White Coat Underground

Platelet rich plasma

Posted by PalMD on February 23, 2010
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Several months ago, Dr. Val Jones wrote about a growing fad in the treatment of musculoskeletal disorders. The therapy, called platelet rich plasma (PRP) injection, involves taking a small amount of blood from a patient, spinning it down in a centrifuge, and then injecting the plasma component into…somewhere. This treatment is becoming increasingly popular, and can be very lucrative for doctors. But does it work?

Blood platelets are very biologically active particles and plasma is not a bland fluid. Platelets and plasma contain many biologically active molecules, some of which may be implicated in “healing”. This gives PRP at least a veneer of plausibility, but like any other treatment, plausibility is only the first step.

There have been a few human studies of PRP. A recent article in the Journal of the American Medical Association (JAMA) showed no difference between PRP and saline injections for chronic Achilles tendon problems.

A small pilot study looked at PRP for the treatment of a particular periodontal disease, and found some possible benefit.

Another interesting study looked at PRPs affect on the healing of anterior cruciate ligament (ACL) grafts in the knee. This study included long term (two year) follow up, and found no benefit.

And that’s really about it. There is little evidence to support platelet rich plasma for the treatment of anything. And yet it is being hyped and sold everywhere as a miracle cure for musculoskeletal injuries. Perhaps more studies will enlighten the issue further, but at this point, PRP is nothing but expensive snake oil, and those who promote and use it should re-examine the data and their ethics.

References

de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H, & Tol JL (2010). Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA : the journal of the American Medical Association, 303 (2), 144-9 PMID: 20068208

Markou N, Pepelassi E, Vavouraki H, Stamatakis HC, Nikolopoulos G, Vrotsos I, & Tsiklakis K (2009). Treatment of periodontal endosseous defects with platelet-rich plasma alone or in combination with demineralized freeze-dried bone allograft: a comparative clinical trial. Journal of periodontology, 80 (12), 1911-9 PMID: 19961374

Nin JR, Gasque GM, Azcárate AV, Beola JD, & Gonzalez MH (2009). Has platelet-rich plasma any role in anterior cruciate ligament allograft healing? Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 25 (11), 1206-13 PMID: 19896041

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Comments

  1. #1 rob
    February 24, 2010

    it never ceases to amaze me how many new discoveries become the latest miracle cure or diet or path to riches or free energy etc.

    i can’t wait until dark matter is finally identified and wait to see how some quack has managed to capture dark matter in a crystal that you can use to restore your hair, increase your fuel efficiency and get laid.

  2. #2 Dianne
    February 25, 2010

    I have nothing really substantial to say, just that I like this post. PRP injection sounds vaguely plausible as a way to improve healing but the results suggest that it’s yet another beautiful theory ruined by an ugly fact.

  3. #3 Chris H
    February 25, 2010

    I wouldn’t be so quick to dismiss PRP. Here are positive results from a recent level 1 study published in the American Journal of Sports Medicine:
    http://www.shoulderdoc.co.uk/article.asp?article=1323

    PRP will not cure everything. This is a new tech with much promise we need more studies to see it’s true effectiveness but as far as tennis elbow, it looks like a valid treatment…

  4. #4 Mark Baldwin
    February 27, 2010

    Orthopedic Docs such as Alan Mishra of Stanford University, are furthering PRP research. They are also the musculoskeletal specialists that focus on areas of the body where PRP may be used.

    This is where we agree Dr. Pal: Sports Medicine Specialists, or Neurologists that incorrectly call themselves ‘neuro-orthopedists,’ offering PRP as an initial option for soft-tissue conditions, should be called into question.

    However, Orthopedic Surgeons should offer PRP as a last resort before invasive surgery to patients who have failed conventional methods. People have jobs and lives requiring them to be active. Many cannot afford (financially, physically or both) the challenges invasive surgery presents.

    This article ignores most recent findings supporting PRP. Published in Academy Journal of Sports Medicine this month (Feb.), the study by Dr. Gosens concludes PRP is significantly more effective in tennis elbow than cortisone injections. Another article published in October from the renown Rizzoli Othopedic Institute in Italy, studied 115 arthritic knees and concluded PRP increased knee function and decreased pain at one year follow-up.

    The JAMA article, while a legitimate study, reported results at its midpoint (6 month). The results were incomplete. It is likely PRP patients will improve in the second half of the study, similar to Dr. Mishra’s PRP tennis elbow study.

    The media has given PRP significant coverage as a legitimate therapy due to professional athlete use. Dr. Kenneth Jaffe of Birmingham posted a brilliant blog article at birminghamprp.blogspot.com framing how these cases should be perceived by the public. Dr. Jaffe concludes PRP should be seen as important, but as it is used in pro athletes whose livelihood depends on their return, simultaneous treatments are used. Thus, their recovery is not valid support for PRP use.

    Many sports-injury experts and the ‘neuro-orthopedists’ of the medical world are offering PRP as an initial treatment option, using Tiger Woods and Hines Ward are shinning examples of effectiveness. This is dangerous medical practice.

    When an Orthopedic Surgeon offers PRP as a last resort however, they are actually trying to save patients time, painful recovery and money; profit margins are exponentially higher for performing surgery than administering PRP. Orthopedic experts that first educate patients and then offer the therapy as a last resort, are not only attempting to ‘do no harm,’ they are seeking to improve the quality of patient lives.