Charles
Krupa/Associated PressJose Reyes is one of a few injured Mets who have tried
platelet-rich plasma (PRP) therapy, which channels the healing power in a
patient's own blood to accelerate recovery.
As mounting injuries
have turned into mounting losses for the Mets this summer, they have swiftly
found their season in need of saving. So with many core players on the disabled
list, the team has turned to an intriguing injury treatment that has shown
promise among the ranks of top-tier athletes.
Platelet-rich plasma
(PRP) therapy, which channels the healing power in a patient's own blood to
accelerate recovery, was used to help Pittsburgh Steelers receiver Hines Ward
start in Super Bowl XLIII, former Dodgers closer Takashi Saito avoid Tommy John
surgery last summer and a handful of Rutgers athletes continue their college
careers.
"That's what I
heard, this is a new procedure that helps to heal," Mets All-Star center
fielder Carlos Beltran said earlier this month. "I would try whatever it
takes to get better and to be back on the field."
For Beltran, out with
a bone bruise on his right knee since late June, and teammate Jose Reyes, who
tried the treatment after sustaining a small tear in his right hamstring tendon
in early June, it's still uncertain how much PRP has aided their recovery. Both
are still on the disabled list.
But encouraging
research and case studies of the therapy, particularly when used on tendons and
ligaments, have established it as a hopeful option that may transform sports
medicine -- with its growing use in professional athletics leading the way.
"It's not a
miraculous cure, but we've been having great success," said Robert Monaco,
the Rutgers team physician and a clinical associate at Robert Wood Johnson
Medical School, where he conducts research on PRP. "If the studies
continue to show what we expect, confirm what we're seeing now, I think it's
going to become very common."
Star-Ledger
StaffPlatelet-rich plasma therapy is relatively easy to perform and takes less
than an hour.
The procedure, which
takes less than an hour, is designed to jump-start the body's ability to heal
itself with few side effects or risks. A few tablespoons of the patient's blood
are spun in a centrifuge, concentrating platelets into about a teaspoon of PRP,
which is injected into the injured area.
Platelets are a
natural source of growth factors, which recruit other cells to enhance tissue
regeneration and healing. Those effects are multiplied in PRP, which can have a
concentration of platelets four to 10 times the normal level in blood. For
acute injuries, ones that have just occurred, healing can be accelerated by 30
to 50 percent, Monaco said.
A shorter recovery
period translates to less missed time. And for certain injuries, PRP therapy
may also replace cortisone shots, which can cause damage over time, or preclude
the need for surgery. While the treatment has special appeal to professional
players rushing back to work, another target group is recreational athletes
with chronic injuries like tennis elbow or jumper's knee.
"There are a lot
of things done in sports, on athletes and weekend warriors, that are a little
fadish," said Allan Mishra, an orthopedic surgeon at Stanford University's
Menlo Clinic and a pioneering researcher in the field of PRP therapy. "But
I don't think PRP will fall into that category, simply because the scientific
data supporting it is so strong."
Mishra was first
encouraged by the possibilities of PRP therapy seven years ago, while treating
former NFL quarterback Steve Bono. He had torn each of his Achilles' tendons,
18 months apart, and Mishra tried supplementing the second repair with PRP.
Mishra found that Bono recovered faster and was able to perform quarterback
drills sooner.
Over the past several
years, researchers have worked backward from anecdotal evidence like this to
understand why and how well PRP can treat injuries. Today, a search for
"platelet-rich plasma" in PubMed, a database for biomedical journal
articles, yields more than 5,000 results.
Mishra has published
results showing that 90 percent or more of patients who are facing surgery for
chronic tennis elbow can improve with PRP. Another group conducted a
double-blind, randomized trial comparing PRP and cortisone shots, and found
that, after six months, those treated with PRP had less pain and regained more
function. Not all PRP is the same, however -- there are a handful of preparations
with different concentrations of platelets and white blood cells -- so these
results are for the certain variety used in the study.
