Platelet
in-between a Red Blood Cell (RBC) on left and White Blood Cell (WBC) on
right. Platelet Rich Plasma (PRP) contains a high concentration of
platelets (and few RBCs and WBCs)
Researchers at the American Ortheopaedic Society for Sports Medicine’s (AOSSM) Annual Meeting discussing Platelet Rich Plasma (PRP) presented evidence this week that Platelet Rich Plasma (PRP) therapy is a safe and effective method for treating certain sports injuries including cartilage tears.
Researchers at the American Ortheopaedic Society for Sports Medicine’s (AOSSM) Annual Meeting discussing Platelet Rich Plasma (PRP) presented evidence this week that Platelet Rich Plasma (PRP) therapy is a safe and effective method for treating certain sports injuries including cartilage tears.
Although PRP therapies had been used for about a decade to aid in healing after oral and plastic surgeries, Platelet Rich Plasma injections became widely known around 2009 following a couple of (at the time) uncoventional applications of PRP.
In 2009, the NFL’s Pittsburgh Steelers were well on their way to the Super Bowl when defensive star Troy Polamalu suffered calf strain, and former Super Bowl MVP and offensive star Hines Ward sprained his “medial collateral ligament” (MCL).[i]
In preparation of the Super Bowl, both stars turned to a controversial and experimental treatment: platelet-rich plasma injections. Remarkably, both players recovered in time to help the Steelers win the 2009 Super Bowl. The New York Times reported:
“I was next in line, the next guinea pig,” Mr. Ward said, referring to Mr. Polamalu’s experience with platelet-rich plasma. “I think it really helped me. The injury that I had was a severe injury, maybe a four- or six-week injury. In order for me to go out there and play in two weeks, I don’t think anyone with a grade-2 M.C.L. sprain gets back that fast.”Platelet Rich Plasma Injections
Platelet-rich Plasma Injections (or more simply PRP injections) are injections of two common blood constituents: platelets and blood plasma. Proponents of Platelet Rich Plasma injections tout its efficacy (or effectiveness) in treating everything from ligament strains and sprains to tendinitis and osteoarthritis.
Interestingly, the injection fluid is actually created from a sample of the patient/athlete’s own blood that has been concentrated with platelets. [ii]
Platelets are immune cells that course through the blood stream. Platelets are frequently recognized for their ability to stem bleeding (people with low platelet counts are at risk for excessive bleeding).
But platelets also release natural “growth factors” that help repair and regenerate connective tissues – tissues that are frequently damaged in athletes including ligaments, tendons, cartilage, and bone.[iii]
Therefore, some physicians believe that injecting a large number of platelets (and associated growth factors) suspended in blood plasma (the liquid or watery component of blood) at the site of an injury helps heal the injury.
Analysis
PRP has become widely publicized over the past half decade as numerous athletes undergo Platelet Rich Plasma injections. Some of the more publicized recipients of PRP therapy include Troy Polamalu and Hines Ward (noted above), Tiger Woods (a golfer who was recovering from ACL surgery), Kobe Bryant (a basketball player with cartilage damage in his knee), Alex Rodriquez (a baseball player recovering from hip surgery), and Rafael Nadal (a tennis player with knee tendinitis). Many other athletes have also undergone the therapy.
Because of the publicity these athletes and their Platelet Rich Plasma treatments have received, PRP therapy’s efficacy may be somewhat exaggerated. For example, some studies demonstrate that Platelet Rich Plasma therapy does not help more than a placebo for certain injuries.
Even in instances where PRP therapy may be effective, questions linger as to the most effective method for preparing Platelet Rich Plasma.
Regenokine, the PRP therapy used by Kobe Bryant and Alex Rodriquez, concentrates not just platelets but also specificl growth factors. In the U.S., regulations for biological therapies like Platelet Rich Plasma therapy are vague and uncertain (for example, the FDA states that biological compounds like blood can only be “minimally manipulated”).
Because of this uncertainty, physicians are reluctant to try novel PRP therapies that may draw the ire of the FDA. (Currently Chris Renna is the only known physician administering Regenokine in U.S. Some athletes [like Kobe Bryant] have travelled to less restrictive countries like Germany to receive Regenokine.)
Finally, Platelet Rich Plasma therapies are not yet covered by most insurance companies. Because the cost of a single treatment usually runs around $1k to $2k, this will likely prohibit many of us “weekend warriors” (or non-professional athletes) from attempting the therapy.
In conclusion, I doubt that Platelet Rich Plasma therapy is merely just a fringe fad adopted by desperate (and perhaps misguided) celebrity athletes as some may suggest. I do believe PRP injections will become more recognized as effective treatments for certain chronic connective tissue disorders.[iv] Those who follow cutting-edge medical treatments will want to keep an eye out for further developments in Platelet Rich Plasma treatments.
Some things to keep an eye out for include:
- Futher studies demonstrating whether PRP therapy is effective for injuries other than cartilage damage (ie more studies investigating ligament, bone, and tendon injuries).
- Further exploration of the biological and scientific mechanisms by which Platelet Rich Plasma therapies facilitate healing.
- Specific protocols for PRP therapies (ie number of injections, volume of injection, additional manipulations like concentrating growth factors, etc.).
- Insurance coverage for Platelet Rich Plasma injections- Will health insurance companies begin covering PRP therapies? If so, under what restrictions?
What do you think?
- Do you think Platelet Rich Plasma Injections are effective?
- Do you think PRP therapies will gain greater widespread acceptance?
- Can you suggest any novel mechanisms for improving Platelet Rich Plasma Injections? (ie concentrating individual growth factors in addition to concentrating platelets)?
- Any additional concerns or questions?
[i] The “medial collateral ligament” (MCL) of the knee is one of 4 primary ligaments that stabilize the knee. Ligaments connect bone to bone, and the MCL connects the upper leg bone (the femur) with the tibia (the inner bone of the 2 primary bones in the lower leg) on the medial (or inner side) of the knee. The MCL is often strained or torn when the knee buckles inward.
[ii] The actual process entails removing blood from the athlete/patient (perhaps 50 milliliters of blood, or approximately enough blood to fill a shot glass). Then the blood is centrifuged (spun very fast to separate out different components of blood including platelets, red blood cells, and plasma). A concentrated layer of platelets is removed and combined with the plasma. (Plasma is the liquid component of blood that suspends blood cells. Plasma is typically over 90% water and makes up a little over 50% of the blood volume.) From the initial 50 or so milliliters of blood, a preparation of approximately 5ml of platelet-rich plasma (plasma concentrated with platelets) is prepared. This concentrated 5 ml injection delivers perhaps 5 to 10 times the number of platelets as an average 5 ml sample of unconcentrated blood to the site of injury.
[iii] A connective tissue is a strong and diverse tissue. The most frequently referred to connective tissues are probably ligaments, tendons, cartilage, and bone.
Ligaments are tough tissues that connect bones to bones.
A tendon is similar to a ligament except it connects muscles to bones.
Cartilage is a flexible tissue found throughout the body, in our ear, our nose, and particularly in between our bones at joints. Cartilage degeneration in joints (or loss of cartilage at joints) can cause a form of arthritis called “osteoarthritis.” (Osteoarthritis literally means inflammation [-itis] of joints [-arthro] of the bone [-osteo].)
[iv] PRP therapy appears particularly suited for chronic injuries (ie strains and sprains that recur or linger). Chronic injury can lead to scar tissue formation and decreased blood flow to the site of injury. Therefore, injecting blood with concentrated platelets and associated growth factors could help promote recovery.
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