OVEREXTENDED?: Will evidence fall in favor of using platelet-rich plasma therapy to treat injuries such as rotator cuff tears?
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Torn tendons, muscles and ligaments plague athletes in many types of sports. In attempts to help heal the wounded tissue, some athletes, both amateur and professional, have turned to platelet-rich plasma (PRP) therapy. For the treatment, doctors take a small vial of a patient's blood, about 30 milliliters, and spin it in a centrifuge to separate the platelet-rich plasma from the other components. Then they inject the concentrated platelets at the site of the patient's injury. In theory, the growth factors that platelets secrete (not including human growth hormone) spur tissue recovery.
Before playing in all four professional golf majors this year, Tiger Woods received four injections of PRP in his left knee following surgery. PRP injections in his elbow may have been the reason that Los Angeles Dodgers's pitcher Takashi Saito was able to return to the mound for the 2008 Major League Baseball playoffs.
Whereas doctors have used PRP therapy since the mid-1990s to aid bone healing after spinal injury and soft tissue recovery following plastic surgery, it has only been in the past year that the treatment has caught on for treatment of sports-related injuries. "PRP treatment really gained speed last January. It got press that two of the Pittsburgh Steelers [Hines Ward and Troy Polamalu] used it before [winning] the Super Bowl. More and more patients started to ask about it," says Dennis A. Cardone, a doctor of osteopathic medicine at the New York University (N.Y.U.) Hospital for Joint Diseases. Cardone has treated 30 amateur athletes with PRP therapy over the past year.
Despite its use among athletes, the effectiveness of PRP therapy in sports medicine remains in question. Canadian doctor Anthony Galea, one of the pioneers in using PRP for athletes, was arrested in Canada for allegedly smuggling human growth hormone (HGH) and Actovegin into the U.S., The New York Times reported on Tuesday, where these potentially performance enhancing drugs are illegal. Galea had treated Woods and several other athletes, including Olympic gold medalist and sprinter Donovan Bailey, with PRP. Galea's arrest raised suspicion that he might have combined HGH with his PRP therapy.
ScientificAmerican.com spoke with N.Y.U.'s Cardone about what we know and don't know about PRP therapy.
[An edited transcript of the interview follows.]
What kinds of athletes have you treated over the last year with platelet-rich plasma (PRP) therapy?
They've been runners to basketball players to football players to collegiate competitive cheerleaders, a lacrosse player and a soccer player.
How could concentrating the platelets that are at the site of injury help healing?
Theoretically, many of the athletes may have a type of tendonitis, [such as] Achilles tendonitis or, say, patellar tendonitis in the knee or tennis elbow. Many of these tendon injuries become chronic, and involve microscopic tearing of the tendon and formation of scar tissue. A reason why it's difficult to heal these tendon injuries is related to poor blood supply to the region. The perfect example would be the Achilles. It's a tendon with, in general, a poor blood supply, so when there are these microscopic tears or chronic scarring, the body has a difficult time healing it. The theory is that the body can't on its own get enough of these healing or growth factors to the area, but now this concentrated platelet injected there just enhances the nutrients and growth factors to allow the body to heal it.
You use the word "theory". What kind of evidence is there that PRP helps heal tendonitis?
We all would like to see more evidence for this therapy. While there is some evidence, we still do not have the type of randomized, blinded, placebo-controlled studies that we would like to see. Most of the early literature has been poorly designed studies so we need better evidence about this treatment going forward. Ultimately we'd all like to see a study where we had 100 people with an Achilles tendonitis, 50 of them were injected with placebo and 50 of them were injected with PRP to really see if there was a difference.
The studies that have been performed have been, "Okay, let's take 30 people with tennis elbow and let's inject these 30 people with PRP therapy, and let's follow them for a month and let's see how they do." So you're just looking at this one population, you're not comparing it to a control population [that receives an injection with placebo]. The thing about doing PRP therapy is that there are potentially other healers going on. Number one is there's always potential for some type of placebo effect any time you put a needle in anyway. Number two is when you put a needle into a tendon, like you do for PRP therapy, you are likely to cause some bleeding and this is known to help healing [by bringing in more platelets]. So even by sticking a needle in a tendon and aggravating the tendon, you actually are helping the healing response.
Everyone looks at this one study that came out more than a year ago on tennis elbow but the problem is, it was a cohort study. Some people come in, they already know they want it, or there are patients that have failed other treatments. Any time we talk to anyone about PRP treatment, one of the first things that needs to be said is that, right now, there's not good evidence to support the treatment.
Are any clinical trials currently going on?
