas tendonitis, 06 athletic pubalgias and 06 biceps brachii tendonitis) all refractory to conservative therapies. They treated these patients with local PRP infiltration, in suitable surgical environment under local anaesthesia. Overall, the patients showed significant improvements with a success ratio in excess of 75 %, concluding that PRP proved to be most efficient in the treatment of tendon injuries that normally pose problems.
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Platelet-rich Plasma Treatment for Injured Tendons, Muscles and Joints
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