In the past several months, the media has been very attentive to a new sports medicine treatment alternative called platelet-rich plasma (PRP) injection for the treatment of soft tissue injuries in athletes. A recent feature column on the front page of the New York Times touted the benefits of PRP after successful use in several high-profile athletes such as; Cy Young Award winner Cliff Lee, for a strained abdominal muscle while pitching for the Seattle Mariners, Pittsburgh Steelers receiver Hines Ward, and golfer Tiger Woods for sprained ligaments in their knees. According to the column, many nonprofessionals “weekend warriors” are willing to pay large sums of money, out of their pockets, for this experimental treatment due to its potential to expedite healing in soft tissues.
According to the Journal of the American Academy of Orthopaedic Surgeons,(JAAOS) platelet-rich plasma (PRP) is autologous (self-donated) blood with an above normal concentration of platelets. Normal blood contains both red and white blood cells, platelets and plasma. Platelets promote the production and revitalization of connective tissue by way of various growth factors on both a chemical and cellular level.
The actual PRP injection requires the patient to donate a small amount of their own blood which is placed into a centrifuge (a machine that spins the blood at a high velocity to separate the different components of blood such as plasma, white and red blood cells), for approximately15 minutes. Once separated, the physician draws the platelet-rich plasma to be injected directly into the damaged tissue. In theory, the high concentration of platelets, with its inherent ability to stimulate growth and regeneration of connective tissue, will promote and expedite healing at the site of damage.
There are many indications for PRP, however, the repair of tendon damage appears to be most successful, due to the naturally poor blood supply of tendons in the body. PRP has been injected in both surgical and non-surgical tissue to promote healing. Surgeons have most commonly injected the following tissues to augment surgical repair: rotator cuff tendon, Achilles tendon, anterior cruciate ligament, patella tendon. Non-surgical indications for a PRP injection include; muscle strains of the rotator cuff, elbow, calf, quadriceps, hamstring and abdomen. Additional indications for PRP are strains of the Achilles, quadriceps and patella tendons, plantar fascia and various knee ligaments. It has shown to be most successful in tennis elbow, rotator cuff and Achilles and patella tendon strains. It is most appropriately directed to tendons that suffer from tendinopathy as opposed to tendinitis. Tendonopathy is a chronic condition in which a tendon has been damaged and the normal inflammatory repair process is incomplete. It is very common in tendons such as the rotator cuff of the shoulder or the tendon crossing the elbow and wrist responsible for tennis elbow. In this case, the tendon suffers from chronic degeneration and becomes very weak and fragile, getting reinjured and painful very easily from the slightest stress. Under these circumstances, these tendons seem to benefit the most from an infusion of new cells (PRP) to the area to stimulate healing.
Due to the fact that the blood is self-donated, there are very few problems associated with PRP. There is a minimal risk for infection, as with all injections. Patients with an active infection, tumor, metastatic disease or pregnancy are not candidates for PRP treatment. Those using anticoagulant drugs or have a history of blood clot problems may also be ineligible.
As is the case with many new procedures in medicine, PRP has been shown to offer great promise due to successful research in the laboratory with cell culture studies in animals. These studies demonstrate that PRP can stimulate the cellular process associated with tendon healing in a laboratory setting (JAAOS). Furthermore, clinical studies, with various amounts of control, also show some promise in the healing process of tendons. However, several other studies are inconclusive.
In view of the current healthcare economic climate, one must weigh the risk vs. benefit and cost effectiveness of any medical treatment. In PRP, the risk in nominal, but the treatment is considered experimental and is not reimbursed by third-party payers. The cost of the PRP is dependent on the individual product manufacturer and physician administering the treatment. While many high-profile medical facilities in New York City charge as much as $1000.00, the average cost is $150.00 per syringe. Locally, Joseph Cronkey, MD, who has performed PRP for several years, charges $180 to $250. Dr Cronkey states, “I have injected approximately 60 patients to date. The most rewarding results have been in patients with chronic rotator cuff conditions, quadriceps and patella tendon problems and tennis/golfer elbow. However, less promising results have been found in patients with degenerative joint disease of the knee.”
Only time will tell as further research with better controls, will provide more definitive evidence of the efficacy of PRP. Until then, PRP may provide a relatively safe treatment alternative for those who have failed traditional options such as pain and anti-inflammatory medications and injections, rest, and physical therapy. In fact, most athletes find most success when PRP is combined with physical therapy to properly prepare the tissue for return to activity.
SOURCES: Joseph E. Cronkey, MD, specializes in advanced, non-surgical orthopedic medicine in the greater Scranton area. American Academy of Orthopaedic Surgeons (AAOS). Visit your doctor regularly and listen to your body.