Platelet-rich plasma (PRP) is a treatment proposed to improve tissue healing for a variety of musculoskeletal conditions. It falls into the category of orthobiologic treatments. In an article on PRP I shared last week, I discussed the theory behind PRP use, its cost and insurance issues and more. In this article, I share different diagnoses for which PRP has been used. I also briefly review some of the data on the effectiveness of platelet-rich plasma for these conditions.
Lateral epicondylitis (tennis elbow)
Lateral epicondylitis is a cause of chronic pain on the lateral side (outside) of the elbow. Counterforce straps, physical therapy, cortisone injections, and even surgery are common treatments. PRP is occasionally used as a first-line treatment or as a measure to try before surgery is considered. Platelet-rich plasma has been shown to have some benefit in improving pain and function in several studies.
Patellar tendon, Achilles tendon and other tendon disorders
Achilles tendinopathy is a debilitating cause of ankle pain in active individuals. They have pain within the tendon above its insertion into the calcaneus (heel bone), and the pain limits sports and exercise. Likewise, patellar tendinopathy causes pain within the tendon just below its insertion into the patella (kneecap). Research so far has failed to show that PRP provides a significant benefit for patients with Achilles tendinopathy or patellar tendinopathy.
Injury to the hamstring muscles in the back of the thigh can often occur in sports as well as physical exercise. For some athletes, hamstring injuries can be challenging to overcome, as they often result in lengthy absences from activity and frequent reinjury. Injection of PRP into the injured hamstring muscles has been tried to decrease times for healing and return to sports and to cut down on reinjury. Some studies show benefit of PRP with those two outcomes, while other studies show little long-term benefit.
Rotator cuff repair
Many orthopedic surgeons have tried to improve the outcomes of rotator cuff repair surgeries by injecting PRP into the shoulder after completing the repair of the tendon. Several studies have looked at the use of platelet-rich plasma to augment surgical repairs of rotator cuff tears. So far, current evidence demonstrates little benefit in terms of outcomes after surgery or re-tear rates.
While traditional treatments for osteoarthritis, such as activity modification, anti-inflammatory medications, use of assistive devices for walking, braces and injections can often provide pain relief, some doctors also use PRP to decrease a patient’s pain. Several recent studies have shown that PRP injections might lead to better outcomes in patients with knee osteoarthritis than either placebo or hyaluronic acid injections (viscosupplementation). Further research will help to define its place in the treatment of osteoarthritis.
Much more research in the coming years will further determine the effectiveness of platelet-rich plasma for these and other bone and joint conditions. Studies that demonstrate the optimal concentration of platelets and white blood cells and the best PRP preparation techniques might improve efficacy as well.
If you are considering PRP for an injury or painful condition, consider discussing the condition and treatment with your surgeon or doctor.
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