BloodCure

Super Bowl High Ankle Sprain and Platelet Rich Plasma

2012-01-31T13:01:00.000-08:00

Rob Gronkowski of the SuperBowl New England Patriots apparently has a "high ankle" sprain. First let's define a high ankle sprain. This is a stretching or tearing of the ligaments that connect the two bones of the just above the ankle, the fibula and tibia. That is why it is called a "high" ankle sprain as opposed to a typical less serious ne that involves the ligaments just below the joint line. It can lead to significant instability of the ankle that at times requires surgery. It also takes between 6-8 weeks to heal even if surgery is not needed.

The details about his injury are little sketchy but here is what I can find so far. He did not practice on Monday and has been wearing a boot. He injured it in the AFC championship game 10 days ago. I think it is possible the doctors may have given him platelet rich plasma to speed the healing of his injury. There is no published data supporting this application but based on preclinical studies, it may be an effective treatment. Here is a link to a story that fuels that speculation. He will also likely to receive game time treatment in the form of tight taping or bracing and perhaps even a pain killing shot into the joint.

Here is what to watch for. Will he be able to block and make sharp cuts during his recieving routes? A high ankle sprain by definition injuries the ligaments that stablize and support these moves. Can he somehow become the Hines Ward of 2012 and make a catch in the first series that helps his team ultimately win the Super Bowl? The first quarter of the game will help all of us better understand. Hopefully, after the game we will learn more about his actual injury and treatment.

Read more about High Ankle Sprains

Read more this speculation on ESPN.

AM
@BloodCure on Twitter

Total Tendon

Platelet Rich Plasma vs Hyaluronate for Ankle Pain and Disability

2012-01-21T11:39:00.000-08:00

Am J Sports Med. 2012 Jan 17.

Platelet-Rich Plasma or Hyaluronate in the Management of Osteochondral Lesions of the Talus.

Mei-Dan O, Carmont MR, Laver L, Mann G, Maffulli N, Nyska M.

Source

Department of Orthopedic Surgery, Meir University Hospital, Kfar-Saba, Israel.

Abstract

BACKGROUND:

Nonoperative options for osteochondral lesions (OCLs) of the talar dome are limited, and currently, there is a lack of scientific evidence to guide management.

PURPOSE:

To evaluate the short-term efficacy and safety of platelet-rich plasma (PRP) compared with hyaluronic acid (HA) in reducing pain and disability caused by OCLs of the ankle.

STUDY DESIGN:

Randomized controlled trial; Level of evidence, 2.

METHODS:

Thirty-two patients aged 18 to 60 years were allocated to a treatment by intra-articular injections of either HA (group 1) or PRP (plasmarich in growth factors [PRGF] technique, group 2) for OCLs of the talus. Thirty OCLs, 15 per arm, received 3 consecutive intra-articular therapeutic injections and were followed for 28 weeks. The efficacy of the injections in reducing pain and improving function was assessed at each visit using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale (AHFS); a visual analog scale (VAS) for pain, stiffness, and function; and the subjective global function score.

RESULTS:

The majority of patients were men (n = 23; 79%). The AHFS score improved from 66 and 68 to 78 and 92 in groups 1 and 2, respectively, from baseline to week 28 (P < .0001), favoring PRP (P < .05). Mean VAS scores (1 = asymptomatic, 10 = severe symptoms) decreased for pain (group 1: 5.6 to 3.1; group 2: 4.1 to 0.9), stiffness (group 1: 5.1 to 2.9; group 2: 5.0 to 0.8), and function (group 1: 5.8 to 3.5; group 2: 4.7 to 0.8) from baseline to week 28 (P < .0001), favoring PRP (P < .05 for stiffness, P < .01 for function, P > .05 for pain). Subjective global function scores, reported on a scale from 0 to 100 (with 100 representing healthy, preinjury function) improved from 56 and 58 at baseline to 73 and 91 by week 28 for groups 1 and 2, respectively (P < .01 in favor of PRP).

CONCLUSION:

Osteochondral lesions of the ankle treated with intra-articular injections of PRP and HA resulted in a decrease in pain scores and an increase in function for at least 6 months, with minimal adverse events. Platelet-rich plasma treatment led to a significantly better outcome than HA.

Interesting new data.

Total Tendon

ApexPRP.com

Platelet Rich Plasma Classification and Tennis Elbow Data

2012-01-10T17:16:00.000-08:00

	PRP Classification
	White Blood Cells	Activated?
Type 1	Increased over Baseline	No
Type 2	Increased over Baseline	Yes
Type 3	Minimal or No WBCs	No
Type 4	Minimal or No WBCs	Yes
	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.

AM

ABC Evening News Platelet Rich Plasma

2011-12-22T20:45:00.000-08:00

ABC broadcasts story about how platelet rich plasma is being used to treat tennis elbow tonight on the evening news. Randomized, controlled trials now support the use of platelet rich plasma for chronic tennis elbow when compared to the standard care of a cortisone shot. Someday PRP may completely replace cortisone. For more PRP information, visit: ApexPRP.com

To view the ABC Story:

http://abcnews.go.com/Health/Wellness/cutting-edge-joint-injections-heal-baby-boomer-arthritis/story?id=15214643#.TvP_PSNWqiV

AM

Kobe Bryant Platelet Rich Plasma

2011-12-22T20:38:00.001-08:00

Kobe Bryant returns to play with LA Lakers after being treated with platelet rich plasma derivative. See video.

http://lakersblog.latimes.com/lakersblog/2011/12/it-depends-on-injuries-if-im-hurt-or-pau-is-hurt-well-take-the-time-to-heal-up-but-for-the-most-part-well-be-out-there-pr.html

More PRP information

Chicago Bear is treated with Platelet Rich Plasma

2011-12-22T20:36:00.000-08:00

Chicago Bear Matt Forte has platelet rich injection for knee ligament injury.

http://espn.go.com/blog/nfcnorth/post/_/id/35552/have-at-it-matt-fortes-best-strategy
To learn more about PRP, visit: http://www.apexprp.com

Medicare Database

2011-12-22T20:34:00.000-08:00

Medicare to allow use of its database to rate Doctors, Hospitals and other Health Care Providers. This will lead to mobile apps to figure out what doctors and hospitals perform the most operations and what their success and failure rates are by procedure. It will also have unintended consequences.

http://news.yahoo.com/feds-allow-medicare-data-rate-doctors-175246424.html

Some thoughts on the Future of Medicine

2011-12-22T20:30:00.000-08:00

Genome data interpretation will emerge as its own medical specialty much like radiology for evaluation of xrays, CTs & MRIs. It will take some time but the complexity of the information will eventually lead to a board certified specialist that helps primary care doctors understand genetic tests.

Transformative solutions more often arise via iconoclastic horizons not via the cognoscenti. Translation: Truly significant advances do not arise from established ideas and people. They destroy established ideas and patterns of behavior.

"Citizen Scientists" and "Health Hackers" Conducting trials, analyzing data and presenting papers. How can we all help in the advancement of science:
http://online.wsj.com/article/SB10001424052970204621904577014330551132036.html

Tumor Treating Fields (electrical current) used to treat brain cancer. 1st prescription patient. Novel GBM treatment

http://medicalxpress.com/news/2011-12-patient-prescription-fda-approved-brain-tumor.html

Platelet Rich Plasma and Stem Cell Treatments in Athletes

2011-11-02T11:01:00.000-07:00

Platelet Rich Plasma (PRP) and Stem Cell Therapies are becoming more commonly used especially by elite athletes. In order to better understand the scope of the situation, I have put up an interactive site with links to any and all articles about either PRP or Stem Cell Treatments in Athletes. Reasons why elite athletes are seeking out stem cell and platelet rich plasma therapies:

They want to get better and get back to their sport at the highest level as fast as possible.
They are dissatisfied with present treatments or those treatments are not working.
They understand that using the regenerative components of your own blood, bone marrow or fat to treat injured or degenerative tissue makes intrinsic sense.
They are further willing to be treated with these autologous biologic products despite the immaturity of the supporting data.

Please visit the site and add to the list of athletes and articles. This is part of a project to better understand how and why athletes are seeking out these types of treatments and how effective they are. Please use a short one line description with links. Part of the list is outlined below:

Updates can be found via twitter: @bloodcure and via this BloodCure.com blog

AM
Total Tendon

7 Billion People on Earth Very Soon

2011-10-19T18:38:00.000-07:00

7 Billion people on Earth soon. We need more efficient ways of discovering and developing transformative therapies.

http://blog.zap2it.com/pop2it/2011/10/earths-population-to-hit-7-billion-people.html

Elite Athletes continue to Embrace Platelet Rich Plasma

2011-10-19T18:36:00.000-07:00

Ryan Howard (Phillies first baseman) has Achilles Tendon Repaired and then augmented with Platelet Rich Plasma. It is clear that elite athletes are still embracing PRP.

http://www.foxnews.com/sports/2011/10/12/phillies-1b-howard-has-surgery/

AM
Total Tendon

Medical Innovation and Design

2011-10-19T18:32:00.000-07:00

"Focus on Patients, rather than on Dubious Animal Models" How Human Center Design can improve HealthCare. Using the idea to cell culture to animal model to human trials paradigm of new treatments is broken. We need simpler pathways that are still safe and cut costs while improving patient outcomes. Can proactive design methods help?
.http://www.theatlantic.com/life/archive/2011/10/design-can-improve-healthcare-can-it-also-lead-to-new-cures/246437/

Platelet rich plasma is following a different accelerated pathway. We are still searching for a mechanism of action but it has already helped thousands of patients.

