Google Trends for Platelet Rich Plasma Rose 107% Last Week

The interest in Platelet Rich Plasma  (PRP) rose dramatically last week according to Google Trends.  This autologous biologic product and treatment continues to gain traction as a simple way to address challenging problems such as chronic tennis elbow.  As more clinicians, researchers and patients gain experience with it, better formulations and protocols will be developed to treat injuries and disorders safely and effectively.

We are now in the second decade of using PRP therapeutically and this trend is a signpost of worldwide interest.  This interest will also spark new innovations surrounding the use of blood therapeutically.

Patients and even payers will benefit from blood based breakthroughs because many newer biologic procedures will be as or more effective than surgery and less costly.

AM
Total Tendon

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Platelet Rich Plasma Helps for "High" Ankle Sprains

"High" ankle sprains are significant injuries that typically result in prolonged recovery and time away from sports.  This type of injury involves the strong ligaments that connect two of the major bones of the ankle.  They are also known as syndesmotic injuries.

A recent randomized, controlled trial found that athletes that were treated with ultrasonic guided injections returned to play faster and has less pain than a control group.  Return to play was almost 20 days faster for the PRP group.  (40.8 days vs 59.6 days, p = 0.006)  (See abstract below)

This data supports the use of PRP for athletes with this type of injury.  Further studies will help confirm this value.

AM
TotalTendon

Knee Surg Sports Traumatol Arthrosc. 2014 Jun 18. [Epub ahead of print]

Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial.

Laver L1, Carmont MR, McConkey MO, Palmanovich E, Yaacobi E, Mann G, Nyska M, Kots E, Mei-Dan O.

Author information

Abstract

PURPOSE:

Syndesmotic sprains are uncommon injuries that require prolonged recovery. The influence of ultrasound-guided injections of platelet-rich plasma (PRP) into the injured antero-inferior tibio-fibular ligaments (AITFL) in athletes on return to play (RTP) and dynamic stability was studied.

METHODS:

Sixteen elite athletes with AITFL tears were randomized to a treatment group receiving injections of PRP or to a control group. All patients followed an identical rehabilitation protocol and RTP criteria. Patients were prospectively evaluated for clinical ability to return to full activity and residual pain. Dynamic ultrasound examinations were performed at initial examination and at 6 weeks post-injury to demonstrate re-stabilization of the syndesmosis joint and correlation with subjective outcome.

RESULTS:

All patients presented with a tear to the AITFL with dynamic syndesmosis instability in dorsiflexion-external rotation, and larger neutral tibia-fibula distance on ultrasound. Early diagnosis and treatment lead to shorter RTP, with 40.8 (±8.9) and 59.6 (±12.0) days for the PRP and control groups, respectively (p = 0.006). Significantly less residual pain upon return to activity was found in the PRP group; five patients (62.5 %) in the control group returned to play with minor discomfort versus one patient in the treatment group (12.5 %). One patient in the control group had continuous pain and disability and subsequently underwent syndesmosis reconstruction.

CONCLUSIONS:

Athletes suffering from high ankle sprains benefit from ultrasound-guided PRP injections with a shorter RTP, re-stabilization of the syndesmosis joint and less long-term residual pain. LEVEL OF EVIDENCE: II.

Platelet Rich Plasma and Knee Arthritis

Knee arthritis is a very common problem for patients worldwide.  With the aging of the population this will become one of the most important medical issues to address with biologic therapies.

Conflicting results have recently been published about the use of platelet rich plasma in the treatment of knee arthritis.  Filardo, Kon et al found no significant differences between PRP and hyaluronic acid injections.  (see full abstract).  Conversely, Cerza et al did find significantly better clinical outcomes when patients were treated with PRP vs hyaluronic acid injections. (see full abstract) The version of PRP used in these two studies were different.  The first study also used three injections and the second four weekly injections.  Clearly, more research is needed to clarify the value of PRP for knee arthritis and determine the optimal formulations and techniques.

AM
TotalTendon

See the video below for a brief description of knee arthritis

Steroid Injections may Deplete Tendon Stem Cell Pools

Steroid injections are commonly used for a number of musculoskeletal conditions.  There is increasing evidence to suggest this is not a good idea especially for tendon related problems such as tennis elbow or rotator cuff tendinopathy.  Clinical studies only confirm short term pain relief for cortisone injections.  Basic science studies are now revealing that such injections may deplete tendon stems cells pools or increase the risk of tendon rupture.  (See Abstract Below)

Platelet rich plasma has been shown to be superior to cortisone injection in a double blind randomized trial at least for tennis elbow.  When discussing the value of evolving biologic therapies it is crucial to compare them to commonly used treatments.  In the case of cortisone for tendon related injuries and disorders at least for now PRP is the superior choice based on basic science and clinical publications for tennis elbow.  (Gosens et al Study)

Allan Mishra, MD

@Bloodcure
TotalTendon

J Orthop Res. 2012 Aug 8. 

The effects of dexamethasone on human patellar tendon stem cells: Implications for dexamethasone treatment of tendon injury.

Zhang J, Keenan C, Wang JH.

Source

Abstract

Injection of Dexamethasone (Dex) is commonly used in clinics to treat tendon injury such as tendinopathy because of its anti-inflammatory capabilities. However, serious adverse effects have been reported as a result of Dex treatment, such as impaired tendon healing and tendon rupture...... Dex treatment depletes the stem cell pool and leads to the formation of non-tendinous tissues (e.g., fatty and cartilage-like tissues), which make tendon susceptible to rupture. 

© 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. 

Copyright © 2012 Orthopaedic Research Society.

See Full Abstract