Dr. Allan Mishra on Sirius-XM Radio

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

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

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

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

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