Absolutely. In the next six months to a year, we should really start seeing results from many clinical trials, and hopefully good ones, ranging in everything from rotator cuff problems [in the shoulder] to tennis elbow to Achilles and patellar tendonitis.
It seems like there's been many studies done on tissue grown in the lab and in lab animals [mice and rats]. Could you give me an idea of what those studies have told you about how well PRP therapy works?
Many of the studies early on are animal studies and lab studies. Many of those have been very positive for PRP in terms of tendon-healing effects. That's part of that lack of evidence. It's great that the animal studies look good but you need human studies.
If there isn't good evidence yet, why do you give PRP therapy to your patients?
There is some evidence from cohort studies, and anecdotally we've had some good experiences where we still think it's worthwhile to offer it to some patients. The ones that we offer it to have failed other types of conservative therapy.
How have your patients done on PRP therapy?
I would say, anecdotally, the whole population overall has done fairly well. There are a number that haven't noticed much response and then there's a good number that have done well. I think that's why we continue [to use it].
A good example is a patient that I have with an Achilles problem and he tried everything, everything, everything—went to other docs and he was all ready for surgery [to remove the scar tissue] and we did PRP therapy on him. He ended up with two sessions of therapy and he's had a great cure that seems to be related to PRP. And then I've had some people, runners with chronic hamstring injury, and they will tell me they haven't noticed a difference.
I'd probably say that maybe 60 percent of my patients do better.
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36 Comments
Add CommentI have accute arthrytis of the knees and I am currently reading about the geneeral plasmic nature of our Universe. My doctorsw haven't helped me and I'm generally in pain especially when I stand. . This plasmic healing could help me and I'd like to know more. In what issue was therer an article on it? Could I buy a copy of the article?
Reply | Report Abuse | Link to thisI had a PRP injection done several months ago on one elbow where I was suffering chronic tendonosis (tennis elbow). I'd had multiple cortisone shots and physical therapy over the course of a year but hadn't gotten relief. The PRP injection itself was so painful that I almost passed out. Three months after the injection, I've definitely noticed an improvement, but my M.D. has recommended another shot in the hope that I can get complete healing (I'll be taking a pain killer beforehand this time around) as the only other alternative at this point is surgery. All in all, I would recommend PRP as a treatment as I'm definitely better off than I was before I got the PRP injection.
Reply | Report Abuse | Link to thisI wonder if this would help with many other kinds of incidents such as whiplash (occurs in most car accidents ).
Reply | Report Abuse | Link to thisI bet the time from injury to application has a major impact on response...
forgot to click email...please ignore this...
Reply | Report Abuse | Link to thisIs it the same as Autologous injections?
Reply | Report Abuse | Link to thisIS THE PRP THE SAME AS AN AUTOLOGOUS INJECTION?
Reply | Report Abuse | Link to thisPrp is similar to autologous injection, but I think the difference is with prp the blood is spun in centrifuge so that the most healing parts, mainly the platelets I think, are concentrated and then only this concentrated part of the blood, super blood basically, is injected back in. This way it is purported to be more potent than just taking blood out of your arm and injecting it as is into your hamstring tendon. Because the prp requires this centrifuge kit, it requires more blood to be drawn and more money to do it to pay for the kit and extra labor. But now at least some doctors are starting to combine it with other things to make it even more potent, like HGH and stem cells. It is basically my last hope of being able to live my life. I have multiple chronically damaged tendons to the point where I really can't manage to stand and walk around any more because of pain. I can physically stand and walk around, just it has become too painful to bear it so I avoid it, in other words, no social life. Is hard to go shopping so is hard to buy stuff I need like new clothes, shoes, end up doing a lot of online shopping, which becomes a pain with shipping boxes back for whatever didn't work out. I think it would work better with more research, but I don't have time to wait for that to happen. I have to try the prp with stem cells now. I just also hate that they can only do one area at a time, I'm not sure yet how many tendons will be hit in one visit, but I hope will be enough to make me feel like I can begin to make some progress.
Reply | Report Abuse | Link to thisI agree with the author's comment that there need to be controlled, randomized, prospective human clinical stiudies but much of the medical community makes important decisions based simply on animal data. Take the bone grafting market, for example. There are over 200 bone grafts on the market that are FDA approved and claim safety and efficacy based on an animal study. There are only a few bone grafts (<5) that have peer-reviewed, published data in humans. If it were my children, my mother, or my wife, I would certainly want the doctor to know that the product being used in surgery had been tested and reviewed by a panel of peers to work in humans, not merely our four legged friends!! Very good point by the auther and one for us to keep in mind when decisions are being made for us.
