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

Hammond JW, Hinton RY, Curl LA, Muriel JM, Lovering RM.

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.

"Tennis" Article

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

Article Link

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Platelet Rich Plasma Video

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

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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
TotalTendon.com

PRP and Major League Baseball

A major league baseball pitcher begins throwing again after Platelet Rich Plasma.

Read the full story. AM (Total Tendon)

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)

Growth Factors in Shoulder Surgery

In the article outlined below, Dr. Randelli and his colleagues have confirmed that valuable growth factors are released when performing an arthroscopic acromioplasty. This is a landmark paper that will be cited many times as we try to understand how to use platelet rich plasma and other biologic treatments. His work for the first time has confirmed that the mechanical removal of an acromial spur has biologic consequences. Excellent information.

AM
Total Tendon
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Knee Surg Sports Traumatol Arthrosc. 2008 Oct 31.

Release of growth factors after arthroscopic acromioplasty.

Randelli P, Margheritini F, Cabitza P, Dogliotti G, Corsi MM.

It has recently been postulated that a variety of growth factors may be released from cancellous bone after an acromioplasty. The aim of this study was to demonstrate the presence of growth factors in the subacromial space after acromioplasty. Between October 2006 and March 2007, 23 patients underwent arthroscopic acromioplasty. A sample of at least 3 ml of fluid from the shoulder was obtained 15 min after the end of the procedure. At the same time another sample of 3 ml of the patient's venous blood was obtained as a control. The concentrations of growth factors in the fluids collected were determined using enzyme-linked immunosorbent assay (ELISA). The growth factors assayed were platelet-derived growth factor-AB (PDGF-AB), basic fibroblast growth factor basic (bFGF) and transforming growth factor beta 1 (TGF-beta1). The concentrations of TGF-beta1 (p = 0.0001), PDGF-AB (p = 0.02), and bFGF (p <>

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.

Best Treatment for Tennis Elbow?

We are polling people to figure out the best treatment for a patient with 3 months of tennis elbow pain (lateral epicondylitis). The patient is a healthy 42 year old female who plays 2-3 hours per week and can no longer participate. Her pain now occurs even with activities of daily living such as driving. Please vote in the poll on this blog.

Comment as you wish as well.

AM (Total Tendon)