Update (October 21, 2010): I did another interview about platelet-rich plasma for Laura Miller which appears in today’s Becker’s Orthopedic & Spine Review. In the article, we discuss tips for orthopaedic surgeons who are considering adding platelet-rich plasma to treatments that they offer.
One of the hottest topics in the sports medicine world, and in sports in general, has been finding methods to speed up healing. Many elite athletes have sought out treatments, both legal and illegal, to accelerate healing of injuries and return to play faster. One of the legal treatments that has received attention recently, and one that MUSC Sports Medicine recently started using, is platelet-rich plasma. I discussed the new technology with David Quick, and his column appears in today’s edition of The Post and Courier.
A Good Idea In Theory
Sports medicine physicians have always sought to get an athlete back on the field or court faster. In the past, some soft tissue injuries, such as muscle strains, ligament sprains, and tendon overuse injuries were treated with the standard rest, ice, compression, and elevation with rest from the sport or activity. Then the physicians and athletes would wait for the body to heal. Typically the healing process involves inflammatory cells and growth factors arriving at the injured area and initiating a healing process that can take weeks or months.
As physicians and surgeons who treat athletes of all levels and ages, we have seen that this time can be frustrating, often causing players to miss most or all of a season. We have searched for methods of accelerating this process by a number of means, such as ultrasound, electrical stimulation, and cortisone injections. These have been marginally effective at best, and sometimes it seems they are counterproductive.
The idea behind platelet-rich plasma is to try to deliver these cells and growth factors directly to the injured area in high concentrations to try to help the body’s natural healing response. The process involves drawing a small amount of the patient’s blood (shown above), spinning off the white blood cells in a centrifuge, and injecting the plasma with platelets into the injured area. The platelets release their growth factors and chemical mediators and initiate a healing cascade, and in theory, attempt to make the injured tendon, ligament, and muscle heal more rapidly.
Platelet-rich plasma peaked national interest when it was reportedly used on Pittsburgh Steelers’ Hines Ward to heal an MCL injury of the knee days before the Super Bowl. While numerous elite athletes have used it in the last year or two, it is starting to be used on high school, college, and even recreational athletes. Sports medicine physicians are starting to use it for many injuries, including tennis elbow, patellar tendinitis, Achilles tendinitis, ligament injuries, and strains of muscles like the quadriceps and hamstrings. Some surgeons have thought that this technology could help improve success rates for surgical procedures. Some manufacturers have a gel-like substance to which platelet-rich plasma can be added. This gel can then be placed at the site of repair, such as a rotator cuff repair, or graft, such as an ACL graft, to theoretically speed healing and fortify the healing tissue.
The Insurance Dilemma
One of the main reasons the use of platelet-rich plasma hasn’t become widespread is that most insurance companies currently do not pay for it. Insurance typically pays for the office visit and the injection procedure, but the actual substance is not covered. Depending on the manufacturer, the out-of-pocket costs are usually about $200, but some products reportedly cost close to $700. Many patients are reluctant to pay $200 or more of their own money when pain relief cannot be guaranteed. While I can certainly understand that point of view, as that is definitely a lot of money to pay on top of insurance, there is another way to look at it. If a PRP injection can get the affected area to heal, then the patient might avoid a surgery, potentially saving thousands of dollars. I expect that when insurance companies start paying for all, or even part, of the cost of platelet-rich plasma, its use will increase tremendously.
Is it Cheating?
I did an interview with Jeremy Repanich several months ago, and in his article in Popular Mechanics, he addresses the idea that platelet-rich plasma could be viewed as cheating. He notes that both the World Anti-Doping Agency and U.S. Anti-Doping Agency have barred PRP unless the athlete obtains an exemption. I expect that physicians, athletes, coaches, and the general public will have differing opinions on whether it should be illegal. Unlike substances such as anabolic steroids and human growth hormone, which are usually synthetic substances, platelet-rich plasma is simply the athlete’s own blood with some of the cells removed. It will be interesting to see how this debate plays out in coming years.
So what is the answer to the question posed by the title of this blog post? Is PRP a breakthrough of modern science for improved healing and performance of athletes or simply hype? Well, we’ll see. While no controlled, long-term studies have shown a definitive benefit, animal studies and early case series on athletes have been encouraging. We need more than just a series of patients having good results to know whether this is a good idea. Studies in which patients are placed into trials where they either get the PRP injection or a placebo and followed over time are crucial. At a minimum, platelet-rich plasma currently offers another option to try before resorting to surgery.
Update (September 19, 2010): The Associated Press is reporting that the World Anti-Doping Agency has removed platelet-rich plasma from its 2011 list of banned practices.
Parts of this post appeared in a post about platelet-rich plasma that I wrote for the MUSC Social Media Newsroom.
I would also like to thank Dr. Roller and Arthrex for granting me permission to use the photos for the post.