AM

Steve Jobs World's Top Innovator

2011-10-19T18:28:00.000-07:00

Who will replace Steve Jobs as the world's top innovator? Searching for "productive narcissists." Another question: Is it possible to be great and also good?
WSJ Reports.http://online.wsj.com/article/SB10001424052970203476804576617432977807982.html

Risk and Innovation

2011-10-19T18:26:00.000-07:00

Novel transformative solutions require risk. We need to increase the incentives to take such risk. Using platelet rich plasma for sports related injuries a decade ago was crazy. Now it is commonplace and backed up with level one data for chronic problems such as tennis elbow.

How can we encourage providers and payers to take more risks to help patients?

AM
Total Tendon

Platelet Rich Plasma Issue of Operative Techniques in Sports Medicine

2011-09-28T09:23:00.000-07:00

The entire September 2011 issue of Operative Techniques in Sports Medicine is dedicated to Platelet Rich Plasma. (PRP) Articles included in this issue discuss what is platelet rich plasma, how it is presently being used in the elbow, shoulder, and foot/ankle. Discussions about the basic science of PRP, its effects on cartilage and even the coding and reimbursement of PRP are outlined. Finally, a paper on the future of PRP and its impact on sports medicine is presented.

Elite PRP researchers including but not limited to: Lisa Fortier, Brian Cole (Editors), Scott Rodeo, Steven Arnoczky, James Bradley, Augustus D. Mazzocca, Anthony A. Romeo, Allan Mishra, Taco Gosens, Lew Schon, Tomasz Bielecki, and David M. Dohan Ehrenfest are among the authors.

This represents the latest information about PRP from the people who have been actively engaged in evaluating it scientifically.

To review the entire issue click here: Operative Techniques in Sports Medicine PRP Issue

AM
Total Tendon

Offshoring of Medical Device Industry

2011-09-27T20:02:00.000-07:00

"Offshoring of Medical Device and BioTech Industries" USA needs to figure out a way to invest in these vital areas.http://www.theatlantic.com/business/archive/2011/09/why-silicon-valley-is-running-scared-from-health-care/245534/#.Tn1wThPtGF4.twitter

Tom Cruise Minority Report Coming Soon?

2011-09-27T20:01:00.001-07:00

Recreating Human Perception via Functional MRI and YouTube Smashup. Minority Report like Movies from UC Berkeley #coolmercurynews.com/science/ci_189

Stem Cells for Blindness

2011-09-27T20:00:00.001-07:00

Human Embryonic Stem Cell trial to Cure Blindness from genetic retinal disease to begin in London. UK Stem Cell Leaderhttp://www.ft.com/intl/cms/s/2/da838c46-e511-11e0-9aa8-00144feabdc0.html#axzz1YhlhQuYo

Intelligent T-Shirt

2011-09-27T19:59:00.001-07:00

Intelligent T-Shirt monitors patients non-invasively. Simple way to gather vital data. http://www.eurekalert.org/pub_releases/2011-09/ciuo-mpu091911.php

Life Lesson From Einstein

2011-09-27T19:54:00.000-07:00

"There are only two ways to live your life: As though nothing is a miracle. Or as though everything is a miracle." ~Einstein

Big Blue Brother

2011-09-24T11:29:00.003-07:00

IBM's Watson Supercomputer teams with Wellpoints Blue Cross/Shield to "recommend" treatment options. Big Blue Brother!
http://news.yahoo.com/blogs/technology-blog/watson-supercomputer-quits-playing-games-gets-job-medicine-210223123.html

Chinese Remedy for Malaria

2011-09-24T11:29:00.001-07:00

Lasker Prize ($250k) awarded for malaria drug discovery based on ancient Chinese folk remedies and protein folding.
http://news.yahoo.com/medical-prize-honors-discoverer-malarial-drug-120606526.html

Cancer is like a Snake

2011-09-24T11:27:00.003-07:00

Cancer can shed its skin like a snake providing itself protection against chemotherapy and radiotherapy.
http://www.sciencedaily.com/releases/2011/09/110902110144.htm

FDA Killing Innovation?

2011-09-24T11:27:00.001-07:00

Is the FDA Killing Innovation? The story of a non-invasive Melanoma Detection Device's Battle to Win Approval.
http://finance.fortune.cnn.com/2011/09/02/melafind-fda-innovation/?source=yahoo_quote

Viral Cancer Therapy

2011-09-23T19:02:00.002-07:00

World's First Viral Cancer Therapy Trial. 75% of higher dose patients showed tumor shrinkage or stabilization
http://www.eurekalert.org/bysubject/medicine.php

Chocolate Beats Stem Cells for Heart Disease

2011-09-23T19:02:00.000-07:00

Chocolate Better than Stem Cells for Heart Disease? 37% lower risk of Heart Disease with High Chocolate Consumption.
http://yourlife.usatoday.com/health/healthcare/studies/story/2011-08-29/Chocolate-lowers-heart-stroke-risk/50174422/1

Albert Einstein "On Science"

2011-09-23T18:59:00.001-07:00

Imagination is more important than knowledge. Imagination points to all we might yet discover and create.

2011-09-23T18:57:00.003-07:00

164 Million Obese Americans by 2030 costing $66 Billion/year, leading to 8 mill. more Diabetics. Staggering Numbers
.http://www.webmd.com/diet/news/20110825/report-164-million-obese-adults-by-2030

2011-09-23T18:57:00.001-07:00

Stem Cells Developed from your Mouth Muscosa. A Simple, Innovative and Potentially Transformative Development.
http://www.eurekalert.org/pub_releases/2011-08/afot-wf081911.php

2011-09-23T18:56:00.001-07:00

Saffron provides an anti-cancer protective effect by promoting cell death (apoptosis)" Need to understand mechanism.
http://www.eurekalert.org/pub_

2011-09-23T18:55:00.001-07:00

Orthopedic Surgeons Question Rick Perry's Adipose Derived Stem Cell Treatment for his Back Pain.
http://abcnews.go.com/Health/wireStory?id=14338388

2011-09-23T18:54:00.001-07:00

Cells Derived from Pluripotent Stem Cells Express Cancer Development Genes. Serious Implications for Clinical Use. Point of care autologous therapies such as PRP do NOT have these risks.
http://www.eurekalert.org/pub_releases/2011-08/uoc--cdf081611.php

2011-09-23T18:53:00.002-07:00

Cancer's Secrets, Dark Matter, Dark Energy and the Bacteria that may direct our DNA .http://www.nytimes.com/2011

2011-09-23T18:53:00.000-07:00

Platelet rich plasma---better efficacy than HA injections in reducing pain at 6 months in knee arthritis patients http://www.ncbi.nlm.nih.gov/pubmed/21831567

Platelet Rich Plasma Paper compares Biomet GPS vs Arthrex ACP

2011-08-21T15:16:00.000-07:00

Bloodcure has long stated that platelet rich plasma composition matters. A new study just published by Dr. Lisa Fortier's group at Cornell compares two of the most popular PRP systems: Biomet and Arthrex. It is clear these two PRP systems have significantly different bioactivity.

"PRP-1 (Arthrex) system consisted of concentrated platelets (1.99×) and diminished leukocytes (0.13×) compared with blood, while PRP-2 (Biomet GPS) contained concentrated platelets (4.69×) and leukocytes (4.26×) compared with blood. Growth factors were significantly increased in PRP-2 (Biomet) compared with PRP-1 (Arthrex) (TGF-β1: PRP-2 = 89 ng/mL, PRP-1 = 20 ng/mL, P < .05; PDGF-AB: PRP-2 = 22 ng/mL, PRP-1 = 6.4 ng/mL, P < .05). The PRP-1 (Arthrex) system did not have a higher concentration of PDGF-AB compared with whole blood. Catabolic cytokines were significantly increased in PRP-2 (Biomet) compared with PRP-1 (MMP-9: PRP-2 = 222 ng/mL, PRP-1 = 40 ng/mL, P < .05; IL-1β: PRP-2 = 3.67 pg/mL, PRP-1 = 0.31 pg/mL, P < .05)."
See Full Abstract

This important work helps to highlight that different types of PRP exist and should be recognized by patients, clinicians and researchers. A PRP classification system also has been published based cellular composition. See Classification System

Total Tendon

ApexPRP

DNA Sequencing or Magnetic Resonance Imaging MRI

2011-07-25T08:19:00.000-07:00

Today, one of the most common tests ordered in the United States is a Magnetic Resonance Image or MRI. These images are typically ordered of a specific body part or region. The cost of this type of test is variable ranging from $800 to over $3000 and produces exquisite information anatomic images.

