You may have heard of Platelet Rich Plasma or PRP treatment. Does it deliver on its promise?
In today’s blog post, I’d like to address the topic of Platelet Rick Plasma (PRP), a sports injury treatment that’s attracted a lot of public attention due to its effectiveness and its use by a few high-profile athletes.
PRP in the news
In 2009, The New York Times reported that professional football player Hines Ward of the Pittsburgh Steelers underwent PRP therapy for a sprained medial collateral ligament. The Steelers went on to win Super Bowl XLIII two weeks later, and Hines credited the PRP therapy with his speedy recovery.
Many early media reports on the potential benefits of PRP also highlighted other elite athletes (including Tiger Woods and Alex Rodriguez) who have been successfully treated with PRP. The general public became immediately intrigued by its effects, with much of the curiosity focusing on the fact that PRP is derived from a patient’s own blood, making it a safe biologic treatment.
What is PRP?
Platelet rich plasma is produced from a person’s own blood and contains concentrations of platelets above baseline values. (Platelets are cells that circulate through the blood and are critical for blood clotting.)
After a blood sample is obtained from the patient, the blood is placed into a centrifuge, which is a machine that spins the blood and separates it into many components. The platelets and liquid plasma portion of the blood contain many factors that are essential for cell recruitment, multiplication and specialization — all required for healing.
PRP is given to patients through an injection, and ultrasound guidance can assist in the precise placement of the PRP. Because PRP is given in the hope of enhancing the “inflammatory phase” of healing, it is typically recommended that NSAIDs (such as Advil and Motrin) are avoided around the time of the PRP administration.
Is PRP treatment effective?
The good news is yes! I have a lot of personal experience with the use of PRP in high-level collegiate and professional athletes, as well as in recreational athletes. I will give a brief overview below of the orthopaedic conditions that have been shown to benefit from treatment with PRP in controlled human and basic science studies.
PRP has been shown to improve the symptoms of knee osteoarthritis and chronic tendinitis, especially in the elbow (i.e., lateral epicondylitis or “tennis elbow”) and in the Achilles tendon. Some studies have shown promising results with regards to improvement in rotator cuff healing. PRP can also improve pain scores after surgery, which results in less narcotic use.
PRP has also been shown to speed the recovery of acute soft tissue injuries, including hamstring and quadriceps strains. These soft tissue injuries can often take weeks to heal and can keep an athlete out of competition for an extended period of time. In a controlled trial that was published last month in the American Journal of Sports Medicine, athletes with moderate hamstring strains underwent one PRP injection into the injured site. The mean time to return to play was 42.5 days in the control group and 26.7 days in the PRP group. For this reason, PRP has gained a lot of attention in professional sports. A quicker recovery translates into an earlier return to play and ultimately a financial incentive.
ACL reconstructions typically have good outcomes, but graft healing can be slow. The enzymes in the lubricating fluid inside of the knee break down blood clots and can slow ACL graft healing. Graft healing is important since it provides the strength of the new ACL, decreasing the chance for re-injury. PRP can accelerate the healing with its growth factors, and numerous studies have shown quicker ACL graft maturation on MRI and histological studies when PRP has been added at the time of the ACL reconstruction.
What are some of the concerns with PRP?
PRP is a low-risk procedure since it comes from the patient’s own blood. It is a concentrated source of growth and cellular signaling factors that play a significant role in biological healing, and the risk of infection is low as the procedure is done under sterile conditions.
However, studies in the literature show variable results in outcomes after PRP administration. We have to remember that orthopaedic conditions vary from person to person and are also affected by anatomic location, associated injuries, and natural history. In addition, there are over 40 different types of commercially available PRP. These formulations have different processing techniques, blood volume requirements, additives, and white blood cell content, thereby making clinical outcome comparisons difficult.
My professional opinion is that each athlete, and each injury, should be carefully considered within the context of the individual’s history and pathophysiology. If a patient expresses interest in PRP treatment, the conversation needs to include weighing all of the risks and benefits. Every new treatment should not be considered the “magic cure.”