PLATELET RICH FIBRINE – BREAKTHROUGH THERAPY IN THE TREATMENT OF MOTION ORGAN DISEASES.

Autologous platelet fibrine.

The need for effective treatment of diseases of the musculoskeletal system caused the intensive development of research on platelet growth factors (PRP- Platelet Rich Plasma) and autologous platelet-rich fibrin (PRF- Platelet Rich Fibrin). Thanks to regenerative medicine, physicians can now help patients with injuries, overload syndromes or osteoarthritis. more effectively.

Autologous Platelet Rich Fibrin (PRF) is a concentrate of the proprietary platelet growth factors (PRP) and fibrin. Autologous platelet-rich fibrin prepared from the patient’s blood contains platelet growth factors that activate the stem cells. These factors stimulate the regeneration of articular cartilage, tendons, muscles and bones. They work by activating and migration of stem cells, collagen synthesis, formation of blood vessels. Platelet-rich fibrin creates a network of fibers on which, by stimulation with platelet growth factors, stem cells are deposited, forming the basis for the regenerating tissue. The great advantage of such treatment is the fact that the prepared autologous platelet-rich fibrin has a liquid form (I-PRF, Injectable Platelet Rich Plasma), which makes it possible to inject it under USG guidance exactly to the place affected by the disease. A few minutes after injection, it forms a three-dimensional structure at the target site, acting as an internal dressing for the diseased area, while embedding itself into the diseased tissue with the help of stem cells.  

The advantage of autologous platelet-rich fibrin (I-PRF) over ordinary platelet-rich plasma (PRP) is the formation of a three-dimensional network that replenishes diseased tissues creating a biological dressing. Autologous platelet-rich fibrin uses the body’s ability to self-regenerate. Its injection causes the same reaction that we see in the healing of, for example, wounds or bone fractures. Because in some situations (age, overload syndromes, degenerative disease) the regenerative abilities are depleted, they are induced by injection of autologous platelet-rich fibrin. The healing process is therefore supported by the concentration of natural stem cells and growth factors.

The indications for the administration of autologous platelet-rich fibrin are pain caused by overload syndromes, osteoarthritis, fracture complications, muscle injuries and support for regeneration during orthopedic procedures.

Autologous platelet-rich fibrin is especially indicated in ligament and tendon overload syndromes, plantar fasciitis, Achilles tendinopathy, enthesopathy, cysts and meniscal injuries, partial injuries of the shoulder tendons.

The feature of platelet-rich fibrin that allows for filling the defects in tissues allows it to be used in disorders of bone union, bone cysts, as well as muscle tearing It is used as an auxiliary in orthopedic surgeries, such as ligament reconstruction, meniscus repair and articular cartilage reconstruction.

Administration of autologous platelet-rich fibrin starts the natural regeneration of tissues. The analgesic effect is due to the healing of the lesion, unlike painkillers or steroids. They only bear the sensation of pain, not affecting the healing of the tissue, and often at the same time contributing to its degradation. The effects of the administration of autologous platelet-rich fibrin, due to the time needed for the regeneration process, appear after 1-3 weeks. By healing the diseased tissue, however, they allow you to enjoy the painless function for a long time.

The safety profile of this treatment method is very high. Only the patient’s own cells are used, which minimizes the risk of side effects.

The autologous platelet-rich fibrin administration procedure involves collecting the patient’s own blood as it is collected for regular laboratory testing. Depending on the diagnosis, the volume ranges from 9 ml to 36 ml.

Blood prepared in a specialized centrifuge allows the separation of the healing fraction, i.e. the autologous platelet-rich fibrin (I-PRF) concentrate. Autologous platelet-rich fibrin concentrate is administered to the diseased site.

The surrounding tissues may be anesthetized, which will take away the pain sensation on administration. Administration under ultrasound control increases the precision in locating the lesion. The entire procedure is repeated until healed, usually 1-3 times at intervals of 3-4 weeks. Contraindications to the procedure include blood diseases, active neoplastic disease, liver diseases, exacerbation of rheumatological diseases, the use of anticoagulants, i.e. blood thinning drugs, including acetylsalicylic acid derivatives (aspirin, acard, polocard).

How to prepare for the procedure?

It is important to properly hydrate the body by drinking at least 1.5 liters of water, preferably within a few hours before the procedure.

Discontinue blood thinning medications (including aspirin derivatives such as acard and polocard) and painkillers (including ointments) 3 days before and 7 days after surgery. The use of paracetamol is acceptable. Both before and after administration, physical activity should be discontinued.

Following administration of autologous platelet-rich fibrin, medical adherence will be required. These generally include restriction of physical activity, the use of a disease-specific stabilizer or orthosis, and rehabilitation.

High effectiveness in treatment can be achieved by adhering to the indications and recommendations. In conjunction with the doctor’s experience and the effectiveness of administration under ultrasound guidance, very good treatment results can be expected.

Author. M.D. Paweł Sokołowicz

Medical specialist in orthopedics and traumatology of the musculoskeletal system. A graduate of the Faculty of Medicine at the Medical University of Karol Marcinkowski and the Faculty of Social Sciences of the University of Adam Mickiewicz in Poznań, majoring in Psychology.

– in 2008-2018 an assistant at the Knee Surgery Department of the Orthopedics and Traumatology Clinic of the W. Degi in Poznań

– in the years 2008-2013, a doctor of the Olympic Team for Seniors of Grass Hockey

– in the years 2016-2018 a doctor of the National Team in Women’s Handball

– since 2010 a member of the Polish Society of Orthopedics and Traumatology

– since 2014 a member of the European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESKKA)

– in 2016 he was awarded the title of doctor of medical sciences on the basis of a research work on the genetic basis of osteoarthritis of the knee joint

– in 2014 he took part in an internship in Germany with Dr. Heinz-Jürgen Eichhorn Orthopädische Gemeinschaftspraxis

Experience:

– over 2,500 treatments of the knee joint

– over 150 arthroscopic procedures of the knee joint annually