Autologous Conditioned Plasma (ACP) / Platelet-Rich Plasma (PRP): Targeted injection for chronic tendinosis (Level 1)

Q1. What is ACP or PRP, and how does it help heal my elbow?

Autologous Conditioned Plasma (ACP) and Platelet-Rich Plasma (PRP) are modern, non-surgical treatments that use your body's own healing cells to repair damaged tissues. Blood is made up of liquid (plasma) and tiny solid components (red cells, white cells, and platelets). Platelets are famous for helping blood clot, but they also contain hundreds of proteins called growth factors. Growth factors are essential for healing injuries. By concentrating these platelets and injecting them directly into the injured area, we deliver a powerful dose of natural healing factors to kickstart and accelerate the repair process.

Q2. What is chronic tendinosis, and why does it occur in the elbow?

Chronic tendinosis is a condition where a tendon becomes damaged, weak, and painful over a long period. Unlike tendonitis, which is sudden inflammation, tendinosis is a degenerative process. This means the tendon fibers are worn out, scarred, or disorganized. In the elbow, this commonly happens due to repetitive strain from activities like tennis, golf, typing, or heavy lifting. The repetitive motions cause tiny tears in the tendon. Because tendons have a relatively poor blood supply, the body struggles to heal these tears, leading to ongoing pain and weakness.

Q3. How is the autologous conditioned plasma (ACP) or platelet-rich plasma (PRP) obtained?

The entire process is simple and completed right in our clinic during your appointment. Here is how it works:

• Blood draw: A small amount of blood (typically 10 to 15 milliliters) is drawn from a vein in your arm, just like a standard laboratory blood test.
• Centrifugation: The blood tube is placed in a special machine called a centrifuge, which spins it at high speed for about 5 to 10 minutes.
• Separation: The spinning separates your blood into layers. The platelet-rich layer (plasma) is separated from the red and white blood cells.
• Preparation: The concentrated platelet-rich plasma is drawn into a syringe, ready for your injection.

Q4. What makes this injection "targeted" or "Level 1"?

A "targeted" injection means we use advanced medical imaging, specifically musculoskeletal ultrasound, to guide the needle. This allows us to see the damaged tendon and the needle in real-time, ensuring the healing platelets are placed precisely into the tear or degenerative area. "Level 1" refers to the first tier of orthobiologic care, utilizing a single spin, autologous (your own blood) product that has a high concentration of platelets with minimal inflammatory white blood cells. This combination ensures the safest, most precise delivery of healing factors directly to the damaged tissue.

Q5. How does PRP/ACP compare to a standard steroid (cortisone) injection?

Cortisone and PRP/ACP work in very different ways:

• Cortisone (Steroids): A powerful anti-inflammatory medication. It provides fast, temporary pain relief by reducing inflammation. However, it does not heal the tendon and can actually weaken the tendon tissue if used repeatedly.
• PRP / ACP: A biological treatment that stimulates actual tissue repair and regeneration. It may take longer to work, but the results are typically long-lasting because it addresses the underlying damage. It is a biological therapy that promotes structural healing rather than just masking the pain.

Q6. Am I a good candidate for a PRP or ACP injection for my elbow?

You may be a good candidate if you meet the following criteria:

• You have been diagnosed with chronic elbow tendinosis (such as Tennis Elbow or Golfer's Elbow) that has lasted for several months.
• You have tried conservative treatments, including rest, physical therapy, bracing, and anti-inflammatory medications, without sufficient improvement.
• You want to avoid surgery or are looking for a biological option to help your body heal.
• You do not have a history of bleeding disorders, low platelet counts, active infections, or active cancer.

Q7. What should I do to prepare for my PRP/ACP injection?

Preparing for your injection is crucial for the treatment's success:

• Stop anti-inflammatory drugs: You must stop taking NSAIDs (like ibuprofen, naproxen, Advil, Aleve, or aspirin) for at least 7 to 10 days before the injection. These medications block the inflammatory process, which is exactly what we want to trigger to start healing.
• Stay hydrated: Drink plenty of water the day before and the morning of the procedure. This makes drawing your blood much easier.
• Arrange transportation: While not always mandatory, we recommend having someone drive you home, as your elbow may feel sore or stiff immediately after the procedure.

Q8. What happens during the actual injection procedure in the clinic?

