Sunday, January 17, 2010

Platelet Rich Plasma JAMA Article

A recently published article by de Vos et al in JAMA has resulted in a flurry of lay press articles declaring platelet rich plasma (PRP) does not work.  Much like the overhype of PRP after Hines Ward was treated just before the Super Bowl last year, this declaration cannot be defended.

In their study, patients with MODERATE achilles tendinopathy did not do better with PRP compared to saline controls.  All patients received eccentric strengthening exercises.  Their data does support the conclusion that PRP is not better than saline but ONLY for moderate tendinopathy (as measured clinically, no imaging data was reported) at six months of follow up.    The authors stated they will be following those patients for a year.  If for some reason, the PRP patients continue to improve and the saline ones do not, there could be a difference at one year.  However, the conclusion could then only be made that PRP works for MODERATE achilles tendinopathy not any other clinical entity.  Patients with SEVERE tendinopathy that has failed eccentric training was not tested in this study.

The authors need to be recognized for completing this study as we need more level one evidence like it to best define how to use PRP.  Soon, we will have more published literature to discuss. 

We still need to define the optimal formulation and dosage of PRP.  No data was collected on the patients with regard to what was actually put into the patient in terms of total platelet concentration and or white blood cell concentration.  Importantly, we also need a better understanding of the mechanisms behind PRP.
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