By: M. ALEXANDER OTTO, Frontline Medical Communications
Most evidence
supports the effectiveness of platelet-rich plasma therapy for elbow
tendinitis and anterior cruciate ligament reconstruction, raising the
possibility that insurance companies might one day cover the procedure
for those problems, according to a literature review in the Journal of
the American Academy of Orthopaedic Surgeons.
"The clinical evidence suggests that local injection
of PRP [platelet-rich plasma] containing [white blood cells] may be
beneficial to patients with chronic elbow epicondylitis refractory to
standard nonsurgical treatment. However, the results of PRP treatment of
other chronic tendinopathies are not as clear," concluded lead author
Dr. Wellington Hsu, an orthopedic surgeon at Northwestern University in
Chicago, and his coauthors, also orthopedic surgeons. They also
determined that "although no significant difference in clinical outcomes
has been found, preliminary clinical evidence suggests that PRP may be
beneficial during the ligamentization and maturation processes of
[anterior cruciate ligament] graft healing as well as that of the
patellar tendon graft harvest sites."
However, for rotator cuff and Achilles tendon
repairs, "the results of clinical studies are equivocal, and further
study is needed before definitive conclusions can be drawn and
recommendations can be made." Similarly, "further study is required
before conclusions can be made regarding the efficacy of PRP in the
management of osteochondral lesions and knee osteoarthritis," they
wrote.
"Limited clinical evidence exists demonstrating any
beneficial effects from the use of PRP in bone-healing applications. The
available evidence indicates that PRP is not efficacious either alone
or as an adjunct to local bone graft[s]," the authors wrote. The review
included more than 60 PRP studies and publications (J. Am. Acad. Orthop. Surg. 2013;21:739-48).
PRP is created by spinning down a patient’s blood
sample to isolate and concentrate platelets; the resulting solution is
then injected into their joint spaces, tendon sheaths, or other areas.
It’s rich in growth factors and other substances thought to aid tissue
healing and regeneration.
PRP was first used in the 1950s for dermatology and
oromaxillofacial conditions; "interest in PRP jumped way ahead of the
research" during the last 5 years partly because celebrity athletes have
been using it to recover from injuries. "The hype around PRP definitely
came before the science," which is why insurance companies don’t cover
it, Dr. Hsu said in a statement.
Instead, patients sometimes pay more than $1,000 for
just one of several injections during a typical treatment course. As
evidence builds for some indications, "insurance companies hopefully
will consider coverage," he said.
Success varies depending on the preparation method
and composition. With more than 40 commercial PRP systems on the market,
both preparation method and composition vary from one study to the
next, as do protocols. In addition, "the dose-response curve is not
linear, and a saturation effect has been described in which an
inhibitory cascade ensues once a sufficiently high concentration of
platelets is reached," the authors wrote.
"Because platelets can exert the greatest influence
on healing during or immediately after the inflammatory phase of injury,
some authors have postulated that the timing of the administration of
PRP has a greater impact on healing than does the number of platelets,"
they wrote.
Valued at $45 million in 2009, the PRP market is expected to grow to $126 million by 2016.
Dr. Hsu and most of the other seven authors reported
financial ties to companies that make PRP equipment or products,
including Medtronic Sofamor Danek, Stryker, Terumo Medical, Zimmer,
Baxter, Biomet, ThermoGenesis, BioParadox, Smith & Nephew, and
DePuy.
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