Cartilage is the strong rubbery tissue that covers bones as they meet at joints, and acts as a cushion between the bones of joints, protecting against shock absorption. It is this cartilage that makes our joints function optimally. This being said, it is very easy to damage this cartilage because our joints are highly active and our cartilage does not contain blood vessels or nerves, which make it takes much longer to heal.
When joint cartilage becomes damaged, it often causes severe pain and inflammation, which often leads to impaired function. This type of cartilage damage occurs most commonly in the knee, but other joints can also be affected.
What can cause joint cartilage damage?
Direct injury to the joint can cause cartilage damage and is very common in people who are active in professional sports. But it is not just trauma that can cause cartilage damage, inactivity can also result in cartilage damage or degradation. Your joints require movement regularly to remain keep in good shape. It is important to understand that you increase your risk of cartilage damage, if you spend long periods inactive, this is because movement stimulates your cartilage and keeps its healthy. On the contrary, repetitive over work of your joints can also causes cartilage damage, especially if you are overweight. The gradual wear on our cartilage can eventually lead to loss of cartilage in the joints, and can lead to osteoarthritis.
There are 2 types of cartilage damage which are easy to understand:
1) Impact or direct trauma - in the knees for example, this can causes what is know as a meniscal injury or tear.
2) Degenerative cartilage damage - often through either repetitive trauma, long periods of inactivity, or a genetic predisposition.
So how can cartilage be treated?
Other than conservative treatments like manual therapy (osteopathy) and physical rehabilitation, there are injection treatments and surgical intervention, and lets face it - we all want to avoid surgery if possible. So from Injection therapies, there are a couple of options available, from steroid injections to biological treatments (regenerative therapies). For the purpose of this article, we are just going to cover hyaluronic acid injection treatment and biological treatments. For further information on steroid please click here.
Viscosupplementation – This is the injection treatment of hyaluronic acid (HA) in to the joint space. It is recommended for patients with mild to moderate degenerative condition or as a preventer. Hyaluronic acid (HA) acts as a joint lubricant, which enables bones to move smoothly over each other, reducing friction, and enhancing shock absorbing properties for the joint. Over a period of time use lose the fluid in our joint which can leas to cartiledge breakdown. HA treatment replaces this lost fluid and can reviled added cushioning.
Platelet-rich plasma (PRP) injections
Over the past decade, much has been written and established about the treatment called platelet-rich plasma (PRP), which is a biological regenerative treatment. Platelets are specialised blood cells that contain proteins that help us with the healing and recovery process. It has been found that injecting areas of tissue damage and inflammation with high concentrations of platelets can encourage healing processes and speed up recovery from injury. A fully qualified clinician will take a small blood sample from you, and then extract your platelets via centrifugation. These platelets are then further concentrated and then injected into the area of your body that needs to be treated.
Because the injection contains a high concentration of platelets, which can be from 5 – 10 times more than the untreated blood, it is well documented that these platelets will speed up healing, reduce inflammation and even have regenerative propertiea. More and more people now are turning towards PRP injections as opposed to cortisone injections, especially as it gets more well-known. This is why it is commonly used within sports medicine. Many famous athletes — Tiger Woods, tennis star Rafael Nadal, and many others — have received PRP for various problems, such as sprained knees and chronic tendon injuries, and some have credited PRP with their being able to return more quickly to competition.
So why are people choosing PRP over Cortisone?
Looking at all the literature and current clinical practice evidence – we can see that cortisone injections appeared to be good option for short-term for pain relief, but not so good long-term. On the contrary, PRP treatment although does not work straight away, has more beneficial properties long term. Better still, we understand that PRP treatment is completely natural and has no side-effects, whereas unfortunately, cortisone is chondro-toxic, meaning, that it can be damaging to cartilage and soft tissue long-term. So this begs the question, why are we having cortison, if there is a potential for tissues becoming worse off long term? This being said, I also believe one treatment is not going to be the end of the world and it can be effective enough to reduce inflammation to the degree where tissue can enable self recovery. Note: due to the drug toxicity, cortisone should not be used for loading tendons, due to this increasing the chances of tendon rupture.
So if the above is correct, why is the NHS still prescribing cortisone over PRP or hyaluronic acid?
Firstly, the NHS is governed by NICE guildines, which dictates use of treatment by effectiveness (from research) and cost effectiveness. Cortisone is very cheap and has extensive research. Also, it is important to remember that research takes time and is very expensive, large pharmaceutical companies invest money into research. Hyaluronic acid and PRP treatments are still fairly new treatments, explaining that research is still fairly new and up-and-coming. This being said, most data has shown very exciting results. Unfortunately, hyaluronic acid is expensive and therefore is unlikely to be given to all NHS patients. Hyaluronic acid was recommended by NICE for the treatment of mild to moderate knee osteoarthritis around 2016/17, but unfortunately cutbacks were introduced. As it currently stands, hyaluronic acid and PRP treatments are only available in the private sector, however, this is likely to change with new exciting data on the short-term and long-term effects of PRP treatment and hyaluronic acid versus cortisone for the treatment of osteoarthritis and more more. This being said, aside from hyaluronic acid, PRP treatments are currently being used for many tendinopathies (chronic tendon issues), examples are tennis elbow and knee tendinitis.
So this pretty much gives our summary. But firstly it is important to understand that acknowledge that the majority of musculoskeletal pain and injury can be managed conservatively with the right treatment. Furthermore, we are not completely against cortisone because we value its anti-inflammatory properties, and we do in fact deliver this service for the NHS too, we just do not support this in the private sector.
We are very proud to say we are the UK’s leading provider of advanced PRP treatment and have been providing this fantastic treatment with ongoing success for almost 10 years, providing over 13,000 treatments to date. We are hugely proud of the significant help and success this has provided to many people, literally changing lives.
Furthermore, we offer the best quality and concentration of PRP at very affordable prices. This is for two reasons, 1) we are the UK distributor for PRP iStem, which allows us to significantly reduce prices, and 2) we truly believe that that payment has to be justifiable as you are using patient’s own cells.
Our Clinic Director and Clinical Scientist Mr Adam Whatley is continuing on clinical research in this fascinating area of platelets and stem cells, and to offer the best level of clinical practice to all patients. PRP treatment has been ongoingly praised for its huge safety profile and effectiveness for various different conditions are very different areas of clinical medicine. Risks and adverse complications associated with PRP treatment is practically non-existent.
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