Some time back, my wife had plantar fasciitis. I treated her for 3 months—heel cups, anti-inflammatory medications, cortisone injections, the works. Nothing seemed to help. She fired me and turned to E. Greer Richardson, MD, a renowned foot surgeon and a partner of mine. He treated her, even resorting to a cast for 3 months.
S. Terry Canale, MD
Enter, stage left, PRP. What is PRP? It is not EMR (electronic medical records). It is not BP (British Petroleum). It is platelet-rich plasma. It not only sounds medical and expensive—it is both. Draw the patient’s own blood, centrifuge the cells to isolate the platelet-rich plasma, and re-inject it for a mere four-figure price (averaging more than $1,000) that’s not normally covered by insurance.
PRP is the hot new treatment. Patients, the public, referring physicians, and my fellow orthopaedists can’t seem to get enough of it. “I want the TNT they gave Tiger Woods,” insist my patients.
This issue of AAOS Now takes a close look at this new “phenom” from several angles—from some practical guidelines to a thought-provoking roundtable discussion led by Jo A. Hannafin, MD, on the science, research, and scope of treatment with PRP and its various formulations. A second roundtable, moderated by Letha Y. Griffin, MD, approaches the topic from the perspective of sports medicine.Finally, a report from the AOFAS Annual Meeting discusses one surgeon’s experiences with using PRP to treat Achilles tendinosis.
In addition, Barbara D. Boyan, PhD, provides an update on the research that needs to be done to make PRP a valid, reputable, and respected product. Although I don’t know much about basic science research, I did do an on-line search of recent research on PRP. In just 0.12 seconds, Google returned about 400,000 results! PubMed returned 5,385 peer-reviewed studies. (A list, abridged by me, of the pertinent articles can be found below)
The problem seems to be that most of the reports are anecdotal case descriptions, or level IV clinical research, encompassing a wide range of applications for PRP: tennis elbow, Achilles tendinitis, plantar fasciitis, anterior cruciate ligament surgery, rotator cuff injuries, and more.
I am reminded of the extra corporeal shock-wave therapy that was going to cure not only renal stones but also plantar fasciitis and tennis elbow. Similarly, at one point, different electronic sound wave frequencies to cure decubitus ulcers, tennis elbow, sprained ankles, and Achilles tendinitis were the rage. Thus, I, as well as others, am leery of one form of treatment or medication (platelets) that claims to cure multiple afflictions.
On the other hand, look at the multiple uses of aspirin—aspirin alleviates cures headaches, common colds, and fevers and has anticoagulation, analgesic, and anti-inflammatory powers. I have to admit that I want to believe in the multiplicity of uses for PRP—it would be nice to have something to help this old musculoskeletal system that I live in!
But I’m hoping that this focused issue of AAOS Now will increase awareness of what PRP can realistically be used for; it is not a panacea for everything and it will take considerable research to make PRP a reputable, reliable product that insurance companies will cover.
If you still can’t get enough, then take two boli of PRP and call me in the morning!
Additional reading on platelet-rich plasma
Positive Effect of an Autologous Platelet Concentrate in Lateral Epicondylitis.
Platelet-rich Fibrin Matrix in Arthroscopic Rotator Cuf Repair: A Prospective, Randomized Study.
Platelet Rich Plasma (PRP) Effectively Treats Chronic Achilles Tendonosis.
Treatment of Chronic Elbow Tendinosis With Buffered Platelet-Rich Plasma
Positive Effect of an Autologous Platelet Concentrate in Lateral Epicondylitis in a Double-Blind Randomized Controlled Trial: Platelet-Rich Plasma Versus Corticosteroid Injection With a 1-Year Follow-up
Platelet-rich Plasma: Current Concepts and Application in Sports Medicine
Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy : A Randomized Controlled Trial
Has Platelet-Rich Plasma Any Role in Anterior Cruciate Ligament Allograft Healing?
Effects of platelet-rich plasma on the quality of repair of mechanically induced core lesions in equine superficial digital flexor tendons: A placebo-controlled experimental study.
Anatomic ACL reconstruction: does the platelet-rich plasma accelerate tendon healing?
Treatment of Achilles Tendinopathy with Platelet-Rich Plasma
The effect of platelet-rich plasma on the neovascularization of surgically created equine superficial digital flexor tendon lesions.
Comparison of Achilles Tendon Repair Techniques in a Sheep Model Using a Cross-linked Acellular Porcine Dermal Patch and Platelet-rich Plasma Fibrin Matrix for Augmentation
The influence of platelet-rich plasma on angiogenesis during the early phase of tendon healing.
Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions
The effect of platelet-rich plasma gel in the early phase of patellar tendon healing
Platelet-rich plasma: New clinical application A pilot study for treatment of jumper's knee.
Use of Autologous Platelet-rich Plasma to Treat Muscle Strain Injuries
Platelet-rich plasma alone is not sufficient to enhance suture repair of the ACL in skeletally immature animals: An in vivo study