Platelet-Rich Plasma (PRP) For UCL Ligament Tears

UCL Ligament Tears Overview

Ligaments are resilient bands of connective tissue that work as tethers between a joint’s bones. They stabilize movements, preventing the bones from moving too much during motions and reducing the risk of injuries such as dislocations. 

In the elbow, the UCL has a specific function: it connects the bone of the upper arm (humerus) to the bone in the forearm (the ulna). This ligament is located on the inner aspect of the elbow and consists of three main bundles of tissue:

• The anterior or front bundle
• The posterior bundle
• The transverse or oblique bundle 

The anterior bundle is most important for the elbow’s stability, while the oblique bundle is the strongest component of the ligament and the primary restraint to valgus (outward) stress. Excessive valgus force may occur when falling on an outstretched arm or when receiving direct trauma to the side of the elbow (i.e.: the forearm is pulled outward at the elbow).

UCL injuries occur when the ligament is stretched, torn, or becomes completely detached from the adjacent bones (an injury known as ligament rupture). When these injuries occur, you may experience sharp or chronic pain, elbow instability, and a loss of grip strength. 

Over time, this can put an end to your athletic career – especially if you are a javelin or baseball athlete – and cause disability in your everyday life. Some of the most common causes of UCL tears include:

• Overuse. Engaging in recurring or forceful overhead throwing motions can cause repetitive stress to the UCL. Initially, this may lead to minor tears and microdamage, but over time, these injuries can develop into more severe tears. 
• Direct trauma. Receiving a direct blow to the elbow can cause the UCL to stretch in an abnormal direction or beyond capacity. Additionally, direct trauma can cause other injuries, such as a joint dislocation or fracture, which can result in a consequential ligament tear. 

Playing in sports represents the highest risk factor for UCL tears. Today, it is estimated that between a quarter and a third of young baseball players will deal with elbow pain at some point during their sports career.

Symptoms Of UCL Ligament Tears

The symptoms of a torn UCL will depend on the severity of the injury. Generally, ligament tears are categorized by severity into three groups: 

• Grade 1: Microdamage or mild stretching of the ligament. Usually, this does not involve joint instability. 
• Grade 2: The ligament is significantly stretched and partially torn. It may cause minor instability. 
• Grade 3: A grade 3 injury usually requires surgery. This is referred to as a complete tear or rupture, and it occurs when the ligament becomes completely torn from the adjacent bones. 

Minor injuries are not likely to cause disability, but they are often associated with pain, inflammation, and discomfort. These symptoms can, however, have a profound impact on your ability to continue playing sports. If you are recovering from an injury, a torn UCL may also delay your return to play. 

Some of the most common symptoms associated with UCL tears include:

• Painful sensations, which intensify during movements of the elbow. In particular, you may experience flare-ups when performing overhead throwing movements or when accelerating the arm forward. 
• Sharp pain, often accompanied by a loud “pop,” at the time of injury
• Tingling and numbness in parts of the hand, usually in the pinky and ring fingers, due to nerve compression
• Joint instability, or a sensation that your elbow will “give up” when carrying weights or performing overhead movements
• Loss of pinch and grip strength. This symptom occurs when a ligament injury interferes with the functioning of nearby motor nerves

It is important to treat ligament tears as acute injuries that require medical attention. This is because, without adequate treatment, this injury can lead to chronic pain, elbow instability, and recurring ligament tears.

Conventional Treatment Options 

Minor UCL injuries are generally treated with conservative therapies. These lines of treatment aim at reducing inflammation and boosting recovery times – but they are not free of side effects and risks. 

In more severe cases, healthcare providers may recommend surgical interventions to restore elbow function and increase the chances of a swift return to sports for athletes. However, these invasive procedures can lead to long-lasting side effects, including recurring elbow pain and instability, and often involve lengthy immobilization and rehabilitation periods. 

Below, we’ll look at some of the most common treatment strategies recommended for UCL tears.

Corticosteroid Injections

Corticosteroids mirror the properties and actions of cortisol, a naturally occurring hormone in your body. The primary role of this hormone is to regulate inflammation and decrease the transmission of pain signals from the injury area to your brain.

These chemicals are delivered directly into the injured area – the elbow, in this case – via injections. The substances they release help alleviate pain over an extended period, thus offering longer-lasting relief compared to other pain medications.

Despite how widespread the use of corticosteroids is, this form of treatment isn’t free of risks. Chronic use of corticosteroids can lead to increased blood pressure, mood swings, and muscle weakness. Recent studies also suggest a link between corticosteroid injections and severe conditions such as cartilage degeneration and adrenal gland insufficiency.