MRI of Torn Rotator Cuff

An MRI, however, gives the clinician no information about the patients systemic physiology or potential underlying risk factors. If DNA sequencing can follow Moore's Law from computer science, then the cost should drop to $1000 within five years or perhaps less. Databases are already being created with numbers reaching over 100,000 patients. As the cost drops, physicians will begin ordering these tests almost as often as MRIs and we will then see dramatic shifts in the practice of medicine. The natural history (what happens if no intervention occurs) is different for different patients. We may be able to predict with DNA sequencing who will recover WITHOUT any specific or expensive treatment. We also may be able to predict which patients will require aggressive treatment. The era of personalized genomic medicine will have arrived. This has broad implications for reducing the cost of care if implemented appropriately.

Read more about the falling cost of DNA sequencing in the LA Times.

Total Tendon

Kobe Bryant, Tiger Woods and Platelet Rich Plasma

2011-07-16T15:56:00.000-07:00

According to published reports, Kobe Bryant has had three arthroscopic (scopes) surgeries on his right knee. (2003, 2006 and 2010) This is similar to the three surgeries that Tiger Woods has had on his left knee. Both of these athletes are in their 30s and the question for both of them is: What is going on inside these elite knee joints and why did they both turn to platelet rich plasma to potentially help them?

BLOODCURE thinks it is safe to assume that both of them have some arthritic changes in their knees. This means that they have lost some of both the smooth cartilage covering the bone (articular cartilage) and some of the cushioning cartilage between the thigh and shin bones (meniscus cartilage). In Tiger's case, he may have been treated for patellar tendonitis after an ACL reconstruction but there is no presented or published information about the specifics of his treatment. In Kobe's case, he may have been treated for knee arthritis but despite BLOODCURE contacting its many sources in the USA and Europe, no one has come forward with specific information about his treatment. What did he have done and why did he travel to Germany to get it done? Plenty of physicians within the USA and specifically California have experience with PRP. So, did he get some form of PRP that is not available in the USA?

Answers to these questions will help us all better understand the value of PRP for iconic professional athletes and for sports medicine in general. Importantly, we also need to learn what type of PRP (many exist) they received. Here is a video of a PRP Classification System.

If anyone has information about these cases, please post a comment below.

AM
Total Tendon.com

AAOS Now Reports on Platelet Rich Plasma

2011-06-11T11:48:00.000-07:00

AAOS NOW just published a discussion about what's behind the hype of platelet rich plasma Read an excerpt below:
--------------------------------------------------------------------------------------------------------------------------------

"Dr. Mishra also presented a concise classification system for PRP formulations (See Video of PRP Classification) to help compare data from various studies. The system takes into account the inclusion of white blood cells, the addition of a thrombin activator, and the final concentration of platelets.

He noted that PRP is “autologous engineering” a way to help maximize how the body helps heal itself. Stem cells and bone marrow are other examples.

“Patients are seeing elite athletes, like Tiger Woods and Raphael Nadal, being treated with some form of PRP and are asking their orthopaedic surgeons to give them ‘what Tiger got.’ The problem is that we don’t know ‘what Tiger got,’ what happened to him before or afterwards, or what was used, and no one is publishing that data,” noted Dr. Mishra.

“But all three major sports organizations—the National Football League (NFL), Major League Baseball, and the National Basketball Association—as well as the World Anti-Doping Agency, have declared that PRP is a reasonable treatment, despite the fact that we may all agree that there’s limited research to support the efficacy of its use,” he continued.

Read the full article.
------------------------------------------------------------------------------------------------------------------------------------
Clearly, PRP needs more evidence to be fully validated. This will require investigation of specific PRP formulations and specific indications with important but expensive large randomized trials. Athletes in general, however, do not wait until there is definitive proof. They are constantly searching for the best ways to recover from injuries and PRP has increasing evidence that it may help.

AM
TotalTendon.com

Platelet Rich Plasma Classification Video

2011-06-01T16:24:00.000-07:00

This is a Platelet Rich Plasma Classification System proposed by Dr. Allan Mishra at the American Academy of Orthopedic Surgery (AAOS) in San Diego Feb. 2011

AM
Total Tendon.com

New Study shows PRP improves Rotator Cuff Repair Outcomes

2011-05-18T06:29:00.000-07:00

Dr. Pietro Randelli and his colleagues just published a prospective randomized trial on the use of platelet rich plasma for rotator cuff repair surgery. He showed a specific type of PRP (Increased platelets in combination with white blood cells) improved outcomes especially within the first 30 days.

Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up.

Authored By: Randelli Pietro; Arrigoni Paolo; Ragone Vincenza; Aliprandi Alberto; Cabitza Paolo

Department of Scienze Medico Chirurgiche, University of Milano, IRCCS Policlinico San Donato, Milano, Italy.

Pub Date: 06/2011

Source/Vol: Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]/20

Hypothesis  Local application of autologous platelet rich plasma (PRP) improves tendon healing in patients undergoing arthroscopic rotator cuff repair.

Study Design  Prospective, randomized, controlled, double blind study; considering an alpha level of 5%, a power of 80%, 22 patients for group are needed.

Materials And Methods  Fifty-three patients who underwent shoulder arthroscopy for the repair of a complete rotator cuff tear were randomly divided into 2 groups, using a block randomization procedure. A treatment group (N = 26) consisted of those who received an intraoperative application of PRP in combination with an autologous thrombin component. A control group (N = 27) consisted of those who did not receive that treatment. Patients were evaluated with validated outcome scores. A magnetic resonance image (MRI) was performed in all cases at more than 1 year post-op. All patients had the same accelerated rehabilitation protocol.

Results  The 2 groups were homogeneous. The pain score in the treatment group was lower than the control group at 3, 7, 14, and 30 days after surgery (P < .05). On the Simple Shoulder Test (SST), University of California (UCLA), and Constant scores, strength in external rotation, as measured by a dynamometer, were significantly higher in the treatment group than the control group at 3 months after surgery (strength in external rotation [SER]: 3 ± 1.6 vs 2.1 ± 1.3 kg; SST: 8.9 ± 2.2 vs 7.1 ± 2.7; UCLA: 26.9 ± 3 vs 24.2 ± 4.9; Constant: 65 ± 9 vs 57.8 ± 11; P < .05). There was no difference between the 2 groups after 6, 12, and 24 months. The follow-up MRI showed no significant difference in the healing rate of the rotator cuff tear. In the subgroup of grade 1 and 2 tears, with less retraction, SER in the PRP group was significant higher at 3, 6, 12, and 24 months postoperative (P < .05).

Conclusion  The results of our study showed autologous PRP reduced pain in the first postoperative months. The long-term results of subgroups of grade 1 and 2 tears suggest that PRP positively affected cuff rotator healing.

Publication Types: Journal Article

PubMed Link:	http://www.ncbi.nlm.nih.gov/pubmed/21570659

World Wide Regenerative Medicine Leader?

2011-05-04T20:38:00.000-07:00

Regenerative Medicine is exploding worldwide. There is a healthy debate emerging about who is in the lead. Is it North America (USA, Canada), Europe, South America, Australia or Asia? Could Africa be the place of a monumental discovery discovery much like when Christiaan Barnard did the first heart transplant in Cape Town in 1967?

Countries and continents are taking vastly different approaches to stem cell treatments, genetic engineering and other forms of regenerative medicine. Regulatory issues are especially different by country and changing rapidly. It is also difficult to keep track of all the trials that are popping up everyday.

Send in your comments or follow bloodcure on twitter to be part of the conversation.

AM

Regenerative Medicine Treatment Value Equation

2011-04-24T08:07:00.000-07:00

Regenerative medicine is a buzz phrase right now. Patients, providers and politicians are all in favor of "Regenerative Medicine". There are three major components to evaluate when assessing treatment value (TV). Treatment value is directly related to overall efficacy (E) of the drug or procedure and inversely related to cost (C) and risk (R). A simple equation can define it:

TV = E / C x R2

That is Treatment Value = Efficacy divided by Cost times Risk squared.

We need treatments of high value with maximal efficacy that have reasonable costs and minimal risks. When evaluating new potential "Regenerative Medicine Treatments", consider this equation.

Please post any comments or suggestions.

