Thursday, December 17, 2009

Platelet Rich Plasma Story on CNN

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

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

Monday, November 30, 2009

PRP and Ultrasound

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

Thursday, November 26, 2009

PRP Enhances Tendon Vascularity

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


Saturday, November 21, 2009

Platelet Rich Plasma and ACL Surgery

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

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

Wednesday, November 18, 2009

Stem Cells Improve Heart Function

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

Monday, November 16, 2009

Umblical Cord Stem Cells Accelerate Liver DIsease

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

Friday, November 13, 2009

Stem Cell Types

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.

Sunday, November 01, 2009

American Journal of Sports Medicine

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

Total Tendon.com

Saturday, October 03, 2009

AAOS Journal Article about Platelet Rich Plasma


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.

Monday, September 21, 2009

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)

Tuesday, September 08, 2009

Stem Cells from Liposuction

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)

Monday, August 31, 2009

Excellent Evidence for Platelet Rich Plasma (PRP)

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

Thursday, August 20, 2009

Another NY Times Article about Platelet Rich Plasma

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

Monday, August 10, 2009

NFL Player Platelet Rich Plasma

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

Wednesday, July 22, 2009

New York Times Article: Personal Best


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

Sunday, July 19, 2009

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

Sunday, July 12, 2009

PRP Published Data Link

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

Tuesday, June 23, 2009

PRP at the Advanced Team Physician Course


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.

Sunday, June 07, 2009

PRP Improves Muscle Function

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.

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.

Tuesday, June 02, 2009

Unactivated Platelet Rich Plasma Proves Better

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 on Day 14 and osteogenesis on Days 28 and 56, whereas thrombin-activated platelet-rich plasma acted as an inhibitor of such events. In addition, inflammatory cells were detected in demineralized bone matrix samples that were mixed with thrombin-activated platelet-rich plasma. These cells were not present in matrix mixed 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

Monday, June 01, 2009

Platelet Rich Plasma Beats Stem Cells

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

Wednesday, May 27, 2009

Platelet Rich Plasma and Cartilage Restoration


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

Thursday, May 14, 2009

New York Yankee and Platelet Rich Plasma



New York Yankee outfielder Xavier Nady may be using Platelet Rich Plasma (PRP) to treat an ulnar collateral ligament injury in his elbow. This is another example of PRP going more mainstream. It will be important to follow his progress and potential return to play to better evaluate the role of PRP in this injury. Read more of the story.

AM
Total Tendon

ApexPRP.com

Friday, May 08, 2009

Platelet Rich Plasma presented at the NFL Sports Meeting



Platelet rich plasma was discussed today at the NFL Sports Medicine meeting in San Francisco. It was presented in the "alternative" therapies session. No data or specific recommendations were outlined. It is clear we need to actually study the use of PRP in elite athletes before drawing any specific conclusions. It is also important for clinicians and patients to understand that not all PRP is the same. When studies are designed and evaluated, actual platelet counts and white blood cell counts should be included. Only then will we be able to truly define the value of the formulation of PRP derived from any specific machine.

AM
Total Tendon

ApexPRP.com

Sunday, May 03, 2009

Emerging Trends in Tendinopathy


AM with Dr. Robert Nirschl at AMSSM Meeting in Tampa

Dr. Kim Harmon, president of the American Medical Society for Sports Medicine organized an amazing group to discuss tendinopathy in Tampa last week. Dr. Robert Nirschl, the Godfather of tennis elbow spoke about his pioneering work in surgery. Dr. Hakan Alfredson from Sweden discussed the value of eccentric exercises for chronic tendinopathy. Dr. John McShane outlined the value of percutaneous tenotomy and Dr. David Connell from London spoke about the use of blood and stem cells for severe cases. AM presented the case for using platelet rich plasma for tendon related problems.

Overall, it was one of the best sessions ever presented on the topic. Great work and thanks to Dr. Harmon for bringing us all together.

AM
Total Tendon
ApexPRP.com

Wednesday, April 22, 2009

Platelet Rich Plasma at Elite Meetings

Platelet rich plasma is on the agenda for several elite meeting in the next month. The NFL team physician meeting, the American Medical Society for Sports Medicine and the International Cartilage Research Society all have PRP presentations. BloodCure will report on these meetings including the discussions. Post any questions you may have on this blog and we'll try to get the answers. This level of attention by these established academic conferences means PRP is close to becoming a mainstream treatment.

AM
Total Tendon

Friday, March 27, 2009

Platelet Rich Plasma for Muscle Injuries

This study supports the use of PRP for acute muscle injuries. PRP treated animals recovered faster and the authors suggest PRP may stimulate myogenesis. A prospective, randomized trial of PRP for acute severe strains is warranted.

AM
Total Tendon
ApexPRP
------------------------------------------------------------------------------------------------------------------

Use of Autologous Platelet-rich Plasma to Treat Muscle Strain Injuries.

American Journal of Sports Medicine

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.

Wednesday, March 11, 2009

"Tennis" Article


An article about the use of Platelet Rich Plasma for chronic tendonitis was just published on Tennis.com

Article Link

Total Tendon

ApexPRP

Monday, February 16, 2009

Platelet Rich Plasma New York Times Article

The New York Times just published an article about the use of Platelet Rich Plasma for professional and weekend warrior athletes.

NY Times PRP Article


Check it out and post your comments here.

AM
Total Tendon

ApexPRP

Sunday, February 01, 2009

Super Bowl Platelet Rich Plasma Treatment

Pittsburgh Steeler wide receiver Hines Ward did in fact have a platelet rich plasma (PRP) treatment. This was confirmed by BloodCure.com late Monday. He was apparently treated with PRP for a medial collateral ligament (MCL) sprain. The specific form of PRP has yet to be declared but it is apparent that he was treated with plasma that contained an increased concentration of platelets. This by the definition proposed by Dr. Marx, is indeed platelet rich plasma.

Previously, PRP has been used to treat the same injury in major league soccer players. On the second play of the game, Mr. Ward caught a 38 yard pass and contributed significantly to the Steelers' Super Bowl win.

The reporting on the novel treatment by NBC just prior to his important catch was excellent timing. Good work! For more information about PRP, please visit: ApexPRP.com

AM
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