PRP enhances healing after Achilles Tendon Rupture

PRP being added to an Achilles Tendon Repair

If you rupture your Achilles tendon, new data suggests platelet rich plasma can enhance the healing.  In an abstract published by the journal Lancet, researchers from England discussed how they treated patients who had ruptured their Achilles with either PRP or a placebo.  Six weeks later, they biopsied the healing tendons under ultrasonic guidance.  In the study, they found improved cell content, better tendon fiber structure and more normal collagen (type 1) in the tendons treated with PRP.  The study included 20 patients (10 PRP, 10 Control) and is the first investigation in humans showing the significant value of using PRP to help treat Achilles tendon ruptures.  Of course, more data will be needed to confirm these important findings.  For years, I have been adding PRP to my achilles tendon repairs and if I ever rupture my own, I will certainly request that PRP is included in the treatment protocol.

AM 

Total Tendon

Systemic Effects of Platelet Rich Plasma

In a well done study, researchers have shown when athletes are given an intratendinous injection of leukocyte-enriched platelet rich plasma (PRP), they will have elevated levels of growth factors in their blood up to four days after the procedure.  (see abstract below)

Vascular-endothelial growth factor  (VEGF), a molecule known to enhance angiogenesis (new blood vessel formation), was elevated in all 25 patients after injection.  This is very interesting and important data suggesting PRP may trigger a systemic response.  It also helps explain why PRP may be a useful treatment for tendon related injuries and disorders.   Several controlled studies confirm PRP can be an effective treatment for chronic tennis elbow and this study may reveal one of the mechanisms of action.
Tennis Elbow Study 1,  Tennis Elbow Study 2

It would be quite interesting and important to also measure growth factors in athletes who have received a saline injection or dry needling of their tendons to see if the act of introducing a needle into a damaged tendon produces a similar or different systemic response.

AM
TotalTendon.com

Am J Sports Med. 2012 Dec 4.

The Systemic Effects of Platelet-Rich Plasma Injection.

Wasterlain AS, Braun HJ, Harris AH, Kim HJ, Dragoo JL.

Source

Department of Orthopaedic Surgery, Stanford University, Stanford, California.

Abstract

BACKGROUND:Platelet-rich plasma (PRP) is an autologous blood product used to treat acute and chronic tendon, ligament, and muscle injuries in over 86,000 athletes in the United States annually. The World Anti-Doping Agency (WADA) banned intramuscular PRP injections in competitive athletes in 2010 because of concerns that it may increase performance-enhancing growth factors. The ban on PRP was removed in 2011 because of limited evidence for a systemic ergogenic effect of PRP, but the growth factors within PRP remain prohibited. PURPOSE:To quantify the effect of PRP injection on systemic growth factors with performance-enhancing effects and to identify molecular markers to detect treated athletes. STUDY DESIGN:Descriptive laboratory study. METHODS:Six ergogenic growth factors monitored by WADA-human growth hormone (hGH), insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), basic fibroblast growth factor (bFGF or FGF-2), vascular endothelial growth factor (VEGF), and platelet-derived growth factor-BB (PDGF-BB)-were measured in 25 patients before (baseline) and at 0.25, 3, 24, 48, 72, and 96 hours after intratendinous leukocyte-rich PRP injection. Eating and exercise were prohibited for 3 hours before testing. Growth factors were quantified by enzyme-linked immunosorbent assay, and the change relative to each patient's baseline was calculated. RESULTS:Relative to serum, PRP contained significantly more bFGF (226 vs 5 pg/mL), VEGF (1426 vs 236 pg/mL), and PDGF-BB (26,285 vs 392 pg/mL), but IGF-1 and hGH were not elevated. Serum levels increased significantly for IGF-1 at 24 and 48 hours, for bFGF at 72 and 96 hours, and for VEGF at 3, 24, 48, 72, and 96 hours after PRP injection. Additionally, VEGF was increased in all 25 patients after PRP treatment. CONCLUSION:Serum IGF-1, VEGF, and bFGF levels are significantly elevated after PRP injection, supporting a possible ergogenic effect of PRP. An indirect marker for hGH doping, the product of IGFBP-3 × IGF-1, also significantly increased after PRP. Platelet-rich plasma appears to trigger an increase in circulating growth factors through activating biological pathways rather than by serving as a vehicle for the direct delivery of presynthesized growth factors. Elevated VEGF was observed in all patients after PRP, and ≥88% of patients had elevated VEGF at each time point from 3 to 96 hours after PRP, suggesting that VEGF may be a sensitive molecular marker to detect athletes recently treated with PRP. CLINICAL RELEVANCE:This is the first and only adequately powered study of the systemic effects of PRP. We present evidence that PRP contains and may trigger systemic increases in substances currently banned in competitive athletes. Finally, we provide evidence that VEGF could serve as a useful molecular marker to detect athletes treated with PRP.

WADA to Approve PRP

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)

PRP Cutting Edge Treatment for Athletes

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