AM
ApexPRP.com

Level One Two Year Follow Up Paper Supports Use of Platelet Rich Plasma for Tennis Elbow

2011-03-23T11:08:00.000-07:00

Dr. Taco Gosens and his team from the Netherlands have just published in the American Journal of Sports Medicine the best paper to date on the use of platelet rich plasma for tennis elbow. Using the Biomet GPS device to create platelet rich plasma (Type 1A PRP in Mishra's classification system of PRP), they found PRP patients were successfully treated more often than patients treated with corticosteroid injections at two year follow up. This was highly statistically significant at a p value of < 0.0001.
Read the entire abstract here.

This paper confirms that a specific type of PRP is better than the often used cortisone injection for chronic lateral epicondylar tendinopathy. This team of researchers also needs to be congratulated on finishing this important work.

AM
Total Tendon
http://www.twitter.com/bloodcure

AAOS Now PRP Forum

2011-02-18T10:45:00.000-08:00

AAOS Now reported on the recent platelet rich plasma forum in San Diego.

"The participants of the 2011 PRP Forum also endorsed the development of standards in the manufacture of PRP, noted that PRP may be contraindicated in some conditions, and called for the establishment of a study group to follow up on the other recommendations resulting from the session."

"At the end of the day, an informal survey of participants found most in agreement that PRP would be an option, particularly if conservative treatments have failed and the next step would be surgery."

The group agreed that PRP needs a classification system. Dr. Allan Mishra proposed one that is under consideration.

AM

Platelet Rich Plasma Forum at AAOS

2011-02-14T06:24:00.000-08:00

The American Academy of Orthopaedic Surgery and AAOS Now will be conducting a Platelet Rich Plasma Forum on February 14, 2011 just prior to the Annual Meeting in San Diego. Participating in this meeting are an elite group of clinicians and researchers including but not limited to Dr. James Andrews, Dr. Steven Arnoczky, Dr. Terry Canale, Dr. William Clancy, Dr. Freddie Fu, Dr. Taco Gosens, Dr. Elizaveta Kon, Dr. Nicola Maffulli, Dr. Robert Marx, Dr. Allan Mishra, Dr. Pietro Randelli, Dr. Scott Rodeo, and Dr. JR Woodall.

This group along with several others has been tasked with evaluating the state of platelet rich plasma. It will be the most comprehensive discussion of the topic with regard to orthopedics and sports medicine. The goal is to hopefully make some sense of how to best evaluate and potentially use PRP.

Stay tuned for details.

AM

RevaTen Platelet Rich Plasma Shows Promise as a Heart Attack Treatment

2011-01-27T11:31:00.000-08:00

Researchers at the Stanford University School of Medicine, in collaboration with BioParadox, Inc., have published data supporting the use of RevaTen platelet-rich plasma as a promising biologic treatment for myocardial infarction (heart attack).

The findings were published online in Cardiovascular Revascularization Medicine and will be presented at The Sixth International Conference on Cell Therapy for Cardiovascular Disease at Columbia University Medical Center, New York City, on January 20, 2011.

Platelet-rich plasma (PRP) has been identified as a novel biologic treatment for wound healing and sports-related injuries. Studies indicate PRP stimulates cell repair via growth factor release and by attracting reparative cells. Only recently, however, have scientists begun to study PRP's potential in repairing damaged cardiovascular tissue.

Working with colleagues at Stanford University Medical Center, lead author Allan Mishra, MD, a leading PRP researcher, studied the effects of RevaTen PRP (a proprietary formulation of concentrated platelets and white blood cells) on cardiac function after inducing cardiac ischemia (damage to myocardial tissue caused by blood restriction) in mice. The research was conducted under the direction of Robert Robbins, MD, chairman of the department of cardiothoracic surgery at Stanford University.

In this study of 28 mice, researchers induced ischemia by either permanently occluding the left anterior descending artery (Group A) or temporarily ligating it for 45 minutes (Group B). The hearts were then injected with RevaTen PRP or saline control. In order to assess cardiac function after treatment, magnetic resonance images were taken at seven days post-procedure (Group A) and 21 days (Group B). Tissue from all hearts was collected for histopathologic evaluation.

In both groups, mice that received PRP after ischemia had significantly better cardiac function as measured by left ventricular ejection fraction on MRI than those that had been injected with saline only. In group A, the RevaTen-treated animals had 38% better ejection fraction compared to saline controls. In group B, the RevaTen-treated animals had 28% improvement in ejection fraction compared to controls. Additionally, less scar tissue was found in RevaTen-treated hearts than in controls.

"Although this is an observational study using an animal model, PRP might someday be employed at the point of care to treat patients who have had a heart attack. This could preserve cardiac function and limit the progression to congestive heart failure," Dr. Mishra says. "Since myocardial infarction remains the leading cause of death in industrial nations, RevaTen PRP may become a powerful biologic tool in fighting heart disease and provide cost savings." The authors caution that this is a preclinical study and that further translational research is needed to understand how RevaTen PRP might work to repair and/or protect cardiovascular tissue.

Platelet Rich Plasma Tennis Elbow Study

2011-01-13T16:25:00.000-08:00

Enrollment in the most comprehensive platelet rich plasma study to date was recently completed. The study is a double blind randomized trial of 230 patients of PRP vs Saline for chronic tennis elbow. It followed the protocol outlined in the first published study on the topic.
(American Journal of Sports Medicine--Mishra and Pavelko, 2006)

It will take 8-10 months to finish the follow up and analyze the data but it is a milestone to have simply completed enrollment in this important investigation. We can all look forward to the results.

AM
TotalTendon

Platelet Rich Plasma 2011

2011-01-12T10:52:00.000-08:00

2011 will be the year we begin to figure out how to best use platelet rich plasma. For almost a decade now, it has been employed as a treatment for a variety of problems. Last year, level one data was published showing how PRP is better than cortisone for tennis elbow. Other data revealed that achilles tendionpathy that is mild to moderate and that had NOT been treated did not get significantly better with PRP and exercise compared to a saline injection and exercise.

This year, large specialty organizations have dedicated time to debate the value of PRP. Via this forums, we will learn from experts. New formulations and indications will emerge as some will fade. These changes will be based on presentation and publication of elite data.

AM
Total Tendon

Embryonic Stem Cells used to Treat Spinal Cord Injury Patient

2010-10-11T18:09:00.000-07:00

For the first time in history, embryonic stem cells have been used to treat a patient with an acute spinal cord injury. According to several reports the protocol calls for using the treatment within two weeks of the initial injury. Geron, the company sponsoring the trial has spent years and tens of millions of dollars just to get to this first patient. The hope is for this first phase that safety can be demonstrated.

We have officially entered the era of biologic medicine. For quite some time there has been promise, now there is action. It is hard to compute the amount of effort that has likely gone into getting to just this point. It is the researchers and especially this first brave but tragic patient that deserve the credit for this advancement.

In the future, the use of either adult stem cells or induced pluripotent stem cells may become a better option. For now, regardless of your stance on the ethics of embryonic stem cells this day must be marked as a milestone.

AM
Total Tendon

HalfDome.TV

Sports Illustrated Platelet Rich Plasma Article

2010-10-03T16:47:00.000-07:00

Sports Illustrated recently published an article about platelet rich plasma.

"While Galea's use of PRP on Tiger Woods and other athletes has stirred debate, the technique is not particularly new. Allan Mishra, adjunct clinical assistant professor of orthopedic surgery at the Stanford University Medical Center and a pioneer of PRP therapy, has been using it for nearly a decade. In a breakthrough study last year based on work by Mishra, PRP therapy performed significantly better than cortisone -- and with fewer side effects since it makes use of the patient's own blood -- in the treatment of chronic lateral elbow tendinosis, aka tennis elbow. "I can say pretty definitively that PRP is a reasonable choice for tendon [injuries]," Mishra says. "Now it needs to be studied in other applications."

The breakthrough study was actually performed by Dr. Taco Gosens from the Netherlands. He and his colleagues have published the best clinical data to date on the use of platelet rich plasma for tendinopathy.
To read more of the SI article, click here

For sports medicine related videos, go to HalfDome.TV

AAOS Discussion about Platelet Rich Plasma

2010-10-03T16:25:00.000-07:00

The American Academy of Orthopaedic Surgery recently published a expert panel discussion about platelet rich plasma (PRP). Its goal was to help clarify the many issues surrounding this novel therapy. Dr. Allan Mishra, Dr. Freddie Fu, Dr. Steven Arnoczky and Dr. Jo Hannafin participated. Below is an excerpt from the article:

Dr. Hannafin: I did a Google search and found more than 400,000 citations for PRP treatment, including YouTube videos on how the procedure is performed. Clearly, patients, physicians, and scientists are interested in the use of PRP. What conditions is PRP being used for?

Dr. Mishra: I use it almost exclusively in treating tendinopathy, particularly chronic tendinopathy that has failed to respond to other treatment modalities. That would include conditions such as chronic, recalcitrant lateral epicondylitis, patellar tendinopathy, and Achilles tendinopathy. I think the data—and the work that I have been doing for almost a decade now—provide the greatest support for its use in that area.

To read more of the article, click here.