Reply | Report Abuse | Link to thisI am a college student at the U of M Duluth. I have researched Autologous Platelet Concentrate (AKA:Platelet Rich Plasma), and platelet gel thoroughly. In my sophomore year I conducted research on Platelet Gel and found it to be effective in eleven out of twelve mice in healing wounds made to the neck of each mouse.
Reply | Report Abuse | Link to thisI myself went to St. Louis to a private clinic to have Platelet Concentrate Treatment used in conjunction with a GE Logiq e ultrasound to treat a partially torn UCL ligament and nerve. The treatment worked and my once half torn UCL is now 100 percent. Prior to tearing my UCL i threw 86 MPH as a junior. After tearing the UCL my velocity dropped to mid 70's at best, after the APC injection I am now throwing 90 MPH.
The APC machine used to treat my arm and for my undergrad research was manufactured by Harvest Tech. Medtronic's platelet concentrate system is also suppose to be very effective. In order for APC injections to be effective for subcutaneous injuries Ultrasound Guided Injection is necessary. Something I also learned while dealing with the UCL injury is the Ultrasound imaging picked up my UCL tear where as the MRI had not. The difference between the MRI and the Ultrasound was the Ultrasound cost $150 the MRI cost $2,200. The cost of one set of three PRP injections $450, the cost of and avoiding Tommy John surgery in my opinion priceless, but monetarily in the thousands.
The main lesson I have learned from all of this is MEDICINE and MONEY are prioritized equally. Platelet injection therapies should have been made common place years ago. I hope the AMA and Drug Company owners rot in hell, this treatment could be helping save people from needing surgery, and also help aid healing from life threatening conditions.
My husband just had PRP injections in both of his feet for plantarfaciaitis and tarsal tunnel syndrome (they think) about 4 days ago. He is still in a lot of pain and can't walk very well. We are hoping this cures his pain. He has had this "injury" for 2 years now and he has undergone every kind of treatment there is except cortizone injections (he will not get that done) and doctors say it wouldn't help anyway. If anyone has had the PRP done for plantarfacitis, could you let me know how you are doing or if it helped. We are crossing our fingers this works, because his life for the last 2 years has basically been a nightmare. :( Thanks!
Reply | Report Abuse | Link to thisI'm looking at PRP for a shoulder injury but responding to you about the plantarfaciaitis you're husband is experiencing. I empathize with him and had the same situation about 5 years ago. If PRP doesn't work for him pursue a procedure which is ultrasound to the affected area via a specialized machine where he will need to be knocked out for the procedure. My podiatrist had administered cortizone injections for a period of 6 months before we got to this step ; the shots to the affected area were temporary only. The specialized machine is circulated to, generally, a handful of states as shared as I understand the machine runs about $1M. It actually travels with a trained technician and my doc was actually present during the procedure in an out patient clinic. I'll see if I have the name of that device in any paperwork and I'll try to get that back to you asap. However, your doc should know of this machine. Do note that I had to go thru the cortizone treatments (or so I was informed) before the insurance company with cover this which they did -I only had to pay for a small portion which was related to the out patient facility but not the treatment itself. I only needed to have this treatment done once but realize some patients do need a second treatment. I hope this information helps.
Reply | Report Abuse | Link to thiszoibear...please keep us posted as to how this turns out for your husband - I have had every treatment possible for this diagnosis and my doctor has "given up" (not for lack of trying) and referred me to someone who does the PRP. I too have been dealing with this for almost 2 years. I plan to schedule a consult with that office today...I am soooo hopeful!
Reply | Report Abuse | Link to thisI have suffered with the coccyx for many years The last year has been unbearable , not being able to sleep or sit. My pain became constant. If I finally fell asleep on my side, I would be awakened with such pain that I had to stand or pace for hours for some relief. What a blessing when I got Dr Magaziner's name. I have had 5 sets of shots so far and its made such a difference in my life. I can actually sleep on my back, do not have pain so I am not crying or complaining. I have also started PRP for my shoulder for a rotocup tear. With only one set of shots to date I can only hope for the same fabulous results. I highly recommend PRP. Carole Naso
Reply | Report Abuse | Link to thisi had good results with my treatments cerole in n.j.
Reply | Report Abuse | Link to thisPhil, Pincourt. I had tendonitis on my right shoulder that restricted my full range of motion because of the pain. It has been 3 weeks since my injection (one entry with several injections to the tendon). The pain was an 11 out of 10, that lasted a week (with codein). Now the pain is less, but still hurts when I raise my arm higher than my shoulder, also after a busy day it hurts at night (mild). I`m wondering when I will notice positive results.
