Platelet-rich plasma, or PRP, has exploded in popularity in sports medicine in recent years. Before you get this treatment, here are some points to consider for your pain or injury.
An Internal medicine physician in South Carolina asks:
I have had a lot of patients in my office recently ask me about platelet-rich plasma. It’s been in the news a lot lately, and I’ve seen your name quoted in an article in the Post and Courier. I have a lot of patients with arthritis. Does it work? What has been your experience with it?
I can’t remember a topic in the last few years in sports medicine that has generated as much public interest as platelet-rich plasma. In the last few months, I’ve done interviews on the subject with the Post and Courier, Becker’s Orthopedic & Spine Review, and even, Popular Mechanics. When Outpatient Surgery Magazine recently asked me to do an interview on emerging trends in orthopaedic surgery and sports medicine, the first one I mentioned was platelet-rich plasma.
Points to consider about platelet-rich plasma
I think the appeal of platelet-rich plasma to the general population comes from a desire to avoid surgery at all costs and wanting the latest and greatest treatments and technologies. I certainly understand the desire to avoid surgery. I see it all the time with people who avidly participate in a specific sport or exercise and don’t want to stop. Certainly I would agree that if you can get someone better without surgery, that is absolutely a desirable goal. Wanting the latest treatment, even when it’s an unproven one, has always been a part of healthcare. I think it’s somewhat related to marketing and media attention, and this is no exception.
I do think that there are a couple points to keep in mind with platelet-rich plasma. First of all, it is still an unproven treatment strategy. The basic science theory makes perfect sense. The physician takes blood from the patient and spins off the white blood cells and red blood cells and reinjects the plasma. Plasma and its growth factors stimulate an inflammatory response, which in theory gets the diseased area to heal.
Research proving the benefits of PRP
However, research that shows a definite improved healing response is lacking. The problem with the studies out there is that they have been mainly case series and not randomized control trials against a placebo, or even traditional treatment measures, such as cortisone injections. Some of the studies give reason for optimism, though, as there does seem to be at least some benefits in the case series. Only time and further research will show whether or not the technology works in real patients.
Another important point is that it seems to be mainly a treatment for tendon and ligament injuries. In theory, it seems to have the best applications for disease processes where there is tendinopathy, or problems where there is a small area of intrinsic degeneration within the tendon. Examples of this are lateral epicondylitis (tennis elbow), patellar tendinopathy, and insertional Achilles tendinopathy. It also seems to work well for certain ligament injuries, such as medial collateral ligament (MCL) injuries. Unfortunately, despite what a few proponents of platelet-rich plasma suggest, I see no reason that it would be beneficial for osteoarthritis, especially arthritis that has progressed to the point that patients have bone rubbing against bone. Maybe I will be wrong, and I hope so, but I don’t see any way that the platelet-rich plasma would stimulate new bone and cartilage formation in a worn out joint.
Talk to your doctor about PRP
Finally, if a patient wonders if he or she is a good candidate for platelet-rich plasma, I think the discussion is best held between the patient and physician. Talk to the sports medicine physician and see if it might be a reasonable option depending on what the problem is. Regrettably, I have had two patients in the last month who traveled over two hours to get PRP for severe arthritis. Not only had both of them traveled a long way to find out that this treatment is probably not appropriate for their problems, but even if it had been appropriate, we likely would not have been able to do it right then anyway. We are close to having done enough to purchase our own centrifuge, but most of the time, these injections are scheduled so that the representative can bring the equipment. The patient would see us initially and together we would decide if it’s an appropriate treatment. If it is, then we would schedule an injection.
Use of PRP for arthritis of the knee
Platelet-rich plasma not covered by insurance
The patient also has to remember that as of now, these injections are not covered by insurance. The patient has to be ready to pay out of pocket for the injection. We only charge what the product company is charging us for it. We do add on a procedure fee for the injection that is billed with insurance, but the actual PRP injection has to be paid for by the patient. I think as the research progresses, and especially if it shows a definite benefit, insurance companies will get on board and start paying for the treatment.
Short-term experience with PRP
As for results in my experience, I will say that at least the short-term results have been encouraging. I have used it for insertional Achilles tendinopathy, quadriceps tendinopathy, and tennis elbow. The patients who are far enough out from the injection to see a result seem to be doing much better than before the injection. For patients with symptoms and problems that might be appropriate for PRP, I am going to use it more. I do think that patients need to have realistic discussions about the technology to see if it is right for them.
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