AM

For PRP and other related videos, go to HalfDome.TV

Stanford Football Player may start after PRP San Francisco Chronicle

2010-08-21T09:42:00.000-07:00

Tom Fitzgerald of the San Francisco Chronicle wrote an article about a Stanford football player who may start after being treated with platelet rich plasma. To read more, click here.

There is now mounting evidence that a specific type of PRP that contains increased concentrations of platelets AND white blood cells has value in the treatment of chronic tendinopathy. Several studies are underway and some will soon be published.

To view more about PRP and sports medicine videos, go to HalfDome.tv

AM
Total Tendon

Stem Cell Video Description

2010-08-08T10:32:00.000-07:00

This is a video describing stem cells. It helps with understanding why stem cells are being studied for a variety of problems including heart disease and cancer. Harvesting the value of these cells and other treatments such as platelet rich plasma will transform how we take care of patients within the next five years.

AM

High School Stem Cell Course

2010-08-08T10:22:00.000-07:00

In the San Francisco Bay Area, it is now possible to begin studying stem cell biology in high school. This is an important and interesting development. If we can expose young men and women to this exciting and new field early, they will lead to discoveries we can now only dream of today.

To read more about this new program: click here.

AM
Total Tendon

Trial of Embryonic Stem Cells for Spinal Cord Injury

2010-07-30T12:48:00.000-07:00

The FDA lifted a hold on Geron's trial of embryonic stem cells to treat spinal cord injuries. Geron hopes to begin the trial by the end of the year. The specific cell line in use for this trial is GRNOPC1 which contains cells called oligodendrocyte progenitor cells.

This is an interesting development. Geron's stock popped 17% ($80-90 million in market cap) today on the news. That speaks to the importance of a regulatory pathway for novel biologic treatments. With the value in their stock, they can fund at least part of the trial.

Any thoughts out there on how to best fund new biologic treatments through the early clinical stages?

AM

Personalized Medicine

2010-07-29T11:01:00.000-07:00

We are at the beginning of Personalized Medicine. This concept can take many forms. It can mean an evaluation the DNA of a breast cancer that predicts a poor prognosis. (Overexpression of the human epidermal growth factor receptor type 2, HER2) It can also mean a diagnostic test to determine if a patient will response to a specific type of cancer treatment like Gleevec (imatinib). Recently, several companies have started offering over the counter DNA tests. These are presently being evaluated by the FDA because of concerns for consistently and how they will be interpreted.

On the horizon are also various autologous (your own) engineering treatments such as stem cells from your bone marrow or fat to treat heart disease. Platelet rich plasma is another form of personalized medicine that has evolved rapidly in orthopedics and sports medicine.

An important question is who will pay for the continued development of these diagnostic tools and treatments? The present macro health care environment is all about covering more patients with less money. The micro enviroment (patients coming into the office) are demanding access to these new tests and treatments without regard to cost. We will have to solve this fundamental conflict sooner than later. It is not possible to have both.

AM
Total Tendon.com
ApexPRP.com

How to Grow an Ear...

2010-07-26T07:04:00.000-07:00

Regnereative medicine is simply exploding. New body parts are now being grown in the lab.

See a video of Dr. Tony Atala in his lab at Wake Forest growing an ear. Simply amazing.

Video of how to grow an ear

AM

Platelet Rich Plasma used to treat Nadal's Knees

2010-07-25T19:51:00.000-07:00

It appears as if Nadal has had his creaky knees treated with platelet rich plasma. He has described it himself but only incompletely. What we do not know is what type of PRP was used, how it was injected and how he is being treated after the procedure. These are all critical issues. Presently, PRP with platelet concentrations around 5x baseline combined with concentrated white blood cells has the best published data supporting its use.

It is clear that Nadal has chronic, severe tendonitis also know as tendinopathy. It will help all of us who are studying how to best use PRP we knew more about his specific treatment. Does anyone out there know any of the details?

AM
Total Tendon

Orthopedics Article

2010-07-03T09:04:00.000-07:00

Dr. Allan Mishra recently had his commentary about the state of platelet rich plasma published in Orthopedics.

Allan Mishra

Is PRP a better solution than cortisone for treating tendon injuries? If so, why?

"Platelet-rich plasma is clearly a better treatment for tendon injuries than cortisone. A recent double-blind randomized trial found significantly better outcomes in the treatment of tennis elbow in patients who received PRP when compared to cortisone.^3,4 There is also a risk of dermal atrophy or even tendon rupture when using cortisone. For these reasons, I rarely, if ever, use cortisone in the treatment of a tendon problem in my practice."

Read more of the article...

AM
Total Tendon
ApexPRP.com

Orthopedics Today PRP Discussion

2010-07-03T08:58:00.000-07:00

Orthopedics Today recently published a discussion about platelet rich plasma. Dr. Allan Mishra, Dr. Steven Arnoczky, Dr. Freddie Fu and Dr. Nicolas Sgaglione commented about the state of PRP.

“The lay press does not understand the complexity of PRP,” Allan Mishra, MD, said. “As more data emerge, it will become clear to both physicians and surgeons that the specific formulation of PRP matters significantly in terms of bioactivity.”

“The thing I would emphasize is that we have got to get a better understanding of the formulations in order to figure out whether PRP is valuable or not,” he added. “What is missing in the lay press – but also in the medical literature – is the discussion of what PRP is.”
Mishra pointed out that a formulation of PRP containing only concentrated platelets differs greatly from a formulation composed of concentrated platelets and white blood cells.

Read more of the artilcle....

AM
Total Tendon
ApexPRP

Tennis Elbow PRP Discussion at ESSKA in Oslo, Norway

2010-07-03T08:37:00.000-07:00

Dr. Pietro Randelli moderated an excellent discussion of the treatment of tennis elbow (lateral epicondylitis) at the recent ESSKA meeting in Oslo, Norway. Presentations about conservative care, platelet rich plasma injections and surgical treatment were given, including a debate about open versus arthroscopic techniques. It is clear there are a variety of treatment options for this problem. Platelet rich plasma is now considered a viable non-operative option. Further data is presently being developed about the value of PRP vs surgery. Stay tuned.

AM
Total Tendon
ApexPRP.com

Blood Spinning vs Blood Doping San Francisco Chronicle PRP

2010-05-20T17:47:00.000-07:00

There is WAY too much confusion about the differences between blood spinning and blood doping. Put simply, blood spinning is the separation of the whole blood into its components: red blood cells, white blood cells, platelets and plasma. Various techniques concentrate the components and then are used either individually or in combination. Platelet rich plasma can be the product of blood spinning. It is used immediately after preparation and for injuries.

Blood Doping is the collection and storage of typically whole blood to be used to enhance performance. Blood is drawn, stored and then reinjected at later date typically right before a race to improve endurance. Cyclist Floyd Lanis has recently admitted to blood doping and accused Lance Armstrong of the same.

Gwen Knapp of the San Francisco Chronicle discusses these issues in conjunction with Dr. Tony Galea a Canadian doctor who has treated Tiger Woods and several other US athletes. Read her article here.

AM
Total Tendon

HalfDome.tv

Pac-10 Athletic Trainer Conference

2010-05-12T20:26:00.000-07:00

Platelet rich plasma was discussed in depth at the Pacific 10 Athletic Trainer conference in Berkeley yesterday by Dr. Allan Mishra. Almost all of the schools represented had used PRP to treat their athletes. It was clear from the discussion, however, that the various forms of PRP (with and without white blood cells) were not well known to the group. Moving forward, it was noted that the type of PRP should be recorded and studied in greater detail. Also, the use of ultrasound to guide PRP injections and follow patients was found to have value. Better and more specific post PRP protocols were found to be lacking. Overall, it was interesting to note how much PRP was being used. Clearly, the need for better indication data was still needed. More later....

AM
Total Tendon

LA Dodgers and Seattle Mariners using PRP to treat players

2010-05-01T06:33:00.000-07:00

Seattle Mariner Cliff Lee pitched 7 innings yesterday of shut out baseball after receiving a platelet rich plasma injection for an abdominal strain. The Safeco field crowd of 34,055 were treated to 93 mile per hour fast balls and eight strikeouts. An impressive return to pitching.

Did PRP help him in his return? That is a good question to ask Mr. Lee. Clearly, it didn't hurt him. We need to follow his progress and better understand if PRP can treat abdominal strains and or sports hernia type injuries.

Los Angeles Dodger Rafael Furcal also has used PRP. In his case, the platelet rich plasma was used to treat a hamstring injury. We clearly need better data on whether PRP really helps these problems but for now it is clear that major league players and their doctors are using it.