Reply | Report Abuse | Link to thisI am a 76 year-old man whose left hip was fused in 1943, resulting in a 4" leg difference, a profound limp, and an almost completely inflexible left knee. Now I have I have a calcified right achilles tendon. Surgery on it would require a long period of having to walk on crutches with my left leg bearing the brunt of the burden, not a pleasant prospect. Is prp my only alternative?
Reply | Report Abuse | Link to thisI am a 52 year old male and have had prp done to my right elbow 5 weeks ago for tendinits from which i was suffering for 4 months before i had the treatment. The prp put me back to day one of the injury, but now i am slowly making progress. Has anyone out there used herbal supplements to speed up the healing process. If so, which ones? I've avoided NSAIDS and steroids per my doctors instructions and will do so for 3 more weeks. He's not at all familiar with homeopathic remedies, as most doctors are not. I'm not sure if anti-oxidants and anti-inflamatory herbs obstuct the healing process as do NSAIDS and steroids. Please help me with this, doctors responses most welcomed also.
Reply | Report Abuse | Link to thisIhave had mild golfers elbow (medial epycondilitis)for about 6 weeks and went to an Orhtopedic specialist to see if there was any therapy available to aid in the healing process. He sugeested PRP and that my insurance would cover it. So I went ahead with it. Fisrt let me tell you the pain was EXCRUCIATING!!! Although the pain was only at 10 on the 10 scale for about 10-15 minutes it was so bad I was moaing loudly throughout the procedure. Was the pain worth it? I don't know yet. It was done yesterday but the pain is pretty much gone after 10-15 minutes or so and remains mildly sore the next morning...Stay tuned
Reply | Report Abuse | Link to thisI have an chronic case of plantar fasciitis. It started two years ago, received a cortisone injection and orthotics and I was fine. Then this past Nov. my foot started hurting again, between now and then I am on my 4th foot doctor. I have received 4 cortisone injections, been on anti-inflammatory meds since Dec, been to physical therapy rest, twice, wearing excellent supportive shoes, heel cups, night splints, stretching exercises, orthotics...after my 4th cortisone shot, I was in excruciating pain so I went to a different doctor to find that I had a heel bone stress fracture. So, on top of all the treatments that haven't worked, I'm now in a soft cast, boot and crutches. Foot is still in pain and can't walk "normal" 4th foot doctor wants to do PRP-Platelet Rich Plasma to heal my damaged fascia at the bottom of my foot. I truly don't know what to do...I'm hoping and praying that someone who has experienced PRP for plantar fasciitis will respond as the doctor thinks I should do it--but of course he does! It's not his foot and the procedure is expensive bringing $ into his pocket---
Reply | Report Abuse | Link to thisWould a person that has to have knee replacement surgery be a candidate for PRP Therapy?
Reply | Report Abuse | Link to thisI too had PRP therapy for arthritis in both thumbs. Had done
Reply | Report Abuse | Link to this4 cortisone injections and was ready for surgery and my
MD referred me to his partner doing this PRP. I did one in
June 2009 then another in Aug 2009 my pain level has been
way down and activities up. The injection was painless,
afterwards had to use meds for several days with ice. It
was all worth it. I would say YES try it to stay out of surgery -
I can now do push ups again. With assistance the body can heal itself.
My doctor had me try NaturaCell, higher Fish Oil supplements,
Reply | Report Abuse | Link to this99% dark chocolate (1 pc per day) for high antioxidants. I eat
healthy and continue to work out - I'm 1 year post PRP and doing 95% to excellent.
two years ago I injured my neck tearing ligaments and tendons and pinching a nerve. i thought i was going to die and at times i really wanted to. for two years the doctors said there was nothing they could do but give me drugs and physical therapy. nothing helped. one day a friend told me to talk with a naturopathic doctor and I did. the doctor said the my tendons were very weak and said a procedure called prolotherapy would help. this is similar to prp but instead of blood a dextrose solution is used. i had the procedure two months ago and i feel 90% better now! the doctor said he wants me to now try prp injections in the hope that i will be 100% better. I just want everyone who is suffering to know there is help. you can be healed, but you must find a doctor who believes in prolotherapy and prp. before i had this procedure i was seriously contemplating suicide. thank god for my naturopathic doctor, he saved my life!
Reply | Report Abuse | Link to thisdavid,
salem, or
Hi! I too had procedure done...five days ago. It was, like for you, one of the most painful things I've ever had done! When does this pain( from injection ) go away?
Reply | Report Abuse | Link to thisI saw your comments relating to PCP therapy for UCL injury. My high school age son is going through a similar situation (MRI shows UCL tear) and we would very much like to learn more details on your experience with PRP therapy as we consider all the options. He also is a baseball player. Please let us know how to connect with you.
