Understanding How Ligaments Repair Themselves After Regenerative Medicine Treatments

Published on Dec 26, 2016

I often get asked by patients after a platelet rich plasma (PRP) or stem cell treatment of a damaged ligament what to expect. I also get calls and e-mails from patients not understanding the different phases of healing they’re going through. So this morning I’d like to go over what you can expect and why.

Interventional Orthopedics and Ligament Repair

Trashed or stretched-out ligaments is a common problem that often goes undiagnosed. However, when identified, it’s usually easy to fix with regenerative medicine treatments, like precise ultrasound or fluoroscopy-guided PRP or bone marrow concentrate which contains stem cells. However, often patients don’t understand how ligaments heal, and they get surprised by the various phases of ligament repair. Let me explain.

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The Three Phases of Ligament Healing

There are three phases of ligament healing following a PRP or stem cell treatment for ligament repair, and patients feel different in each phase. Symptoms can kind of roller coaster up and down a bit before leveling off, and this can confuse patients following their procedure. Understanding the phases and what to expect should help alleviate confusion and concern. Be sure to watch the video above in conjunction with this blog post so you can see helpful visuals of the phases as they run their course and overlap.

Phase One

Phase one is the inflammatory phase. It starts immediately following the PRP or BMC procedure, and it typically lasts one to two weeks. During the inflammatory phase, cells are called to the treated ligament area to help with repair. During this first one to two weeks, patients might actually experience an increased amount of pain stemming from the inflammatory response, or they could feel much better because a loose ligament is now tight. Different patients will respond differently.

Phase Two

Phase two happens typically through the two to six weeks’ post-procedure timeframe. During this phase, those local ligament and progenitor repair cells begin laying down new tissue; however, that tissue, the collagen or extracellular matrix (ECM), is disorganized. For those patients that had a positive experience in phase 1 because a lax ligament was tight, this is when many of their symptoms may return. This is because the swelling has left the ligament, so it’s loose again. Other patients who had pain due to inflammation in phase 1 will feel better as the swelling goes away and then may experience gradual relief in their symptoms.

Phase Three

Phase three happens from about the six week post-procedure mark to three months mark in a ligament repair, but could stretch out all the way to six months to a year. During this phase all that disorganized collagen finally reorganizes into strong tissues, or ligament fibers. During phase three the patient should feel better as his or her ligament feels tighter and some or all of the symptoms subside.

What Can You Expect with Multiple Repetitive Treatments?

It’s also important to understand that if you have multiple repetitive treatments you may feel more like two steps forward and one step back. So you might have some relief and then some of the pain may return again, but not all the way to where it was prior to treatment. And then, the same thing—relief and then the return of some pain—but this, too, should lessen each time as repetitive treatments are performed.

The upshot? Understanding the three phases of ligament healing following a PRP or BMC procedure will help you interpret and feel better about what is happening in your recovery. If you’ve had repetitive ligament repair treatments, you may experience less of a roller coaster and more of a two steps forward and one step back process. But in either case, as that ligament heals the pain should subside.