AM
Total Tendon

Ultrasound and Platelet Rich Plasma

2010-04-18T20:07:00.000-07:00

Ultrasound of a Partial Elbow Extensor Tendon Tear

Ultrasound is a powerful non-invasive tool to evaluate soft tissue. It can be especially helpful when imaging tendons. Platelet rich plasma has been used extensively in tendinopathy and I believe ultrasound could provide an objective endpoint for future studies. The size of the lesion could be measured before and after treatment. Calculation of reduction of the pathologic hypoechogenic area could then be made. We are beginning to evaluate a variety of ways to use ultrasound and would welcome any questions, comments or suggestions.

AM
Total Tendon

HalfDome.TV

Mishra Platelet Rich Plasma Classification

2010-04-03T16:58:00.000-07:00

Not all platelet rich plasma (PRP) is the same. In order to be able to compare PRP, I am proposing a new classification system based on the presence or absence of white blood cells, activation status and platelet concentration. Activation implies the use of thrombin and or calcium to cause the platelets to gel and release their bioactive molecules. No activation implies in vivo activation by collagen.

Platelet Concentration:
A = 5 x baseline or higher
B = Less than 5 x baseline

Type          White Blood Cells        Activation

Type 1:       Increased WBCs                  Unactivated

Type 2:       Increased WBCs                 Activated

Type 3:       Few/None WBCs                 Unactivated

Type 4:       Few/None WBCs                 Activated

Example:

Type 1A PRP: Formulation with increased WBCs, 5.5x baseline platelets injected in an unactivated fashion.

The system is meant to be simple for now. Clearly, there are other components to PRP including anticoagulation and buffering. Importantly, new formulations may arise but for now we need a simple reproducible structure to discuss the different types of PRP. I hope this represents a start.

AM
Total Tendon

Platelet Rich Plasma and Abdominal Strains

2010-03-29T20:19:00.000-07:00

Cliff Lee from the Seattle Mariners was recently treated with PRP for an abdominal strain. This is a novel but potential valuable application for platelet rich plasm a. Presently, there is no data to suggest it may work for this problem. Basic science and preclinical work, however, suggest it may be helpful.

I must applaud the doctors who made this choice because if it does help Mr. Lee return to the mound without surgery they will have helped many other athletes and physicians. I would recommend, however, this case be documented in the medical literature so we all can follow the specifics.

As new potential applications arise, we must be aware of the value created by the researchers, physicians and patients who make that initial decision to try something that no one else has done.

AM
Total Tendon

Platelet Rich Plasma Debated at AAOS meeting in New Orleans

2010-03-14T14:13:00.000-07:00

Dr. Taco Gosens and Dr. Allan Mishra at AAOS New Orleans 2010

The concept of using platelet rich plasma for orthopedic applications was vigorously debated at the recent AAOS meeting in New Orleans. Dr. Gosens presented his prospective randomized trial of 100 patients with chronic tennis elbow. They found PRP was significantly better than cortisone at one year. This has been published in the American Journal of Sports Medicine in Feb. 2010. See Abstract

Dr. Gosens and his colleagues used PRP in a form that contains both concentrated platelets and white blood cells in an unactivated (no addition of thrombin or calcium) composition. The details of this are critical as other forms of PRP may not have the same efficacy. As the debate about PRP continues it will be paramount for researchers, clinicians and patients to understand that not all PRP is the same. Presently, the lay press is trying to state that PRP either works or does not work. This is too simple. We need more studies such as the one presented by Dr. Gosens to understand when and where to apply PRP and in what form. We may conclude from his study that unactivated platelets in combination with concentrated white blood cells is more effective than cortisone for chronic elbow tendinosis. That is important. More soon on the other data presented at AAOS on PRP.

WebMD Article

AM
Total Tendon

Lindsay Vonn Gold Medal Olympic Downhill Whistler 2010

2010-02-18T17:24:00.000-08:00

Linsday Vonn won the Gold Medal in the Olympic Downhill yesterday at Whistler. Given the severity of her injury the performance was amazing. I do not know any of the details of how she has been treated but kudos to her treating providers. I still believe she should have been able to use platelet rich plasma as a means of treating her deep muscle bruise. However she recovered and competed, she will now forever be known as an Olympic Champion.

US Olympian Daron Rahlves treated with Platelet Rich Plasma

2010-02-16T20:49:00.000-08:00

US Olympic skier Daron Rahlves dislocated his hip at the Winter X Games recently. He was treated with platelet rich plasma to help speed healing. He is potentially going to compete in the Olympics this week.

We'll have to watch to see if he can recover in time.

Read the full story.

AM
Total Tendon

Lindsay Vonn Olympics, Leg Injury and Platelet Rich Plasma

2010-02-11T18:16:00.000-08:00

Olympian Lindsay Vonn apparently has a deep bruise to the muscle on her leg. No one knows the details of the injury or how it is being treated but it sounds like it may be a good application for platelet rich plasma. There is NO data suggesting PRP would help her other than accelerating her healing and obviously she has little or no time left before competition.

Does anyone out there have any comments on it would be a good idea to treat her with PRP?

Therapeutic Use Exemption for PRP in Muscle Injuries

2010-02-10T16:15:00.000-08:00

It has been unclear in the media and in the literature if the World Anti-Doping Agency has banned platelet rich plasma for intramuscular injection. There is a need to better understand their position.

Via BloodCure sources, we have definitely determined that PRP is LEGAL to be used via the intramuscular route with a therapeutic use exemption, also known as a TUE. To my knowledge there is NO data suggesting PRP is anabolic for skeletal muscle injuries in humans. If there is any specific data out there please post it here.

Athletes of all kinds need to know PRP may be an option for them if they apply for the appropriate exemption. As always, check with the governing body of your chosen sport and consult with your physicians to best determine if it is appropriate.

AM
Total Tendon

PRP beats Cortisone for Tennis Elbow in Level One Study

2010-02-02T06:40:00.000-08:00

Under the direction of Dr. Taco Gosens from the Netherlands, a prospective, randomized, controlled trial of 100 patients was done to evaluate the efficacy of platelet rich plasma against cortisone for chronic tennis elbow. They recently reported their results in the American Journal of Sports Medicine. (Feb. 2010)

73% of the PRP treated patients were successful compared to 51% in the corticosteroid group (p < 0.001) at one year of follow up according to visual analog pain and functional scores. This represents a 43% better success rate for PRP. This data should put to end the option of using cortisone for chronic tennis elbow. There is only limited support for its use in short term pain relief. It is also clear from these last two papers that the evaluation of PRP must be done by specific clinical problem and the severity of the problem. Only by doing careful studies we will be better able to predict which patients will respond to PRP as a therapy.

Finally, PRP in my opinion should be reserved for patients that have failed non-operative treatment and are considering surgery. Most patients with tendinopathy will respond without invasive intervention. A study directly comparing PRP to surgical outcomes for tendinopathy should be considered.

AM
Total Tendon

Platelet Rich Plasma JAMA Article

2010-01-17T15:40:00.000-08:00

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.

Platelet Rich Plasma Story on CNN

2009-12-17T10:26:00.000-08:00

Anderson Cooper and Dr. Sanjay Gupta reported last night on AC360 about platelet rich plasma. Their description of the process and potential benefits of the PRP will help patients better understand how the treatment works. They also discuss how PRP was used by Tiger Woods and how his doctor is under investigation. See the video below for details. AM (Total Tendon)

Tiger Woods and Platelet Rich Plasma

2009-12-17T09:42:00.000-08:00

Many news outlets have reported Tiger Woods was treated with Platelet Rich Plasma (PRP) after his anterior crucitate ligament surgery. There have been no reported details but it may be reasonable to use PRP if he developed patellar tendonitis post operatively. It must be mentioned that PRP has never been associated with any specific performance enhancement. The use of PRP to treat tendonitis now has significant basic science and clinical support.

The stories center around a physician who treated Woods. The physician is being investigated for a variety of illegal activites. See the links below for details.

New York Times Article
Associated Press Story

PRP and Ultrasound

2009-11-30T07:01:00.000-08:00

Using ultrasound to guide platelet rich plasma injections is becoming more popular. For some indications it may be crucial. Importantly, ultrasound may an excellent way to test the value of platelet rich plasma for tendon related injuries and disorders. In the following study, Bosch et al did just that. The researchers confirmed the value of ultrasound and also found PRP treated cases had better tissue alignment.

AM
Total Tendon
HalfDome.TV

"The effectiveness of new therapies to treat tendon injuries is difficult to determine and is often based on semi-quantitative methods, such as grey level analysis of ultrasonographic images or subjective pain scores. The alternatives are costly and long-lasting end-stage studies using experimental animals. In this study, a method of ultrasonographic tissue characterisation (UTC), using mathematical analysis of contiguous transverse ultrasonographic images, was used for intra-vital monitoring of the healing trajectory of standardised tendon lesions treated with platelet rich plasma (PRP) or placebo. Using UTC it was possible to detect significant differences between the groups in the various phases of repair. At end stage, over 80% of pixels showed correct alignment in the PRP group, compared with just over 60% in the placebo group (P<0.05). UTC also showed significant differences in the course of the healing process between PRP treated and placebo treated animals throughout the experiment. It was concluded that computerised analysis of ultrasonographic images is an excellent tool for objective longitudinal monitoring of the effects of treatments for superficial digital flexor tendon lesions in horses."

