ACTIVE CARE

The Internet is a powerful tool and anyone with a connection and a device (i.e. everybody) can dial into an almost unlimited stream of information.  But with the flood of testimonials, Yelp pages and blogs it can be difficult to determine fact from fiction.  The continually evolving field of medicine can accentuate the difficulty as treatments, medicines and surgeries can change at a pace that even Wikipedia can’t keep up with.

One such topic in the field of sports medicine is the use of concentrated portions of the blood as agents to speed healing and tissue repair.  Kobe Bryant famously flew to Germany for treatment of his knee with one such product, Regenokine.

For most of us without a private jet and millions in disposable income, the more common treatment is known as PRP (Platelet Rich Plasma) and is increasingly used to speed up tendon and ligament healing after injury or surgery.  Platelets are an important part of the bodies healing response after injury and their concentrated growth factors are the theoretical reasons behind the use of PRP.

PRP utilizes a small portion of blood drawn from the patient which is then spun in a centrifuge to isolate the platelets and re-injected into the affected area.  While the science behind PRP therapy is widely accepted, its manner of use is not.  Confusion can result as the method of preparing and injecting the PRP-product can vary among physicians.  As a result of this, the type of administration and treatment protocol can affect the clinical outcome of the treatment.

While originally used for tendon injuries, PRP use has spread into surgical and non-surgical interventions.  PRP has been commonly used for chronic tendon injuries and has shown success in treating “tennis elbow “or lateral epicondylitis and patellar tendinopathy or “jumper’s knee”.  With these procedures, the PRP is injected directly into the tendon, frequently under the guidance of ultrasound.  Immobilization and rest of the treated area frequently follow the application of the PRP treatment.

According to a review article in the journal Physical Medicine and Rehabilitation, most patients experienced a reduction in pain when PRP was used to treat their lateral epicondylitis.  However, conflicting outcomes can be found as similar research found PRP no more useful in the treatment of tennis elbow than a saline injection.

Recently, PRP has been used during ACL reconstruction in an attempt to aid in the healing of the bony tunnels and speed the incorporation of the graft into the bone.  While it is similarly used in rotator cuff surgeries, early clinical studies do not show any added benefit when used for either rotator cuff or ACL surgery.

In a recent article in the American Journal of Sports Medicine, PRP showed positive effects in temporary alleviating the symptoms of osteoarthritis.  These improvements lasted for approximately 6 months after the injection of PRP.

Despite its widespread use, PRP shows mixed results and research suggests that its effects can vary depending on where and how it is utilized.  Generally, there isn’t a “silver bullet” treatment that can cure all orthopedic ills, PRP included.  When PRP is indicated, it should involve a comprehensive program that includes physical therapy, possible immobilization and progressive return to more strenuous activity.  Stay tuned (or logged on) to get the latest in PRP research.