Platelet Rich Plasma Tennis Elbow Study

Enrollment in the most comprehensive platelet rich plasma study to date was recently completed.  The study is a double blind randomized trial of 230 patients of PRP vs Saline for chronic tennis elbow.  It followed the protocol outlined in the first published study on the topic. 
(American Journal of Sports Medicine--Mishra and Pavelko, 2006)

It will take 8-10 months to finish the follow up and analyze the data but it is a milestone to have simply completed enrollment in this important investigation.  We can all look forward to the results.

AM
TotalTendon

Platelet Rich Plasma 2011

2011 will be the year we begin to figure out how to best use platelet rich plasma.  For almost a decade now, it has been employed as a treatment for a variety of problems.  Last year, level one data was published showing how PRP is better than cortisone for tennis elbow.  Other data revealed that achilles tendionpathy that is mild to moderate and that had NOT been treated did not get significantly better with PRP and exercise compared to a saline injection and exercise.

This year, large specialty organizations have dedicated time to debate the value of PRP.  Via this forums, we will learn from experts.  New formulations and indications will emerge as some will fade.  These changes will be based on presentation and publication of elite data.

AM
Total Tendon

Embryonic Stem Cells used to Treat Spinal Cord Injury Patient

For the first time in history, embryonic stem cells have been used to treat a patient with an acute spinal cord injury.  According to several reports the protocol calls for using the treatment within two weeks of the initial injury.  Geron, the company sponsoring the trial has spent years and tens of millions of dollars just to get to this first patient.  The hope is for this first phase that safety can be demonstrated.

We have officially entered the era of biologic medicine.  For quite some time there has been promise, now there is action.  It is hard to compute the amount of effort that has likely gone into getting to just this point.  It is the researchers and especially this first brave but tragic patient that deserve the credit for this advancement.

In the future, the use of either adult stem cells or induced pluripotent stem cells may become a better option.  For now, regardless of your stance on the ethics of embryonic stem cells this day must be marked as a milestone.

AM
Total Tendon

HalfDome.TV

Sports Illustrated Platelet Rich Plasma Article

Sports Illustrated recently published an article about platelet rich plasma.

"While Galea's use of PRP on Tiger Woods and other athletes has stirred debate, the technique is not particularly new. Allan Mishra, adjunct clinical assistant professor of orthopedic surgery at the Stanford University Medical Center and a pioneer of PRP therapy, has been using it for nearly a decade. In a breakthrough study last year based on work by Mishra, PRP therapy performed significantly better than cortisone -- and with fewer side effects since it makes use of the patient's own blood -- in the treatment of chronic lateral elbow tendinosis, aka tennis elbow. "I can say pretty definitively that PRP is a reasonable choice for tendon [injuries]," Mishra says. "Now it needs to be studied in other applications."


The breakthrough study was actually performed by Dr. Taco Gosens from the Netherlands.  He and his colleagues have published the best clinical data to date on the use of platelet rich plasma for tendinopathy.  
To read more of the SI article, click here


For sports medicine related videos, go to HalfDome.TV

AAOS Discussion about Platelet Rich Plasma

The American Academy of Orthopaedic Surgery recently published a expert panel discussion about platelet rich plasma (PRP).  Its goal was to help clarify the many issues surrounding this novel therapy.  Dr. Allan Mishra, Dr. Freddie Fu, Dr. Steven Arnoczky and Dr. Jo Hannafin participated.  Below is an excerpt from the article:

Dr. Hannafin: I did a Google search and found more than 400,000 citations for PRP treatment, including YouTube videos on how the procedure is performed. Clearly, patients, physicians, and scientists are interested in the use of PRP. What conditions is PRP being used for?

Dr. Mishra: I use it almost exclusively in treating tendinopathy, particularly chronic tendinopathy that has failed to respond to other treatment modalities. That would include conditions such as chronic, recalcitrant lateral epicondylitis, patellar tendinopathy, and Achilles tendinopathy. I think the data—and the work that I have been doing for almost a decade now—provide the greatest support for its use in that area.

To read more of the article, click here.

AM

For PRP and other related videos, go to HalfDome.TV

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

Stem Cell Video Description

This is a video describing stem cells.  It helps with understanding why stem cells are being studied for a variety of problems including heart disease and cancer.  Harvesting the value of these cells and other treatments such as platelet rich plasma will transform how we take care of patients within the next five years.

AM

High School Stem Cell Course

In the San Francisco Bay Area, it is now possible to begin studying stem cell biology in high school.  This is an important and interesting development.  If we can expose young men and women to this exciting and new field early, they will lead to discoveries we can now only dream of today. 

To read more about this new program:  click here.

AM
Total Tendon

Trial of Embryonic Stem Cells for Spinal Cord Injury

The FDA lifted a hold on Geron's trial of embryonic stem cells to treat spinal cord injuries.  Geron hopes to begin the trial by the end of the year.  The specific cell line in use for this trial is GRNOPC1 which contains cells called oligodendrocyte progenitor cells. 

This is an interesting development.  Geron's stock popped 17% ($80-90 million in market cap) today on the news.  That speaks to the importance of a regulatory pathway for novel biologic treatments.  With the value in their stock, they can fund at least part of the trial.

Any thoughts out there on how to best fund new biologic treatments through the early clinical stages?

AM

Personalized Medicine

We are at the beginning of Personalized Medicine.  This concept can take many forms.  It can mean an evaluation the DNA of a breast cancer that predicts a poor prognosis.  (Overexpression of the human epidermal growth factor receptor type 2, HER2)  It can also mean a diagnostic test to determine if a patient will response to a specific type of cancer treatment like Gleevec (imatinib).  Recently, several companies have started offering over the counter DNA tests.  These are presently being evaluated by the FDA because of concerns for consistently and how they will be interpreted. 

On the horizon are also various autologous (your own) engineering treatments such as stem cells from your bone marrow or fat to treat heart disease.  Platelet rich plasma is another form of personalized medicine that has evolved rapidly in orthopedics and sports medicine.

An important question is who will pay for the continued development of these diagnostic tools and treatments?  The present macro health care environment is all about covering more patients with less money.  The micro enviroment (patients coming into the office) are demanding access to these new tests and treatments without regard to cost.  We will have to solve this fundamental conflict sooner than later.  It is not possible to have both.

AM
Total Tendon.com
ApexPRP.com

How to Grow an Ear...

Regnereative medicine is simply exploding.  New body parts are now being grown in the lab.

See a video of Dr. Tony Atala in his lab at Wake Forest growing an ear.  Simply amazing.

Video of how to grow an ear

AM