AM

PRP Enhances Tendon Vascularity

2009-11-26T13:14:00.000-08:00

Platelet rich plasma is now being used worldwide for tendon related injuries and disorders. Increased vascularity is one of the proposed mechanism of action for PRP. In the study outlined below, this hypothesis is supported in an achilles tendon injury model.

The poor vascularity of tendons is a major factor in their limited healing capacity. The aim of this study was to assess the effect of Platelet Rich Plasma (PRP) on angiogenesis during tendon healing. MATERIALS AND METHODS: Forty-eight skeletally mature New Zealand White rabbits were used. The Achilles tendon was transected transversely and 0.5 ml of PRP was injected into the tendon mass on each side of the incision on both limbs. The injection in the control group consisted of saline. Six animals from each group (12 tendons each) were sacrificed after 1, 2, 3, and 4 weeks following treatment. Three sections from each Achilles were stained with hematoxylinosin for microscopic examination. Further three sections were immunostained with a monoclonal antibody against CD31 (Daco Co), followed by image analysis to count new vessel numbers and statistical analysis was performed. RESULTS: There was significantly more angiogenesis in the PRP group compared to the control group during the first two weeks of the healing process, i.e., inflammatory and proliferative phase (p <> Lyras et al.

AM

Platelet Rich Plasma and ACL Surgery

2009-11-21T11:22:00.000-08:00

The use of Platelet Rich Plasma to augment anterior cruciate ligament reconstruction has been much discussed but not well studied until now. In a prospective randomized trial, Nin et al studied allograft ACL surgery with and without PRP.

"We prospectively randomized 100 patients undergoing arthroscopic patellar tendon allograft ACL reconstruction to a group in whom platelet-enriched gel was used (n = 50) and a non-gel group (n = 50). The platelet concentration was 837 x 10(3)/mm(3), and the gel was introduced inside the graft and the tibial tunnel. The use of PDGF, on the graft and inside the tibial tunnel, in patients treated with bone-patellar tendon-bone allografts has no discernable clinical or biomechanical effect at 2 years' follow-up." Read Full Abstract

This is a good example of where PRP may NOT be helpful.

AM
Total Tendon

DNA Vaccines

2009-11-21T10:54:00.000-08:00

DNA vaccines arose out of failed genetic engineering experiments. In this so called third generation vaccine, a piece of DNA is designed to have a cell express a specific surface antigen. It is then injected and the immune systems responds. DNA vaccines are under development for a variety of diseases including the H1N1 virus also known as the swine flu.

AM
Total Tendon

Stem Cells Improve Heart Function

2009-11-18T10:43:00.000-08:00

Study Shows Benefits of Adult Stem Cells for Heart Disease

"In the 12-month Phase II, double-blind trial, subjects' own purified stem cells, called CD34+ cells, were injected into their hearts in an effort to spur the growth of small blood vessels that make up the microcirculation of the heart muscle....

The largest national stem cell study for heart disease showed the first evidence that transplanting a potent form of adult stem cells into the heart muscle of subjects with severe angina results in less pain and an improved ability to walk."

Read Full Article.

This is well done and interesting investigation into how your own body's cells can improve function in tissue that was once thought not to be able to regenerate. As we investigate deeper into stem cells and other treatments, we are likely to continue to challenge many long held beliefs about human physiology.

AM
Total Tendon

Umblical Cord Stem Cells Accelerate Liver DIsease

2009-11-16T07:27:00.000-08:00

Researchers were in search of a way to regenerate liver cells damaged by cirrhosis. The idea was to use stem cells from cord blood as a treatment. The treatment, however, resulted in increased liver AND kidney damage. We clearly need to better understand such treatment before moving forward in humans. Fortunately, this study was done in rats.

Link to full story.

AM
Total Tendon

Stem Cell Types

2009-11-13T19:46:00.000-08:00

There are three basic types of stem cells. Embryonic stem cells as the name implies come from embryos and have ethical issues surrounding them. Adult stem cells can be purified from a variety of sources including bone marrow and fat. Finally, induced pluripotent stem cells are artificially made from somatic cells such as skin cells. This final type of stem cells is produced by a form of genetic engineering. Viruses are used to insert genes and change the characteristics of the cells.

Embryonic and induced pluripotent stem cells are years away from any real value as treatments because they carry a serious risk of cancer. This has not been well outlined in the press but needs to be discussed. Adult stem cells are used for a variety of treatments already including bone marrow transplants and other indications.

American Journal of Sports Medicine

2009-11-01T17:19:00.001-08:00

The American Journal of Sports Medicine just published a review article about platelet rich plasma.

"PRP contains growth factors and bioactive proteins that influence the healing of tendon, ligament, muscle, and bone. This article examines the basic science of PRP, and it describes the current clinical applications in sports medicine." See abstract

PRP Video

2009-11-01T17:15:00.000-08:00

Total Tendon.com

AAOS Journal Article about Platelet Rich Plasma

2009-10-03T11:55:00.000-07:00

The prestigious Journal of the American Academy of Orthopaedic Surgeons (JAAOS) just published (Oct. 2009) a review article on the topic of platelet rich plasma (PRP). This represents an interesting and important milestone for PRP as a regenerative treatment. The article is well written and outlines the need for specificity in terms of platelet concentration and white blood cell concentration in clinical trials. Claims that 2x platelet concentration have the same clinical value as 4-6x are not supported by this article. Again, it is important to follow peer reviewed literature such as this over unsubstantiated marketing materials.

"(Platelet rich plasma's) use in sports medicine is growing given its potential to enhance muscle and tendon healing. In vitro studies suggest that growth factors released by platelets recruit reparative cells and may augment soft-tissue repair." From Hall et al. See full abstract.

WADA to Approve PRP

2009-09-21T08:35:00.000-07:00

The World Anti-Doping Agency (WADA) just decided to allow the use of PRP for most problems. They will still prohibit its use via an intramuscular injection. This is an interesting and important development. I know that significant analysis went into this decision. Fortunately, elite athletes can now have access to the same valuable treatment that has been used on weekend warriors.

"The agency addressed platelet-derived preparations, commonly referred to as platelet-rich plasma or “blood- spinning," (...a process in which the platelets are removed from the blood and reinjected at the site of an injury for speedier healing). The preparations are prohibited when administered by the intramuscular route. Other methods of administration will require a declaration of use." (Reported by Nancy Kercheval from Bloomberg, See Full Article)

AM
Total Tendon
Apex PRP.com (PRP Videos and Photos)

Stem Cells from Liposuction

2009-09-08T07:58:00.000-07:00

Is it too good to be true? Can you really make stem cells out of liposuction fat?

Yes, you can is the simple answer. The process takes some complicated steps that may result in tumor formation. So, years will be needed to simplify the concept of turning fat into stem cells. The field of autologous medicine (autologous = your own stuff such as fat or blood) is evolving rapidly. Platelet rich plasma is specific example of this type of medicine.

Read the abstract and article below. This is science not science fiction.

AM
Total Tendon

"Stanford researchers have found that globs of fat removed during liposuction contain cells that can be efficiently reprogrammed to become induced pluripotent stem cells — a type of stem cell that does not require the use of an embryo.

The findings were scheduled to be published online Monday in the Proceedings of the National Academy of Sciences, a Stanford press release said.

Stanford surgery professor and study co-author Dr. Michael Longaker described the leftover fat as "liquid gold." (From the Mercury News: See the full article)

Excellent Evidence for Platelet Rich Plasma (PRP)

2009-08-31T10:41:00.000-07:00

Bosch et al in the Journal of Orthopedic Research just reported significant biomechanical evidence supporting the use of a single Platelet Rich Plasma injection for tendon injuries in an equine model. It is important to note this research was conducted using a formulation of platelet rich plasma contained about 4 times platelet concentration and 6 times white blood cell concentration. (Biomet Biologics GPS Device) The PRP was injected under ultrasound guidance.

Some PRP devices concentrate only platelets without any white blood cell concentration. This evidence and published human clinical data support the use of PRP that concentrate both. Make sure when considering a PRP procedure for tendon injuries to have the published literature guide treatment.

