SPORTS MEDICINE

Platelet-Rich Plasma. Where Do Things Stand?

 

The use of Platelet-Rich Plasma (PRP), particularly in orthopedic sports medicine, has risen sharply in public awareness.  A large number of professional athletes have turned to PRP injections to speed their recovery and return to sport.  Furthermore, the use of PRP is being used far outside the orthopedic sphere.  It has been injected into arthritic joints, for cosmetic wrinkle management, and even to treat hair loss.

So, what is PRP, and how is it administered?  PRP is a product from autologous blood (a patient's own blood) drawn from the patient by plasmaphoresis and then centrifuged in order to allow for a concentration of blood components rich in platelets, growth factors, cytokines, proteins, and some cellular components.  Once concentrated, this Platelet Rich Plasma is re-injected into specific areas of the patient’s body to repair local damage in order to speed or facilitate healing after either conservative or operative interventions.    We will look at several areas of use, and review outcomes.

Rotator Cuff Tears
Rotator cuff tears are significant sources of shoulder pain and disability affecting a wide spread of ages as these can arise from sports, work, trauma, and age.  These are generally treated with some combination of conservative and operative measures with satisfactory outcomes.  Numerous studies on the impact of use of PRP in the course of arthroscopic repair have been done, but there is little consistency in how PRP has been utilized.  While there have been some outcomes suggesting a positive effect, most studies fail to demonstrate significant improvement in structural outcome by MRI, rate of retear, or shoulder specific outcome scores.

Knee Osteoarthritis
Wear-and-tear arthritis is one of the most common orthopedic problems, and is likely a result of some combination of age, gender, activity, and genetic factors.  Nonoperative approaches have included intra articular steroid injection, hyaluronic acid (HA) injection, and PRP injection.  Again, numerous studies have been performed, and there is a wide variety in the study designs.   The majority of published results suggest positive results for PCP, and at a level supporting further research to evaluate whether to pursue it as a standard intervention.

Elbow
Throwing athletes are at risk of damage to the anterior band of ulnar collateral ligament on the inside of the elbow from the repetitive stress to the ligament during high velocity throwing.  Complete tears will usually need surgical reconstruction if there is to be a return to sport.  Partial tears, however, are somewhat of a grey zone.  PRP may have a role to play in this population in conjunction with therapy.

Lateral epicondylitis, or tennis elbow, occurs on the outer side of the elbow where muscles that extend the wrist and fingers  connect via a common tendon onto a bony ridge just above the elbow – the lateral epicondyle.  This tendon origin can be damaged or inflamed.   This area is frequently treated by a combination of therapy, anti inflammatory medication,  and corticosteroid injection.  If there is prolonged or limited response to conservative measures, surgery may be indicated.  Studies have had considerable disagreement as to the effectiveness of PRP injection.  Some studies suggest a level of effectiveness similar to corticosteroid.  Outcomes are variable, but there is enough positive effect to warrant further study.

Hamstring Strains
Acute hamstring injuries are typically treated with a combination of rest, therapy, and anti-inflammatory medications.  It was hoped that use of PRP would result in more rapid healing.   There have been mixed results, but even the positive results have observe limited improvement compared to traditional approaches alone.  Further study may change this assessment, but current evidence suggests only limited usefulness in this application.

Achilles Tendinopathy
This condition is an overuse syndrome affecting the Achilles tendon resulting in painful swelling of the tendon above its insertion onto the calcaneus.  Treatment includes rest, anti-inflammatory medication, heel wedges or lifts, and therapy.  There is some risk of these problems progressing to tendon rupture.  Some patients with recalcitrant cases may need surgery.   Corticosteroid injections are typically avoided.  The addition of PRP has not made a clear improvement in outcomes to this point.
Summary
While the concept of enhanced healing by the introduction of products from the patient’s own blood is encouraging enough to stimulate a large research interest, there emerge a number of tantalizing outcomes, but often highly variable or contradictory conclusions.  In part, this may be related to small sample sizes, variable designs for placement, timing, and delivery, and the location and type of injury being treated.   The material itself is of complex composition that may vary from person to person, and therefore, introduce inherent difficulty in evaluating outcomes.  In general, additional research is needed to better understand and optimize the possible benefits of PRP technology.

 

 

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