Saturday, May 13, 2017

The DL on PRP treatment

As an orthopedic PA and a competitive runner, I've been asked a lot of PRP as a treatment modality for tendon, muscle and ligament injuries.  Therefore, I thought I would give everyone my professional opinion.




Platelet Rich Plasma:

First, what are platelets?  Platelets are found in your blood and aide in the clotting cascade when there is injury to a vessel.  If someone has too many platelets they are at an increased risk of developing blood clots verses someone who has too little platelets.  If an individual's platelet level is low, he or she will have trouble clotting and may experience increased bruising, nose bleeds, etc.

PRP Therapy:


injection of one's platelets into an injured area has been around for a couple of decades now.  However, there is no great evidence that this is a quick fix or cure for sports related injuries.  Blood is drawn from the patient, centrifuged down and the platelets are then injected into the site of injury (usually under the guidance of ultrasound).  The thought is that the plasma contains growth factors and proteins that are needed in the repair of tendon, ligament, muscle and bone injuries.  There is however limited evidence to support PRP therapy in the treatment of soft tissue injury.  The other thing is this treatment is expensive!!!  About $600-$1,000 per injection and 2-3 injections are needed.  The other thing to think about is the injection itself is putting a needle into the site of injury, which alone will increase blood flow to that area.  This is the same concept behind dry needling, so if you haven't tried that how do you know that isn't what helped (if it does help).  







Common running injuries and PRP outcomes:

  • Plantar fascitis: PRP injections have been studied against corticosteroid injections in patients with PF.  The results favored the corticosteroid injection...
  • Achillies tendonitis/tear-  Like the PF, there is poor blood flow to this site.  There are some studies that suggest improvement after PRP with this injury, however once again its after months, so who knows.
  • Osteoarthritis of the knee- There seems to be a lot of studies looking at OA and PRP.  One study looked at the MRI of patient's with mild OA, they then received PRP and had another MRI a year later.  The repeat MRI did not show any significant increase in the OA.  Similar studies also used pain, where patients reported less pain after PRP, however patients that received a placebo injection stated the same.  Thus, I am a fan of the imaging studies and not a patient's verbal response that could be mental, aka placebo effect. 
  • Patellar tendonosis: Study in 2007 in the UK used 44 patients showed an improvement in the group that underwent PRP therapy in return to sport as well as improved tendon thickness and reduced tears.  Another study that used a single subject track athlete showed improvement after 6 months from the last injection in combination with other treatment modalities... really?!

Risks: in general the risks are minimal.  As long as you don't have any crazy hematologic issues and have exhausted everything else, it can't hurt.  I'm not saying it will help though!

Conclusion:


I feel this is a benign option for someone that has exhausted all other treatment options.  This includes time off or activity reduction, FULL therapeutic dose of NSAIDs, dry needling, physical therapy, ice, etc.  I understand what it is like to want to return to your sport and being sidelined, but just know it really is a last resort and nothing is really proven.

17 comments:

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  3. I have had 2 procedures of PRP for different issues in different sites and it is amazing how well the results were. I avoided the expensive surgery copays and lengthy recovery time. It truly is a wonderful option if you cannot or do not want to take meds or want surgery. Just must avoid NSAIDS for a long while afterwards, which let's face it, are not good for you anyway.

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  5. A PRP treatment is an injection of your own platelets (cool, because then obviously there's no risk of rejection or other complications). My surgeon did the treatment, and he started by withdrawing a small volume of blood from me (15 mL), which was then centrifuged down to separate the plasma, concentrating all it's components, from the red and white blood cells. That increases the concentration of platelets in that sample of plasma, which should stimulate a rapid healing response. Then, the plasma was drawn off the separated blood and injected into my knee. Um yeah, that hurt a lot! PRP Treatment Dubai

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