NSAIDs

Nonsteroidal anti-inflammatory drugs, or NSAIDs, act as pain relievers by obstructing the cyclooxygenase (COX) enzyme. This enzyme is crucial for producing prostaglandins, which are chemicals responsible for amplifying pain signals and triggering inflammation. NSAIDs can provide short-term pain relief by temporarily curbing prostaglandin production.

NSAIDs are often the go-to treatment for musculoskeletal injuries, often due to their affordability and accessibility. However, it is important to understand that taking these drugs chronically can lead to severe side effects, including an increased risk of stomach ulcers, kidney dysfunction, heart attack, and stroke. Since these drugs do not modify or cure your condition, you may be exposing yourself to such side effects unnecessarily.

Ligament Reconstruction Surgery (Tommy John Surgery)

In the case of severe tears or ligament ruptures, your doctor may recommend you undergo ligament reconstruction surgery. UCL reconstruction surgery is also known colloquially as Tommy John Surgery. This is because, in 1974, the first surgery of this type was performed by Frank Jobe, M.D. on baseball pitcher Tommy John.

This invasive procedure is suggested only when other treatments have not worked or if your injury is preventing you from returning to sports and living functionally. As with any invasive procedure, you may experience blood clots and infections as a consequence of surgery. 

Moreover, there’s always the chance that the reconstructed ligament might not provide you with the same strength or flexibility as your original ligament and may even lead to long-lasting chronic pain. 

Although the number of elbow ligament reconstruction surgeries is on the rise, this isn’t always the best or safest option to regain your elbow’s health.

What Is Platelet-Rich Plasma or PRP? 

Platelet-rich plasma (PRP) is a form of regenerative medicine therapy that leverages the properties of a patient’s own blood. Samples of this autologous blood are concentrated and processed to offer optimized values of platelets. 

Platelets are the blood’s components responsible for healing functions, such as blood clotting and preventing excessive bleeding. Platelets are also exceptionally rich in growth factors. 

Growth factors, which can be found within platelets in “packets” known as alpha granules, are capable of stimulating the activity of repair cells within the site of injury. They can also trigger adult stem cells into proliferating and differentiating (becoming specialized cells) that support the healing of musculoskeletal injuries. 

Given the optimized quantities of platelets – and, in turn, of the growth factors contained within them – you can think of PRP as an “espresso shot,” which stimulates the body’s ability to heal naturally.

PRP For UCL Ligament Tears

Because PRP primarily works by supporting the body’s inherent healing capabilities, platelet-rich plasma injections are considered to be a form of regenerative medicine. In regenerative orthopedics, this therapy can be successfully used in the treatment of a wide range of conditions, including ligament tears, joint instability, and minor arthritis. 

So far, there have been more than 30 randomized trials demonstrating the efficiency of PRP in kick-starting the body’s self-healing processes by stimulating the activity of stem cells within the site of injury. 

When looking at how PRP works for UCL tears, studies have shown that platelet-rich plasma can be used successfully to treat minor to severe ligament tears, especially when combined with physical therapy and rehabilitation programs. The same study (2021) shows that 88% of athletes treated with PRP were able to return to the same level of sport within three months of their injuries. 

Research (2019) comparing the efficacy of PRP and ligament reconstruction surgery in the management of UCL tears also shows that:

• PRP is an effective treatment option for mild to severe ligament injuries.
• Return to sport, even for ligament ruptures, is faster with PRP than with surgical therapy.
• PRP can help athletes avoid surgery.

Why Are Orthagenex PRP Injections Superior?

The studies above, at a glance, show that PRP can be considered a valid, safer, and more efficient alternative to Tommy John Surgery. However, before choosing this alternative, it is important to understand one critical aspect: not all PRP injections are created equally. 

Several factors influence the effectiveness of PRP injections and the outcomes they are able to offer. These aspects are:

• Needle placement accuracy 
• The concentration of platelets 
• The purity of injectates
• The level of customization of the injectable solutions

At Orthagenex, we’ve pioneered a superior PRP protocol that allows us to achieve the greatest health outcomes. This proprietary protocol is known as high-dose PRP.

In the sections below, we’ll look at the features that make this protocol so advanced and innovative. Let’s dive in.

Image-Guidance To Place PRP Solutions

One of the critical aspects that sets the Orthagenex protocol apart from all other clinics offering PRP therapies is the use of imaging guidance. 