The procedure takes about 30 to 45 minutes in total:

• Step 1: The clinical team draws your blood and processes it in the centrifuge to isolate the platelet-rich plasma.
• Step 2: You are positioned comfortably, and the skin over your elbow is thoroughly cleaned and sanitized.
• Step 3: Ultrasound imaging is used to locate the exact area of tendon damage.
• Step 4: A local anesthetic (numbing medication) is applied to the skin and tissues above the tendon.
• Step 5: Under real-time ultrasound guidance, the PRP/ACP is precisely injected into the damaged tendon.

Q9. Is the PRP/ACP injection painful, and what type of anesthesia is used?

We use a local anesthetic to numb the skin and tissue above the injection site to minimize discomfort during the needle insertion. The injection itself can cause a temporary feeling of pressure, fullness, or aching in the elbow as the plasma is introduced into the tight tendon space. Some mild discomfort during the procedure is normal, but it is brief and well-tolerated by most patients. We do not use general anesthesia or sedation, as you will be awake and able to go home immediately afterward.

Q10. What should I expect immediately after the injection?

Immediately after the procedure, you may experience:

• Increased soreness: It is normal for your elbow pain to increase for the first 2 to 5 days. This is actually a positive sign, indicating that the platelets have triggered the inflammatory response necessary to kickstart healing.
• Numbness: Your arm may feel numb for a few hours due to the local anesthetic.
• Stiffness: The elbow joint and surrounding muscles may feel stiff or tight. You can apply a cold compress for 10-15 minutes at a time to help manage severe discomfort, but avoid ice if possible as we want to allow the natural inflammation to work.

Q11. What is the typical recovery timeline after an elbow PRP/ACP injection?

Recovery is a gradual process because biological healing takes time:

• Week 1: Focus on protection. Expect some increased soreness. Use acetaminophen (Tylenol) for pain control; do not take anti-inflammatories.
• Weeks 2-4: The soreness should subside, and you will begin gentle stretching and light range-of-motion exercises.
• Weeks 4-12: You will progress to structured physical therapy to rebuild strength and endurance in the tendon. Most patients begin to feel significant pain relief and improved function around 6 to 8 weeks, with continued improvement for up to 6 months.

Q12. When can I return to daily activities, work, and sports?

Return to activity is phased to protect the healing tendon:

• Daily activities: You can resume light activities (eating, typing, dressing) immediately, as tolerated by your pain level.
• Work: If you have a desk job, you can return the next day. If your work involves heavy lifting or repetitive elbow motions, you may need modified duties for 2 to 4 weeks.
• Sports: You should avoid high-impact sports, racquet sports, or heavy lifting for at least 4 to 6 weeks, gradually returning under the guidance of Dr. Veillette or your physical therapist.

Q13. What are the potential risks, side effects, or complications of this procedure?

Because PRP/ACP is made from your own blood, the risk of an allergic reaction or disease transmission is virtually zero. However, like any injection, there are minor risks, which include:

• Infection: A very small risk of introducing bacteria through the skin (less than 1 in 10,000 cases). We use strict sterile techniques to prevent this.
• Nerve or blood vessel injury: Extremely rare, especially since we use ultrasound guidance to visualize the anatomy in real-time.
• Temporary pain flare-up: Increased pain for a few days after the injection, which is a normal response to the treatment.

Q14. How successful is PRP/ACP for chronic elbow tendinosis?

Clinical studies show that ultrasound-guided PRP/ACP injections are highly effective for chronic elbow tendinosis (such as Tennis Elbow), with success rates ranging from 75% to 85%. Most patients experience significant pain reduction and a return to their previous level of activity. The key to success is combining the injection with a structured, post-injection physical therapy program to help guide the newly forming tendon fibers.

Q15. Will I need more than one injection, and what if it doesn't work?

Many patients achieve lasting relief from a single, well-targeted PRP/ACP injection. If you experience partial improvement, Dr. Veillette may recommend a second injection 4 to 6 weeks later to boost the healing response. If the treatment does not provide relief after several months, we will re-evaluate your elbow with further imaging and discuss alternative options, which may include advanced physical therapy, other minimally invasive procedures, or surgical intervention.

We encourage you to write down any specific questions you have and discuss them thoroughly with your surgeon, doctor, or physical therapist. They are your best resource for personalized advice and care.

Disclaimer: This brochure provides general information and is not a substitute for professional medical advice. Always consult your doctor or qualified healthcare provider with any questions you may have regarding your specific medical condition and treatment plan.