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Platelet-rich plasma therapy for tendons/ligaments


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#1
sportnerd

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During the past few years treatment of athletic injuries with platelet-rich plasma (PRP) has spread across the sports medicine community, but it wasn’t until a well known sports celebrity—Tiger Woods—admitted using it that the general public stood up and took notice.

Prior to his well-known personal problems off the course, Tiger’s main concern was an injured Achilles tendon. Last year he admitted at a press conference that he had received the experimental PRP medical treatment for his frail tendon from Canadian physician Dr. Anthony Galea.

During the PRP procedure the blood is drawn and centrifuged to separate out the red blood cells (erythrocytes) from the plasma. The plasma, which contains platelets, is then injected back into the site of the patient’s injury. The theory is that this concentrated injection mimics the pooling of blood around an injury site, releasing factors that accelerate the healing process.

The jury is still out as to whether the treatment really works—so far studies have shown mixed results: one trial showed no benefit, whereas another showed a benefit for 66% of elbow tendonitis patients.

PRP is currently only restricted by sports organizations such as the World Anti-Doping Agency (WADA), which allows athletes to get PRP treatments to heal torn ligaments, tendons and joint injuries if the athlete submits a declaration of use. Injection into muscles is banned because it is believed it stimulates stem cells to make muscles bigger, which is perceived as an enhancement rather than a treatment.

News article from the New York Times website, posted 1/26/11, 12:01 AM EST:

Does Platelet-Rich Plasma Therapy Really Work?

By GRETCHEN REYNOLDS

Tiger Woods, Chris Canty (a defensive tackle for the New York Giants) and the Phillies’ pitcher Cliff Lee have in the past year or so greatly boosted the popularity of a controversial therapy by employing it to combat a sore knee (Woods), hamstring (Canty) and abdomen (Lee). The treatment, platelet-rich plasma therapy, or PRP, involves centrifuging a person’s own blood until it contains a concentrated mix of plasma cells and growth factors and then injecting the resulting substance directly into the injured tissue. In theory, the distilled growth factors (a protein or substance that helps stimulate growth) should speed healing and improve the tissue’s health, which has happened in the lab. When scientists surgically created lesions in animal tendons and other tissues, PRP therapy nudged the injured tissues to rapidly create new collagen and blood vessels. Meanwhile, testimonials from professional athletes suggested that the shots work in humans as well. Today, recreational athletes reportedly clamor for PRP to treat everything from tennis elbow to back pain, even though the procedure rarely is covered by insurance and can cost $1,000 a shot. “It has buzz,” said Dennis Cardone, a clinical associate professor at New York University’s Langone Medical Center who has written about the use of PRP in sports medicine.

But now, rather belatedly, science is showing up to spoil the fun. Several new studies have examined whether PRP is effective outside the lab, and as Leon Creaney, a sports-medicine consultant in London and the author of one of the papers, said, “the evidence has not been favorable” for PRP.

Perhaps the most telling of the new studies, by Dr. Creaney and his colleagues, has been accepted by The British Journal of Sports Medicine and will published online soon. In it, scientists treated people suffering from refractory tennis elbow with either PRP or injections of whole blood. Whole blood contains far fewer growth factors than P.R.P. Presumably, then, injections of blood would not accelerate and amplify healing in the same way as PRP. But the whole blood turned out to be as effective as PRP at treating tennis elbow after three months, and more so at six months. Both treatments reduced pain in most volunteers (whose tennis elbows had not responded to physical therapy). But in the end, the lower concentration of platelets and growth factors in the whole blood was better. “ ‘Less,’ ” the authors write, “may in fact be ‘more.’ ”

This finding is in line with that of another study reported this month in The British Journal of Sports Medicine. The sequel to a much-discussed experiment from last year, it re-examined patients with Achilles tendinopathy (an overuse injury of the Achilles tendon) who had been randomly assigned to receive injections of either PRP or a placebo of saline solution. In the original study, the patients were assessed after six months and the researchers found no statistical difference between the two groups’ recoveries. Now an additional six months later (meaning a year after treatment), the results were the same. Salt water worked as well as high-tech PRP, prompting the authors to conclude that there is “no evidence for the use of platelet-rich plasma injection in chronic Achilles tendinopathy.”

Why, then, has PRP received so much praise from early adopters, and what are we to make of results like those from yet another report in the same issue of The British Journal of Sports Medicine, in which PRP improved the healing of man-made lesions in lab rats’ tendons?

“This seems contradictory,” admitted Robert-Jan de Vos, a researcher at the Erasmus University medical center in the Netherlands and lead author of the Achilles tendinopathy study. But, he said, there are fundamental differences between overuse injuries, such as tendinopathies, and acute wounds, like those created in animal experiments. In acute injuries, the body initiates a robust healing response, which, Dr. de Vos said, PRP may intensify. But in overuse injuries, the healing process is often blunted, and PRP seems unable to augment it much.

That’s only a theory, however. In general, the mechanisms by which PRP succeeds or fails remain unexplained. “We believe more work on the basic science needs to be undertaken,” a consensus statement about PRP issued late last year by the International Olympic Committee said, adding that people should “proceed with caution in the use of PRP in athletic sporting injuries.”

So what is someone with a sore ankle, knee, elbow, shoulder, abdominal muscle or other sports injury to do? “First, exhaust the standard treatments,” said Dr. Cardone. Begin with physical therapy, he said, which has a proven track record against overuse injuries and is much less expensive and invasive than PRP.

“The injections are very painful,” Dr. de Vos pointed out.

Only if other treatments are unsuccessful, Dr. Cardone continued, should you consider PRP or other shots, like whole blood. (Some researchers suspect that you get benefits, if any, from the needle prick, not the contents of the syringe. The needle causes a small amount of bleeding in the injured tissue, which could potentially initiate a healing response from the body.) “It’s worth trying PRP before turning to surgery,” Dr. Cardone said. Most of the people in the latest studies did recover after receiving PRP, he pointed out, although no better than with other, cheaper injections. So if you’re undeterred by the expense, discomfort and questionable utility of PRP, the treatment may be worth the risk, when almost all else has failed. “Based on what we know at this point,” Dr. Cardone concluded, “I’d say that PRP is probably best reserved as a last resort before the final last resort of surgery.”



#2
fastpitchfan

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Platelet-rich plasma therapy is becoming more and more popular among pro athletes for knee injuries. Fred Mitchell of the Chicago Tribune reported yesterday that Chicago Bears star running back Matt Forte is receiving PRP therapy to his right knee to speed healing of his sprained medial collateral ligament (MCL). Forte suffered the injury in the first quarter of last Sunday's game against the Kansas City Chiefs in Chicago. According to Forte in Mitchell’s article Forte uncertain when he will return:

"I'm here, standing up and walking around, so obviously that's good. MCLs usually don't take a whole lot of time to get back. But it does vary from two to as long as six weeks. I don't want to make any predictions because I really don't know. I got a (platelet rich plasma) injection this morning that is supposed to make it heal faster."

It turns out Forte’s teammate, star quarterback Jay Cutler, also received PRP to his knee after he sustained a similar injury in last season’s NFC championship game.

Another convert is Pittsburg Steelers wide receiver Hines Ward. He suffered an MCL sprain in the first half of the 2008-09 AFC championship game and was able to participate in the Super Bowl two weeks later after undergoing PRP, which was considered cutting-edge treatment at the time.




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