Kobe Bryant Tears Achilles Tendon

Kobe Bryant last night in made a cut on the basketball court he has made a million times and felt like "somebody kicked" him.  He unfortunately sustained an achilles tendon tear.   See the video below of the injury:



He will likely have surgery in the near future.  The surgical takes about an hour.  Rehabilitation typically takes anywhere from 9-12 months.  Some surgeons are augmenting achilles repairs with platelet-rich plasma pointing to anecdotal evidence suggesting PRP could accelerate recovery.

Here is a video of how to clinically diagnosis an achilles tendon tear:



Below are some pictures that outline the steps in an Achilles tendon repair  
Torn tendon, suture repair, closure

If anyone can come back from this injury, Kobe can.  The NBA and all of basketball are wishing him the the best for his surgery if needed and for his full recovery.

AM
TotalTendon

Platelet Rich Plasma Forum at AAOS

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

Stanford Football Player may start after PRP San Francisco Chronicle

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

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.

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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

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

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

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

Future Trends in Sports Medicine

Below is the abstract from a soon to be published article discussing the use of PRP for tendon and muscle. It will be published in a volume of Clinics in Sports Medicine entitled: "Future Trends in Sports Medicine"

AM (Total Tendon, ApexPRP)

Treatment of Tendon and Muscle Using Platelet-Rich Plasma.Mishra A, Woodall J Jr, Vieira A.Clin Sports Med. 2009 Jan;28(1):113-125.Department of Orthopedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, 1300 Crane Street, Menlo Park, CA 94025, USA.

Tendon and muscle injuries are common in elite and weekend athletes. Treatment of these injuries in both groups is rapidly evolving. Sports medicine patients are demanding better and less invasive solutions for all types of musculoskeletal disorders. In this context, platelet-rich plasma (PRP) has emerged as a potential solution. PRP is a fraction of whole blood containing concentrated growth factors and proteins. These cytokines direct tissue healing through autocrine and paracrine effects. The number of basic science, animal, and human investigations of PRP for tendon and muscle injuries worldwide has risen sharply in recent years. These studies are helping clinicians better understand the mechanisms of PRP and are guiding novel treatment protocols. In this paper, the value of PRP as a treatment for acute or chronic tendon and muscle disorders is explored.

Platelet Rich Plasma helps Treat Achilles Tendons

The published and presented data supporting the use of buffered platelet rich plasma continues to grow. PRP has now been shown in a small study to help treat chronic achilles tendonitis (tendinosis).

AM (Total Tendon, ApexPRP)

Guelfi et al recently presented a series of 16 cases of non-insertional achilles tendonitis at a recent meeting in Brazil. They used unactivated, buffered platelet rich plasma prepared using the Biomet Recover System, also known as the GPS. Significant improvement was found in all 16 of their patients via imaging. They also reported the patients returning to sports at six months with a high degree of satisfaction.

MRI Prior to PRP

4 months after PRP

"International Federation of Foot and Ankle Societies", , Third Triennial Scientific Meeting, Costa do Sauipe, Bahia, Brazil September 18-20, 2008. (The case shown is from AM)

PRP promotes Cell Proliferation

Below is still more basic science evidence to suggest platelet rich plasma is helpful for wound healing and tissue engineering.

AM (Total Tendon)

Plast Reconstr Surg. 2008 Nov;122(5):1352-60.

Proliferation-promoting effect of platelet-rich plasma on human adipose-derived stem cells and human dermal fibroblasts.

Kakudo N, Minakata T, Mitsui T, Kushida S, Notodihardjo FZ, Kusumoto K.

Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan. kakudon@takii.kmu.ac.jp

BACKGROUND: This study evaluated changes in platelet-derived growth factor (PDGF)-AB and transforming growth factor (TGF)-beta1 release from platelets by platelet-rich plasma activation, and the proliferation potential of activated platelet-rich plasma and platelet-poor plasma on human adipose-derived stem cells and human dermal fibroblasts. METHODS: Platelet-rich plasma was prepared using a double-spin method, with the number of platelets counted in each preparation stage. Platelet-rich and platelet-poor plasma were activated with autologous thrombin and calcium chloride, and levels of platelet-released PDGF-AB and TGF-beta1 were determined by enzyme-linked immunosorbent assay. Cells were cultured for 1, 4, or 7 days in serum-free Dulbecco's Modified Eagle Medium supplemented with 5% whole blood plasma, nonactivated platelet-rich plasma, nonactivated platelet-poor plasma, activated platelet-rich plasma, or activated platelet-poor plasma. In parallel, these cells were cultured for 1, 4, or 7 days in serum-free Dulbecco's Modified Eagle Medium supplemented with 1%, 5%, 10%, or 20% activated platelet-rich plasma. The cultured human adipose-derived stem cells and human dermal fibroblasts were assayed for proliferation. RESULTS: Platelet-rich plasma contained approximately 7.9 times as many platelets as whole blood, and its activation was associated with the release of large amounts of PDGF-AB and TGF-beta1. Adding activated platelet-rich or platelet-poor plasma significantly promoted the proliferation of human adipose-derived stem cells and human dermal fibroblasts. Adding 5% activated platelet-rich plasma to the medium maximally promoted cell proliferation, but activated platelet-rich plasma at 20% did not promote it. CONCLUSIONS: Platelet-rich plasma can enhance the proliferation of human adipose-derived stem cells and human dermal fibroblasts. These results support clinical platelet-rich plasma application for cell-based, soft-tissue engineering and wound healing.

San Francisco Chronicle Article: "Miracle Cure"

The San Francisco Chronicle calls platelet rich plasma a "Miracle Cure". To read the full story, click here.

Join the FREE Total Tendon Network to interact with patients and providers familar with platelet rich plasma as a treatment.

For more information:

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Platelet Rich Plasma CBS News

Platelet rich plasma and Dr. Allan Mishra's techniques were featured tonight on the CBS evening news. Here is a link to one of the stories:

CBS Evening News Story

For more information about PRP, please visit: ApexPRP.com

Achilles Tendon Repair with PRP

Published data supports the use of platelet rich plasma to augment Achilles Tendon repairs. In the picture above, PRP is injected into the sheath around the tendon just prior to skin closure.

Achilles Tendon Tears and Platelet Rich Plasma 2

PRP has been proposed to improve the outcome of achilles tendon repair surgery. Very recently (Sanchez 2007), a study was published that confirmed this hypothesis. If you are having chronic achilles issues or have recently suffered a tear of the tendon, talk to your physician about potentially using platelet rich plasma.

Basic science data also supports its use. As always, review of all treatment options is best done with your treating doctor.

ApexPRP.com