Four orthopedic sports medicine physicians discuss current use of platelet-rich plasma injections for athletes and whether they think the treatment will stand up to evidence-based research.
T. Jeffrey Emel, MD, Eastern Oklahoma Orthopedic Center, Tulsa: For a traumatic patient who is young with normal anatomy, something like PRP to heal the tendon makes a lot of sense. I've been really impressed with how it works on chronic tendon problems and it seems an effective treatment that could sometimes negate the need for a surgical procedure. Of course, I don't have strong studies to support that yet.
Companies will have to help pay for the studies — which is the problem in orthopedic and sports medicine research to begin with. If you feel like what you are doing is the right thing and there's enough science behind it in a non-academic setting, we want to be able to do the right thing for our patient. But now everything has to be evidence-based, proven through studies. This is contrary to everything having to be evidence-based which is the trend in medical reimbursement.
Tom Hackett, MD, The Steadman Clinic in Vail, Colo.: We're researching PRP right now to determine the best concentration, preparation and timing of the injections at our clinic in Vail. We've done thousands of these cases that we are tracking in our database. Right now, the data is still in the gathering stage and we are evaluating the data as it comes in. Currently, we are seeing more promise in soft tissue than joint applications.
We also use biologic augmentation, a combination of PRP and a bone growth stimulator, in fractures that won't heal. We've also seen success in using patches with growth factors for Achilles tendon repair and rotator cuff repairs. One of the problems with using PRP injections is that insurance doesn't cover it most of the time so patients have to pay out of their own pocket. In terms of broader application, if patients have to pay for it there isn't as much willingness.
Bert Mandelbaum, MD, DHL (hon). at Saint John's Health Center in Santa Monica, Calif.: There are several studies out there looking at the efficacy of PRP with contradictory results. I think in the appropriate situation, PRP might be of some use surgically in enhancing the repair and regeneration, especially in an athlete. Do we need biologics to make a tendon heal? No — but might we need them to help the athletes compete at a high level? Yes, we do. As a sports medicine physician, we are always trying to get the best outcome and performance from our interventions. For example, there are studies that show using PRP during ACL repair decreases healing time in the tunnels and potentially enhances the graft strength.
I think PRP has been a major step and now people are looking at bone marrow aspirates and stem cells. There's a lot of research out there in animal and human models using stem cells for cartilage, ligament, tendon and muscle healing, but at this point none of the studies are definitive in showing efficacy in the long term yet.
Eric Millstein, MD, DISC Sports and Spine Center in Marina del Rey, Calif.: In my practice, I find PRP most helpful in chronic tendinopathies, such as tennis elbow and patellar tendonitis, as well as some revision surgeries. The idea behind PRP is that you have growth factors that help tears heal. I don't have enough confidence that it helps with every surgery I do, but I have found it helps in a compromised healing environment such as revision surgery.
The enthusiasm for PRP is high among surgeons, but it may be even more so among patients. It's one of those technologies that seems easy to apply with the anticipation that it would help patients heal more quickly than it would otherwise. I have many patients who hear about it by reading a news story or following a professional athlete. Like other sport medicine applications, randomized, controlled studies are needed.
There is a big perception out there that PRP does more than it actually does. Patients with arthritis think PRP will help cure them, but there isn't any evidence supporting this application.
Related Articles on PRP:
7 Things Orthopedic Surgeons Should Know about Platelet Rich Plasma
AAOS: PRP an Unproven Treatment Option
What Role Does Biologics Play in Sports Medicine?: 4 Physician Responses
T. Jeffrey Emel, MD, Eastern Oklahoma Orthopedic Center, Tulsa: For a traumatic patient who is young with normal anatomy, something like PRP to heal the tendon makes a lot of sense. I've been really impressed with how it works on chronic tendon problems and it seems an effective treatment that could sometimes negate the need for a surgical procedure. Of course, I don't have strong studies to support that yet.
Companies will have to help pay for the studies — which is the problem in orthopedic and sports medicine research to begin with. If you feel like what you are doing is the right thing and there's enough science behind it in a non-academic setting, we want to be able to do the right thing for our patient. But now everything has to be evidence-based, proven through studies. This is contrary to everything having to be evidence-based which is the trend in medical reimbursement.
Tom Hackett, MD, The Steadman Clinic in Vail, Colo.: We're researching PRP right now to determine the best concentration, preparation and timing of the injections at our clinic in Vail. We've done thousands of these cases that we are tracking in our database. Right now, the data is still in the gathering stage and we are evaluating the data as it comes in. Currently, we are seeing more promise in soft tissue than joint applications.
We also use biologic augmentation, a combination of PRP and a bone growth stimulator, in fractures that won't heal. We've also seen success in using patches with growth factors for Achilles tendon repair and rotator cuff repairs. One of the problems with using PRP injections is that insurance doesn't cover it most of the time so patients have to pay out of their own pocket. In terms of broader application, if patients have to pay for it there isn't as much willingness.
Bert Mandelbaum, MD, DHL (hon). at Saint John's Health Center in Santa Monica, Calif.: There are several studies out there looking at the efficacy of PRP with contradictory results. I think in the appropriate situation, PRP might be of some use surgically in enhancing the repair and regeneration, especially in an athlete. Do we need biologics to make a tendon heal? No — but might we need them to help the athletes compete at a high level? Yes, we do. As a sports medicine physician, we are always trying to get the best outcome and performance from our interventions. For example, there are studies that show using PRP during ACL repair decreases healing time in the tunnels and potentially enhances the graft strength.
I think PRP has been a major step and now people are looking at bone marrow aspirates and stem cells. There's a lot of research out there in animal and human models using stem cells for cartilage, ligament, tendon and muscle healing, but at this point none of the studies are definitive in showing efficacy in the long term yet.
Eric Millstein, MD, DISC Sports and Spine Center in Marina del Rey, Calif.: In my practice, I find PRP most helpful in chronic tendinopathies, such as tennis elbow and patellar tendonitis, as well as some revision surgeries. The idea behind PRP is that you have growth factors that help tears heal. I don't have enough confidence that it helps with every surgery I do, but I have found it helps in a compromised healing environment such as revision surgery.
The enthusiasm for PRP is high among surgeons, but it may be even more so among patients. It's one of those technologies that seems easy to apply with the anticipation that it would help patients heal more quickly than it would otherwise. I have many patients who hear about it by reading a news story or following a professional athlete. Like other sport medicine applications, randomized, controlled studies are needed.
There is a big perception out there that PRP does more than it actually does. Patients with arthritis think PRP will help cure them, but there isn't any evidence supporting this application.
Related Articles on PRP:
7 Things Orthopedic Surgeons Should Know about Platelet Rich Plasma
AAOS: PRP an Unproven Treatment Option
What Role Does Biologics Play in Sports Medicine?: 4 Physician Responses