Samuel G Oltman, ND, RMSK
At Cascade Regenerative Medicine we practice orthopedic medicine, we make exceptionally high-standard orthobiologics, and we inject with exceptional precision. That’s it. We are committed to expertise because we know how deep the rabbit hole goes and we know the value for patients who see a real expert versus someone who does it among the 10 other “specialties” they have. We are continually looking to improve our processes to give our patients the best possible outcomes, which the science now indicates: Platelet Rich Plasma (PRP) is defined by the number of platelets delivered to the target tissue. In following this data, we guarantee high-dose platelets with every PRP treatment.
What Does PRP Mean?
The term “platelet rich plasma” can be confusing because there is no formal definition of what qualifies as “rich”, so “PRP” is often used inappropriately. The biggest problem in PRP research is that studies rarely have clear quantifications of platelet count for the PRP being used in the study (1). Multiplication measures (“Our PRP is 4x!”) are essentially meaningless because there is so much variation in each person’s baseline platelet counts. If you’ve had “PRP” injections that didn’t provide any relief, there’s a chance that they were several billion platelets short of being therapeutic, or “rich” in platelets. This continues to present a big problem not just for prospective patients looking for treatment, but also for doctors and researchers. Without a clear definition of the term, we don’t know if we’re comparing apples to oranges at any given time. What matters is platelet concentration and total platelet dose.
Total platelet dose is also why in most cases we want to do multiple injections over a span of time, to get a continual high dose of platelets into the affected area. See this companion article for more details on this point.
Bad PRP Studies At The Highest Levels
The Journal of the American Medical Association (JAMA, one of the most respected medical journals in the world) published an article in 2021 concluding that there is not sufficient evidence to support the use of PRP for knee OA (2). When you dig into the article you find that the average platelet count for the “PRP” used in the study was 325 (thousand platelets per microliter). This is not PRP! This is platelet poor plasma and nobody who knows anything about this therapy would expect an injection of 325 to exert any therapeutic effect. As Cascade Regenerative Medicine our PRP platelet counts are on average 5-8 times higher than this (1500-2500).
So the accurate conclusion of the article is: “Poorly made unconcentrated plasma injections don’t improve knee OA”.
Why this study got published in the first place is hard to explain. Why it’s been cited 88 times is hard to explain. It’s either intentionally misleading or inexcusably ignorant. It’s not good science, that’s for certain. It reflects the larger problem with studies stating “PRP doesn’t work” when they’re not studying a solution rich in platelets. It is also probably why your other provider told you “there’s no evidence for PRP”.
The thing they studied in that JAMA article is not the thing you get at Cascade Regenerative Medicine.
PRP Is Defined By Platelet Count
Platelet concentration and total platelet dose are what matters and what makes the medicine effective. Studies show that a minimum of 1 million platelets per microliter is required to get a consistent beneficial effect (over 3 times what the JAMA study used)(3). Total platelet dose is another metric that uses absolute number instead of concentration. Let’s use the 1 million as an example: if that’s your PRP concentration, that means you’re getting 1 billion platelets per 1cc of PRP and if you’re injecting 5cc into a knee, that’s 5 billion total platelets (again, in the JAMA study the total would have been just 1.6 billion total on average). A recent study showed that a total of 10 billion platelets is best for knee OA (4). More broadly, the research shows that a higher total dose is better and that improvement is dose-dependent (5, 6).
Low platelet dose (and/or unknown platelet dose) accounts for 2 very important factors in this space:
The variation and amount of poor studies on injections called “PRP”
The “I tried PRP and it didn’t work” experience of many patients who received a poor quality product with a suboptimal delivery technique
On The Leading Edge of PRP Science
Regenerative Medicine science is headed toward classifying PRP based on platelet concentrations and total platelet dose. That’s why at Cascade Regenerative Medicine we test every batch of PRP that we make and ensure a therapeutic platelet dose. It’s why we are a member of DataBiologics, which is a registry that tracks outcomes for patients receiving orthobiologic treatments, contributing to the body of science in the field. It’s also why I put your PRP platelet count in your chart note. It’s part of the record of what we’re doing for you. And it’s why you can always ask us what your platelet count is for your PRP.
This all speaks to a larger issue in the market: how do you know what clinics or doctors are talking about when they say “PRP”?
The Cascade Regenerative Medicine Difference:
We guarantee billions of platelets with every treatment, delivering true, effective PRP
We verify the platelet count of your PRP BEFORE each treatment
We track outcomes using platelet counts and your clinical improvement over time
We customize concentrations to fit the needs of your condition
We use precise image guidance on every single injection, ensuring the platelets get to the correct location, under the RMSK-certified hands of Dr. Oltman
Our commitment to precise and exacting standards for our PRP mirrors our commitment to precise and exacting ultrasound-guided injections. In a field that moves as fast as regenerative medicine, you need to see an expert. If you’re not getting the level of care outlined above, you need to come see what the difference is as Cascade Regenerative Medicine. Schedule today and Keep Moving.
References:
Everts PA, Mazzola T, Mautner K, Randelli PS, Podesta L. Modifying orthobiological prp therapies are imperative for the advancement of treatment outcomes in musculoskeletal pathologies. Biomedicines. 2022;10(11):2933.
Bennell KL, Paterson KL, Metcalf BR, et al. Effect of intra-articular platelet-rich plasma vs placebo injection on pain and medial tibial cartilage volume in patients with knee osteoarthritis: the restore randomized clinical trial. JAMA. 2021;326(20):2021-2030.
Dernek B, Kesiktas FN, Duymus TM, et al. Effect of platelet concentration on clinical improvement in treatment of early stage-knee osteoarthritis with platelet-rich plasma concentrations. J Phys Ther Sci. 2017;29(5):896-901.
Bansal H, Leon J, Pont JL, et al. Platelet-rich plasma (Prp) in osteoarthritis (Oa) knee: Correct dose critical for long term clinical efficacy. Sci Rep. 2021;11(1):3971.
Everts PA, Lana JF, Onishi K, et al. Angiogenesis and tissue repair depend on platelet dosing and bioformulation strategies following orthobiological platelet-rich plasma procedures: a narrative review. Biomedicines. 2023;11(7):1922.
Giusti I, Rughetti A, D’Ascenzo S, et al. Identification of an optimal concentration of platelet gel for promoting angiogenesis in human endothelial cells. Transfusion. 2009;49(4):771-778.