Tuesday, January 10, 2012

Platelet Rich Plasma Classification and Tennis Elbow Data

PRP Classification

White Blood Cells
Type 1
Increased over Baseline
Type 2
Increased over Baseline
Type 3
Minimal or No WBCs
Type 4
Minimal or No WBCs

A:  > 5x Platelets
B:  < 5x Platelets

The classification system outlined above has been published in a peer reviewed journal by Mishra et al.  Published Reference

The use of platelet rich plasma has grown significantly worldwide.  Not all PRP, however, is the same.  This is crucial for patients, providers and hospital administrators to understand.  The most studied clinical problem so far is chronic tennis elbow.  Elite data supports the use of PRP that contains white blood cells applied in an unactivated fashion.  This is type 1 PRP according to the classification.  PRP formulations that do not contain white blood cells have NO controlled data supporting their use for chronic tennis elbow.  Below is a list of the PUBLISHED controlled data supporting the use of PRP for tennis elbow.

Gosens et al:  PRP with white blood cells 77% success vs 43% for cortisone at 2 years (p < 0.0001)

Peerbooms et al:  PRP with white blood cells 64% pain improvement vs 24% for cortisone at 1 year ( p < 0.001)

These are level one studies of 100 patients done using the Biomet GPS system.  It is clear from this data that PRP is a better option than cortisone for chronic tennis elbow.  When debating about whether PRP is effective, it is paramount to ask:

What TYPE of PRP?  and for What APPLICATION?

PRP research is continuing to evolve but the debate should take place in the context of data whenever possible.


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