Imaging guidance refers to a wide range of techniques that allow healthcare providers to monitor the placement of the needle in real-time, from the moment it enters the skin and throughout the procedure. Thanks to these technologies, healthcare providers can avoid relying on tactile sensations and improve the therapy’s clinical outcomes. 

To understand why the use of imaging guidance is so important in the protocol developed by Orthagenex, we need to look at what most other orthopedic clinics across the US consider as standard. 

The majority of PRP therapy providers do not use any form of imaging guidance, which significantly increases the risk of injections missing the target location (even when performed by trained physicians). To make things worse is the fact that, in the few cases where imaging guidance is used, doctors often lack the necessary training to interpret results.

At Orthagenex, the most advanced imaging guidance techniques are used as standard to place PRP solutions, thus significantly increasing the accuracy of the needle placement. These techniques, which can be used in combination, include ultrasound guidance and C-arm fluoroscopy:

• Ultrasound guidance: This technique uses ultrasound waves to create real-time visuals of the placement of the needle as it travels through the skin. 
• C-arm fluoroscopy: This form of imaging guidance uses a C-shaped machine that creates real-time X-ray images of several aspects of the elbow as it is being treated with PRP.

At Orthagenex, these techniques are performed by highly skilled technicians, trained in performing imaging guidance and interpreting results. The use of imaging guidance is one of the pillars of interventional orthopedics.

Interventional orthopedics

With imaging guidance as standard practice in our therapies, Orthagenex is at the forefront of the development of a new, recognized medical field: interventional orthopedics. 

This field of research is based on three key pillars: 

• The use of injection (such as PRP) as the preferred treatment option for musculoskeletal injuries and chronic pain
• The use of imaging guidance to improve needle placement accuracy
• Continuous innovation and development of new, improved injectable solutions, as well as more refined administration techniques

Lab-Processed For Higher Concentrations Of Platelets

The concentration of platelets contained in any given PRP solution is one of the most critical aspects determining the efficacy of the treatment. However, the techniques and equipment used by most standard orthopedic clinics across the US are unable to obtain satisfying results.

Most healthcare providers use standard bedside centrifuge machines to create their PRP injectates. Once a blood sample from the patient is collected, it is immediately fed to these basic machines, which will separate the different components of the blood by taking advantage of centrifugal forces (spinning). 

These machines are inefficient in removing unfavorable components from the mix, and they are only capable of achieving suboptimal platelet concentrations. To make things worse, the resulting PRP solution is often immediately injected into the site of injury, without any further customization process. 

Here at Orthagenex, we are of the firm conviction that the key to improving the outcomes of PRP treatments lies in personalizing each injection to meet your particular needs. After all, no two people experiencing UCL tears will have exactly the same symptoms or impact on their lives. 

This is why, as part of our high-dose PRP protocol, we leverage dedicated cellular lab facilities situated within all our clinics. 

Once your blood sample is collected, it undergoes laboratory processing where state-of-the-art techniques are employed to optimize the concentration of platelets and the level of purification of the injectate. The processed sample is then tailored to match your unique needs. 

Here’s an overview of how the Orthagenex protocol sets itself apart from the techniques used by most other clinics.

Amber PRP vs. Red PRP

PRP can take on different colors, determined by the quantities of certain blood cells and platelets it contains. Currently, there are two types: red PRP and amber PRP. 

Red PRP, also known as leukocyte-rich PRP or LR-PRP, is rich in platelets and packed with both white and red blood cells. Amber PRP or leukocyte-poor PRP (LP-PRP), on the other hand, has high concentrations of platelets but low amounts of white and red blood cells.

Although both formulations contain platelets, the presence of other blood components can yield different results. Laboratory tests conducted at Orthagenex found that the white and red blood cell content in the red PRP could cause inflammation at the injection site. 

What’s more, these blood components can also inhibit the same stem cells that the therapy aims to stimulate, potentially reducing treatment outcomes.

Conversely, amber LP-PRP induces less inflammation while enhancing each shot’s effectiveness, making it Orthagenex’s preferred injectate.

Next-Generation Platelet Lysate 

Platelet lysate (PL) injections, which are considered to be a more innovative form of therapy compared to platelet-rich plasma, are also offered at Orthagenex. Depending on your specific requirements, PL can either be used along with PRP or as a substitute for it.

Unlike PRP, PL is capable of delivering high concentrations of growth factors en masse to the site of injury, thus offering a fast-acting effect. PL is also remarkably anti-inflammatory and suitable for the treatment of sensitive areas. 