Still missing,
though, is this same kind of definitive data for elite athletes, without which
it's difficult for doctors to project what a player's chances of recovery are
-- particularly for injuries like partial rotator cuff tears or ligament tears
in the elbow that can be gray areas. For instance, Yankees outfielder Xavier
Nady tried PRP treatments but still ended up having to undergo Tommy John
surgery on his right elbow.
"I like the
anecdotal stuff, but what do you say to the guys on the Mets or Dodgers or
Yankees when they ask, 'What is my chance of getting better?' " Mishra
said. "If we can develop and really frankly publish data that makes a
difference, so we can say, when someone gets a sore shoulder or sore elbow, he
has an 80 percent chance of getting better. This is kind of science fiction,
but those are the kinds of things we can hope for."
At the beginning of
the decade, Mishra said this kind of treatment seemed "pretty crazy."
Now, he can't keep up with the Google alerts he receives for
"platelet-rich plasma," especially after Super Bowl XLIII.
Ward had sprained his
medial collateral ligament in the AFC Championship Game, an injury that can
sideline a player for several weeks. But the receiver was treated with PRP,
coupled with intense rehabilitation, and started in Tampa two weeks later. In
Saito's case, he had a partially torn ulnar collateral ligament in his throwing
arm and, after PRP therapy, did not need season-ending surgery.
Deanna Poland, a
short sprinter and jumper for the Rutgers track and field team, was one of the
first collegiate athletes on whom Monaco tried PRP therapy. Poland pulled her
left hamstring in two places in March 2006, ending her season and leaving her
with pain and stiffness that lingered for two years.
Last summer, Monaco
tried PRP on one of the sites of the injury. Four weeks later, Poland asked him
to use it on the second site as well. Once she recovered from the soreness of
the injection and rebuilt muscle strength, Poland returned to the track
pain-free and had her most successful outdoor season this past spring.
"Afterward, I
honestly forgot that I had ever had any pain," Poland said. "It felt
like my old hamstring again. It's a great procedure, and I want more people to
know about it."
As the profile of PRP
continues to grow, its use is being monitored by organizational bodies,
including the National Football League, Major League Baseball and the World
Anti-Doping Agency (WADA), spokespersons for each said.
The NFL and MLB
currently regard PRP as a medical treatment, not a performance-enhancement
agent, so its use is left to the discretion of team physicians. WADA is still
gathering information and will address PRP at upcoming meetings. Its Prohibited
List for 2009 doesn't specifically mention PRP, though a spokesperson said
blood processing techniques that lead to the release of growth factors
generally fall under the "Hormones and Related Substances" section of
that list. Athletes, however, can request a Therapeutic Use Exemption for a
substance or method, if it is used to treat a serious medical condition.
The dividing line
between allowed medical treatments and banned performance-enhancing agents is a
doctor's diagnosis, according to Art Caplan, the chair of the Department of
Medical Ethics at the University of Pennsylvania Medical School.
"If you use it
without a diagnosis of disease or injury, it tends to be thought of as
performance enhancement," Caplan said. "But if the doctor says you
need it, it tends to be thought of as therapy."
That is a clear
distinction between PRP therapy and blood doping, a banned practice. Blood
doping boosts the number of red blood cells in an athlete's body to enhance
endurance and performance. PRP is prescribed for injuries to encourage healing
and does not manipulate the bloodstream.
For now, PRP's
best-known use is in the upper-echelon of sports, where pressures and
incentives to stay on the field are intense. But doctors expect it will next
catch on in the general public, particularly among those weekend warriors
looking for a solution to chronic ailments that have slowed their activity. At
one-tenth the cost of surgery, it could be a treatment option insurance
companies authorize in the future.
Outside of sports
medicine, the possibilities are also rich. PRP has been used in fields
including dentistry, heart surgery and wound healing, and studies are looking
into its role in regenerating bone or helping arthritis. As both research and
experience move forward, doctors see a wide range of clientele and applications
on the horizon for PRP.
"The cat is out
of the bag," Monaco said. "Pro sports are leading the way with it,
but it's being adopted quickly."
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