Multiple Platelet-Rich Plasma articles were published in this month’s American Academy of Orthopaedic Surgeons (AAOS) NOW. With over 400,000 citations in a Google search, Platelet-Rich Plasma has become an important and highly discussed treatment. The sum of the articles illustrate it is not yet possible to categorically conclude PRP is beneficial for all conditions related to tendinopathy. However, based on current clinical results, top Orthopedic surgeons are optimistic and believe PRP should continue to be developed, debated and offered to patients for a variety of indications.
What is Platelet-Rich Plasma and why is it an attractive option for patients with soft-tissue injuries?
When an injury occurs, blood platelets release growth factor within the clot that stimulate the recruitment of healing cells to the site and promote their proliferation. These factors also reduce inflammation and stimulate new cell creation. Following a normal blood draw, PRP involves separating these blood platelets from red and white blood cells, concentrating the amount of blood platelets in higher doses, and injecting them directly into the site of injury. “The concept is attractive because the patient’s own blood is used, limiting the potential for disease transmission,” writes Barbara D. Boyan , PhD and author of AAOS cover article “PRP in Orthopaedics.”
Platelet-Rich Plasma has important implications as it represents a less painful and rigorous treatment for patients with various soft-tissue conditions considering surgery, a more cost-effective means of healing relative to surgery, and the potential of using patients’ own cells for healing. Freddie M. Fu, M.D. is one member of the AAOS panel of experts who clarified the importance of PRP. Dr. Fu writes, “All these factors (various healing cells) are already within our bodies during the natural healing response, which has developed over millions of years of evolution. I really want to know how we can improve our own biologic response, especially in an acute injury setting or during healing.”
Dr. Fu suggests PRP may be the tip of iceberg and continued development of PRP will lead not only to greater efficacy, but may advance biological treatments beyond PRP. A variety of questions concerning PRP exist and are being debated. Currently, “which PRP formulations work best” is a hot topic. Another expert on the AAOS panel, Steven P. Arnoczky, DVM writes, “Not all PRP preparations are similar. Several different forms of PRP or PRP-derived products have been used in human medicine…We must acknowledge that not all PRPs are alike and thus the success or failure of one PRP preparation does not necessarily translate to all PRPs.” The leading PRP expert in the US, Dr. Allan Mishra points out, “the PRP formulation that is better for acute muscle injuries may be very different from the one that works with chronic tendinopathy because these are clearly different pathologies.”
Dr. Mishra’s main use of PRP is in treating chronic tendon conditions. He states, “I use it (PRP) almost exclusively in treating tendinopathy, particularly chronic tendinopathy that has failed to respond to other treatment modalities. That would include conditions such as chronic, recalcitrant lateral epicondylitis, patellar tendinopathy, and Achilles tendinopathy. I think the data—and the work that I have been doing for almost a decade now—provide the greatest support for its use in that area.”
Recently, PRP has been shown to be more effective than cortisone in treating and relieving tennis elbow and a potentially effective treatment in healing degenerative cartilage lesions of the knee (arthritis).
It is clear that while indications for PRP may narrow, effectiveness will likely increase. Dr. Mishra concludes the article titled, “Platelet-rich plasma: Clarifying the issues,” by stating, “If we can collectively better understand how it works, we may be able to contribute not just to our own orthopaedic patients but to others as well.”