"The repair tissue in the PRP group showed a higher strength at failure (p = 0.021) and Elastic Modulus (p = 0.019). Histologically, PRP-treated tendons featured better organization of the collagen network (p = 0.031) and signs of increased metabolic activity (p = 0.031). It was concluded that PRP increases metabolic activity and seems to advance maturation of repair tissue over nontreated experimentally induced tendon lesions, which suggests that PRP might be beneficial in the treatment of clinical tendon injuries." See Full Abstract

AM
Total Tendon

ApexPRP.com

Another NY Times Article about Platelet Rich Plasma

2009-08-20T14:53:00.000-07:00

The lay press are clearly interested in Platelet Rich Plasma (PRP) as a treatment. It is intriguing to both athletes and reporters. The worldwide scientific data continues to support the use of PRP for tendon and ligament injuries. Large prospective randomized trials are also on-going. Today this article appeared in the New York Times:

"LAST April, at a meeting of the American Medical Society for Sports Medicine, three experts in tendon injuries sat on a stage and talked about their preferred treatments. One said that the best treatment was to inject small amounts of a patient’s own blood into the injured tendon. Another said that the best method was to concentrate the platelets of the patient’s blood and then inject the concentration, a substance known as platelet rich plasma."

Read the Full Article.....

As the lay press examines PRP as a treatment, it is important to realize PRP still needs continued scientific investigation to prove its efficacy by specific indication.

AM
Total Tendon
ApexPRP

NFL Player Platelet Rich Plasma

2009-08-10T06:59:00.000-07:00

Another NFL player has documented success using platelet rich plasma for elbow tendonitis.

See story in Philadelphia newspaper.

This is a recurring pattern of elite athletes being treated with PRP. The evidence is, however, unfortunately weak. We need formal studies to prove these results are valid. If the NFL, MLB, NBA or other leagues sponsored formal trials or at least prospective studies we would better be able to determine the true value of PRP. We could also hopefully answer questions about what formulation of PRP is best.

AM
Total Tendon

ApexPRP.com

New York Times Article: Personal Best

2009-07-22T18:46:00.000-07:00

A medical reporter from the New York Times just wrote an article about platelet rich plasma for her hamstring injury. Below is her part of her story:

"From what they see in patients with injuries like mine, he said, the doctors are enthusiastic. “The results over all are so promising and so positive,” (her doctor told her) As a skeptical medical reporter, I’d say, that’s not very convincing evidence. As an injured runner, I say, “I’ll take it.”

Full Article Link

As the data surrounding platelet rich plasma matures and is published widely, we will be able to answer her questions better about how and when to use PRP most appropriately. For now, however, it is indeed a reasonable treatment for patients with chronic severe tendiniopathy.

AM
Total Tendon
ApexPRP.com

PRP Cutting Edge Treatment for Athletes

2009-07-19T12:19:00.000-07:00

A well written article by Jenny Vrentas was just published about how ailing athletes are using platelet rich plasma. It discusses many of the hot issues surrounding PRP including doping. She notes:

"The NFL and MLB currently regard PRP as a medical treatment, not a performance-enhancement agent, so its use is left to the discretion of team physicians. WADA is still gathering information and will address PRP at upcoming meetings. Its Prohibited List for 2009 doesn't specifically mention PRP, though a spokesperson said blood processing techniques that lead to the release of growth factors generally fall under the "Hormones and Related Substances" section of that list. Athletes, however, can request a Therapeutic Use Exemption for a substance or method, if it is used to treat a serious medical condition."

Click here for the full article.

Hopefully, soon we will have a definitive ruling about PRP. The argument is actually quite simple. Nothing new or more is added to the patient at the time of the treatment. And, although PRP may speed healing from an injury, it has never been shown to enhance performance.

AM
Total Tendon

PRP Published Data Link

2009-07-12T17:15:00.000-07:00

Platelet Rich Plasma papers are being published almost daily now.

PRP Datalink will periodically be updated. Check it out and send in your suggestions for additions to the list. Only articles available in PubMed will be considered.

AM

Dr. Allan Mishra on Sirius-XM Radio

2009-06-29T12:36:00.000-07:00

Dr. Allan Mishra will be featured on Sirius XM radio this week discussing Platelet Rich Plasma.

Click here for the link to the full audio interview.

PRP at the Advanced Team Physician Course

2009-06-23T07:13:00.000-07:00

Dr. Allan Mishra and Dr. Nicola Maffulli debated how to diagnosis and treat patellar tendinopathy at the Advanced Team Physician Course. It was a spirited discussion of when to use imaging, when to hold an athlete out of competition and then how to treat these patients. It was clear from the meeting that there is no consensus about how to treat this sometimes difficult problem. Dr. Mishra advocated early imaging and a biologically enhanced rehabilitation. The biologic enhancement would come from a platelet rich plasma procedure early on at 6-8 weeks after the onset of symptoms.

Obviously we need better prospective randomized trials of PRP, surgery and other therapies for chronic patellar tendinopathy.

PRP Improves Muscle Function

2009-06-07T15:00:00.000-07:00

Platelet Rich Plasma in a study just published in the American Journal of Sports Medicine was found to significantly improve muscle function. This was in a high repetition injury model. This is excellent evidence to enable a human trial of PRP for muscle injuries.

AM
Total Tendon

Use of autologous platelet-rich plasma to treat muscle strain injuries.

Hammond JW, Hinton RY, Curl LA, Muriel JM, Lovering RM.

Am J Sports Med. 2009 Jun;37(6):1135-42.

BACKGROUND: Standard nonoperative therapy for acute muscle strains usually involves short-term rest, ice, and nonsteroidal anti-inflammatory medications, but there is no clear consensus on how to accelerate recovery. HYPOTHESIS: Local delivery of platelet-rich plasma to injured muscles hastens recovery of function. STUDY DESIGN: Controlled laboratory study. METHODS: In vivo, the tibialis anterior muscles of anesthetized Sprague-Dawley rats were injured by a single (large strain) lengthening contraction or multiple (small strain) lengthening contractions, both of which resulted in a significant injury. The tibialis anterior either was injected with platelet-rich plasma, was injected with platelet-poor plasma as a sham treatment, or received no treatment. RESULTS: Both injury protocols yielded a similar loss of force. The platelet-rich plasma only had a beneficial effect at 1 time point after the single contraction injury protocol. However, platelet-rich plasma had a beneficial effect at 2 time points after the multiple contraction injury protocol and resulted in a faster recovery time to full contractile function. The sham injections had no effect compared with no treatment. CONCLUSION: Local delivery of platelet-rich plasma can shorten recovery time after a muscle strain injury in a small-animal model. Recovery of muscle from the high-repetition protocol has already been shown to require myogenesis, whereas recovery from a single strain does not. This difference in mechanism of recovery may explain why platelet-rich plasma was more effective in the high-repetition protocol, because platelet-rich plasma is rich in growth factors that can stimulate myogenesis. CLINICAL RELEVANCE: Because autologous blood products are safe, platelet-rich plasma may be a useful product in clinical treatment of muscle injuries.

Unactivated Platelet Rich Plasma Proves Better

2009-06-02T06:18:00.000-07:00

In a recently published study by Han et al published in the Journal of Bone and Joint Surgery (JBJS June 2009, American Volume), unactivated platelet rich plasma "stimulated chondrogenesis onDay 14 and osteogenesis on Days 28 and 56, whereas thrombin-activatedplatelet-rich plasma acted as an inhibitor of such events. Inaddition, inflammatory cells were detected in demineralizedbone matrix samples that were mixed with thrombin-activatedplatelet-rich plasma. These cells were not present in matrixmixed with platelet-rich plasma alone." (See Full Abstract)

This data clearly supports the use of PRP that has NOT been activated by thrombin and/or calcium. This unactivated form of PRP has also proved useful for chronic tennis elbow. See References

AM
Total Tendon

Platelet Rich Plasma Beats Stem Cells

2009-06-01T07:10:00.000-07:00

In our completely unscientific poll, PRP beat Stem Cells as the best regenerative therapy: 54% to 41%. This I believe points to the "potential" value of PRP as much as its immediate impact. Because PRP is available at the point of care and is significantly less expensive and less controversial, it may gain traction as a regenerative therapy over stem cells. Combination of these two valuable biologic treatments will likely with time and proper study prove to be better than either individually.

AM
Total Tendon

Platelet Rich Plasma and Cartilage Restoration

2009-05-27T08:15:00.001-07:00

Platelet rich plasma was debated in a scientific session at the International Cartilage Research Society Meeting in Miami Florida this week. Dr. Allan Mishra, Dr. Vannini, Dr. Randelli and Dr. Johnson all spoke about PRP. It was moderated by Dr. Alberto Gobbi.

The discussion after these presentations centered around what type of PRP to use for what indications. It is clear that we need better data. The best published clinical data for tendon related injuries and disorders right now supports the use of PRP that is concentrated to 4-5x baseline platelets with an increased concentration of WBCs. See PRP Reference List.

Most studies so far have NOT been well controlled. However, Dr. Randelli (from Milan, Italy) presented the preliminary results of his prospective randomized controlled trial showing how PRP at a concentration of 4-5x baseline with increased WBCs DECREASES pain after arthroscopic rotator cuff repair and may improve healing in small and medium sized tears. Excellent work.

Several papers, posters and presentations at the meeting supported the use of PRP for cartilage restoration. Level one human data (randomized controlled trials), does not yet exist.

More soon.

AM

Total Tendon