Reply | Report Abuse | Link to thisI would like to ask you a few questions about your experience with prp bc i have the same problem with my ucl email me at metsfan157@yahoo.com or text at 516-945-4715
Reply | Report Abuse | Link to thisI had it done twice for plantarfacitis in the same foot. Not much relief it's been six weeks on the second procedure. How did he make out my pain is still horrible. Any suggestions or any ideas My life is falling apart.
Reply | Report Abuse | Link to thisI use to make PRP in the OR. I was a perfusionist from open heart where PRP was initially used. Autologous simply means your own blood. PRP means Platelet rich plasma, but it is not plasma. It lies between the plasma and the red blood cells. PRP is extracted from the blood by spinning blood in a centrafuge, like a blender, at a high speed. plasma rises to the top because it is a light weight and you let it spill over and collect it.....and then when you slow the speed of the centrafuge down a little you can milk off the buffy coat which lies between the plasma and the red blood cells. The blood cells stay at the bottom of the centrafuge because they are heavy weights. This buffy coat is where the PRP resides ...so you extract it and then give the patient back their own Red blood cells and the plasma...no waste.....No use injecting blood when you only need the PRP and you can concentrate it to make it more potent and put it directly on the area you need it on....It works but you have to find someone who really knows how to make the good stuff. It fizzled out because too many clowns didn't know how to make it properly and started making little portable centrafuges that they claimed made lots of PRP from a small amount of blood....there's only so much PRP you can make from a unit of blood, you can't make more appear, it just isn't there unless you dip into the plasma and claim that is PRP also. Remember Autologous PRP means it is made from your own blood which means it is absorbed back into your own body with no chance of catching anything that someone else might have in their blood.The name PRP is misleading because it isn't plasma, they should have called it "Rich Platelets" Hope I explained it simply enough for you to understand. I used it in Cosmetic surgery, Orthopedics and dental implants. I saw it produce bone growth on dental implant exrays which was incredible and I used it on myself for a surgery I had. It works.... but you need the right centrafuge and because it is not covered by insurance it is not promoted....It just fizzled out after 911 when times got tough and patients didn't want to pay cash for it and then the recession hit us and noone could pay for it. It was a shame because it had great potential in different areas of surgical procedures. Hope this helps.
Reply | Report Abuse | Link to thisHi Phil, can you please share what was the results at the end? Was the pain gone? was there an improvement in your original state?
Reply | Report Abuse | Link to thisI am considering both a surgery or PRP injections to repair my shoulder.
Thanks in advance!
My main tendon in my shoulder is badly torn to the point that there are literally only 3-4 fibers left intact. My doctor mentioned that PRP might help and I am wondering if it will...i have been going for physical therapy for 3-4 yrs now with no relief...pls let me know if this therapy will help even if the tendon is almost completely torn...
Reply | Report Abuse | Link to thisHow much is PRP effective in regrowing hair ?
Reply | Report Abuse | Link to thisI'm a 23 yera-old girl who suffers from a minor hormon abnormality.Doctors say that my male hormones are slightly more than the usual amount and it's 8 years that my hair has been falling .I've lost most of my hair I've tried sevelar treatments including taking Ciprotrone compound but none worked.could this treatment help the regrowing of my hair?
Hello Zoibear. Since its been over two years since you posted I dont know if you will receive this but I caught your comments thru a google search. I'm so sorry to hear about your husband. I too suffer from tarsal tunnel syndrome and was curious if the PRP treatments ever proved to be successful on any level. Thanks for your help.
Reply | Report Abuse | Link to this-Ron
I read about PRP and Antonette Carter treatment by platelet rich plasma here. I would like to share it was interesting
Reply | Report Abuse | Link to thishttp://drbillreleford.com/prp-treat-achilles-tendonitis-olympic-hopeful-antonette-carter/
I was recommended for a partial knee replacement in 2001. I had no health insurance so I started doing research on alternatives. In 2007 I found an in-flight article by a doctor in Florida doing PRP treatments. I then found 6 other doctors through out the country doing the same. The least expensive was a doctor in Santa Fe New Mexico. I flew from Sacramento CA three times for treatment. After 1 year the pain in my knee was down from an 8 to a 3, after 2 years it was down to a 1 or 2, after 3 years I have no pain! I became a Fire Chief in Northern Nevada, work out, run, do everything I did at 30, I am now 58. It has been the best $6,000 I ever spent! I am totally pain free! BJ Foster, Fire Chief Walker Lake Nevada.
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