Explain platelet-rich plasma therapy to most people and the rationale seems to make sense. Inject an injured area with your own blood, spun down so only the platelet-rich plasma is left, and healing and recovery will occur faster.
Unfortunately what we think is obvious on paper doesn’t always play out in the practical world. There is no doubt about it, though: I’ve seen hamstring injuries or tennis elbow injuries respond positively to PRP treatments. It wouldn’t be a stretch to think of PRP therapy as the golden treatment for tendinitis.
But just because PRP therapy works for tennis elbow doesn’t mean it will perform in the same way to an injury to the achilles tendon. What we need are more nuanced studies looking at particular injuries, PRP treatment and recovery over the long haul.
Those studies are starting to appear.
Platelet Injections Study on Achilles’ Tendon Injury
In the Jan 13, 2010 issue of the Journal of the American Medical Association one of the most rigorous studies of platelet injections reported that saltwater was found to be as effective as PRP injections. The study looked at people with Achilles’ tendons injuries.
There are still no good treatments for those who suffer from this injury. And unfortunately this injury is one of the toughest to treat. A year after the injury fewer than half of the patients are pain-free.
But this doesn’t mean we should write off platelet-rich plasma injection. As I said in a previous post, injections typically have different effects on different injures and different techniques can improve the effectiveness of an injection.
Platelet Injections Studies and Tennis Elbow
Another study published in The American Journal of Sports Medicine in February of 2010 reported that the injections did help tennis elbow. However, some argue that this study had a design flaw that casts suspicion on the results.
Currently, Dr. Allan K. Mishra is involved on a “prospective, double-blind, randomized trial of 230 patients with lateral epicondylar tendinopathy under the direction of the U.S. Food and Drug Administration.” (“Lateral epicondytar tendiopaty” is long for “tennis elbow.”)
At the end of 2010 he finished enrolling patients. Dr. Misha said, “This study of PRP versus a saline control will provide some evidence of its value in treating that particular problem at that particular stage.” I’ll give you a report on this study as it comes in.
Keep in mind just because PRP works in tennis elbow doesn’t necessarily mean it will work in acute muscle injury; they are just dramatically different problems.
Why Don’t We Have Better PRP Studies?
So, is it safe to treat patients with PRP therapy if we can’t say to them this is going to work for certain? In other words, is PRP therapy ethical sports medicine?
Well, I think, first of all, it’s ethical if you explain exactly what the technology is, what you’re doing, what the expectations are, and you’re very, very honest with the information that’s out there.
So yes, I think it’s ethical.
Until we understand the the most fundamental things about the causes of tendinopathy, we will always be a bit behind in treating. Until then, I think PRP treatment is a viable option for anyone who has exhausted all other methods and wishes to avoid surgery.
Dr. Rick Lehman is a distinguished orthopedic surgeon in St. Louis, Missouri and an articular cartilage reconstruction pioneer He owns U. S. Sports Medicine in Kirkwood, MO, and LehmanHealth. Learn more about Dr. Rick.