Here’s how the two forms of treatment compare:

Most orthopedic practices across the US are only just starting to recognize the advantages of PL injections and offering them as part of their treatment protocols. 

In contrast, at Orthagenex, PL injections have been part of our offer for years. Today, we are able to provide our patients with third and fourth-generation PL injections, while our unwavering focus remains on developing superior injections and achieving greater health outcomes.

PRP Customized To Every Patient’s Need

Given the complexity of UCL injuries and their potential implications on your personal life and professional athletic career, it’s clear that standard one-size-fits-all therapy is never sufficient. At Orthagenex, we prioritize crafting completely personalized treatment plans for each patient, which include fully tailored PRP injections.

To achieve this, we leverage specialized cellular lab settings located within our clinics. These laboratories provide our team of experts with all the tools needed to tailor PRP formulations to your unique needs. To provide an even higher level of customization, we also incorporate additional therapies such as platelet lysate (PL) injections and bone marrow concentrate. 

Below, we’ll look at these elements of Orthagenex’s high-dose PRP protocol in more detail.

Solutions Are Customized Using Specialized Laboratories 

At Orthagenex, we’re dedicated to giving you the best care possible. That’s why we use a cutting-edge cellular lab to ensure that each injection is processed to yield the highest levels of purity and platelet concentrations.

This innovative lab system is conveniently housed within every Orthagenex clinic. It allows us to craft each injection according to your unique needs, customizing the presence of red and white cells, as well as the volume of platelets.

A team of skilled physicians oversees every stage of the process, from collection to injection. The experts in our medical staff are distinguished by their proficiency in cellular lab processing techniques, interventional orthopedics, and imaging guidance. Their knowledge ensures that each of our patients can access care tailored specifically to their health needs and goals.

Bone Marrow Concentrate (BMC) Can Be Used 

Besides PRP therapies, Orthagenex also offers leading bone marrow concentrate (BMC) treatment plans. BMC works by augmenting the volume of stem cells around the site of injury and, similarly to PRP, boosts the body’s ability to heal naturally. 

This auxiliary regenerative medicine therapy involves collecting the liquid portion of the bone marrow, which is exceptionally rich in stem cells. The bone marrow is sourced through a small needle puncture created in the bone, usually in the pelvis area. 

The bone marrow is then concentrated and purified before being re-injected into the site of injury. The stem cells contained in BMC will aid the activity of repair cells around the injured UCL to stimulate the regeneration of musculoskeletal tissue.

Doctors Specializing In Interventional Orthopedics

Orthagenex is at the forefront of medical advancement, leveraging cutting-edge machinery and sophisticated techniques. However, our greatest asset is our highly knowledgeable and proficient medical team.

Each individual on our team is a musculoskeletal (MSK) specialist with expertise in imaging guidance. Our doctors hold board certifications and are fellowship-trained in the niche field of interventional orthopedics.

Today, only a small fraction – just 1% – of physicians in the US are trained in this specialized discipline. Given these facts, it’s not surprising that Orthagenex stands out from the crowd: so far, we have aided more orthopedic patients than any other regenerative medicine clinic across the globe.

Core Competencies

• Advanced imaging guidance techniques to optimize needle placement accuracy
• The use of in-house, state-of-the-art cellular laboratory environments to create purer and more concentrated injectates
• Using amber LP-PRP as the PRP formulation of choice
• Offering auxiliary interventional orthopedics therapies, such as BMC
• Using SANS – our unique proprietary assessment method

SANS stands for Stability, Articulation, Neuromuscular, and Symmetry. This proprietary evaluation method has been developed to diagnose chronic pain conditions with greater accuracy. Chronic pain is today one of the leading causes of disability, and it affects a growing percentage of the population. However, determining its causes isn’t always straightforward – especially since it often arises as a consequence of environmental influences, psychological factors, and health events. 

The SANS method allows Orthagenex to pinpoint the location, cause, nature, and extent of chronic pain conditions, insights that can be used to guide more informed treatment decisions.

Orthagenex – Your Alternative To UCL Ligament Tears Surgery

UCL injuries can have a profound impact on your life. They can get in the way of everyday activities and even cause your soaring athletic career to come to an abrupt end. However, playing through the pain, enduring the side effects of medications, or living in fear of requiring Tommy John surgery are no longer the only options available. 

Thanks to the superior treatment protocols developed by Orthagenex, you can now restore your elbow’s health without medications or invasive interventions. High-dose PRP treatment plans are here to help you support your body’s ability to heal naturally and avoid surgery.