Platelet-Rich Plasma Shows Effectiveness in Severe Achilles Tendinosis

During a presentation at the EFORT (European Ferederation of National Associations of Orthopedics and Traumatology) Congress, Dr. Raymond Monto, M.D. reported that Platelet-Rich Plasma showed effectiveness in patients with severe Achilles tendinosis who failed conventional treatments.

Dr. Monto's investigation was conducted in Madrid, Spain and focused on 27 patients who failed non-surgical treatments for 8 consecutive months. Patients' pretreatment average AOFAS (American Orthopedic Foot and Ankle Society) score was 34 and all patients had evidence of chronic tendinosis, with 9 having partial tears of the Achilles.

Using ultrasound guidance, Dr. Monto injected 4 ccs of PRP into the site of injury, then had patients fully immobilized removing stress from the Achilles for 48 hours. The most dramatic results came in AOFAS scores: 1 month after receiving PRP treatment, patients' scores increased to 84 . After 2 months, scores increased to 87. After 6 months, scores again increased to 92 with resolution of abnormalities found through MRI and ultrasound in 25 patients.

Another recent study conducted in The Netherlands concluded PRP was no more effective in treating moderate Achilles tendinosis than non-surgical, conventional methods at 12-24 week (3-6 month) follow-up. This 54 patient study was published in JAMA (Journal of the American Medical Association) at its midpoint in January, 2010.

Importantly, the difference between the two studies are: following injection Dr. Monto's patients were fully immobilized for 48 hours; Dr. Monto seemed to indicate his platelet count to an area of 2 million platelets and focused on patients with severe cases who failed conventional treatments for 8 consecutive months; The Netherlands study accepted all patients with chronic tendinosis; The Netherlands study involved more patients, yet did not indicate whether patients were immobilized or platelet concentration levels.

This is important as optimal healing has occurred when stress was removed from the injury following PRP therapy.

Dr. Monto concluded his presentation by saying, "PRP is an effective treatment for patients with severe Achillies tendinosis, with relatively no risk...there were no complications in our series...and potentially high benefits."

Reference: Monto R. Platelet-rich plasma treatment for chronic Achilles tendinosis. Paper #F264. Presented at the EFORT Congress 2010. June 2-5, 2010. Madrid.

JAMA Article review

Public Perception of Platelet-Rich Plasma

Does the use of platelet-rich plasma by professional athletes, change public perception about effectiveness and application? While hundreds of sources (including this blog) have differentiated platelet-rich plasma therapy from steroid use and blood-doping, many remain unaware of the differences. Other posts on this blog explain the different aims and means of PRP compared to illegal substances used in sport. Thus, this post contends that in the current age of professional athletics, where fans' heroes may have cheated their games, the use of PRP by athletes may create public skepticism. While this may be considered a negative result, it also serves to build awareness about PRP and encourage further public investigation. Because the true beneficiaries of platelet-rich plasma will be the working and active public, it the duty of doctors and writers to properly fill the informational gaps that exist as a result of mass-appeal reporting on this therapy.

The public knows pro athletes rely heavily on their bodies ability to perform at intensely high levels. This has conflicting implications: fans know athletes need to be healthy to perform and they know some are willing to test ethical boundaries to gain a physical advantage. For the kind of money pro athletes compete for, few are surprised that these boundaries are crossed and many people are quick to jump to uneducated conclusions about PRP.

An example of these overly quick judgments occurred in December when Tiger Woods was implicated by many bloggers and writers, to having used steroids when he received PRP injections in his surgically repaired knee. CNN's Anderson Cooper accurately distinguished between the two soon after.

It could also be argued that the public perceives treatment effectiveness favorably when athletes credit PRP for their hastened return following injury. This also has negative implications because in such cases, PRP is used simultaneously with other accepted and experimental therapies. To what degree PRP was used in relation to other therapies and recovery procedures, is not reported. There is no way of discerning to what extent PRP actually influenced the recovery in these instances.

In the last four months alone, it has been revealed John Daly, Joakim Noah, Brandon Roy, Blake Griffin and Chris Canty all received PRP for various soft-tissue injuries. In this same time period, at least five legitimate, clinical studies have been published on platelet-rich plasma, with four indicating PRP is or may be effective.

The majority of media attention surrounding PRP however, does not focus on the clinical studies. The construction worker with chronic tennis elbow is then unaware that he may be back to work sooner because he does not require surgery. The mother of four living each day in pain due to Plantars Fasciitis, is unaware she may be able to soon get on the field and play with her children. Therefore, the medical community along with writers, must continue to publish PRP clinical studies and expose them to the public, regardless of supporting or negative outcomes.

PRP has far more potential to one day save jobs and improve people's lives than it does in professional athletics. While platelet-rich plasma therapy remains in development and should currently be offered as a last resort to invasive surgery, improving the flow of accurate information will bring future accessibility and sound judgment to the use of PRP.

Platelet-Rich Plasma Injection More Effective than Cortisone Injection

A recently published study by Dr. Taco Gosens from the Netherlands, revealed platelet-rich plasma (PRP) injections were more effective than cortisone injections for chronic tennis elbow. The controlled trial studied 100 patients with chronic lateral epicondylitis (tennis elbow). The results are reported in this month's (Feb.) Academy Journal of Sports Medicine.

Patients were randomly selected into either the PRP group or corticosteroid group. Successful treatment was defined as "more than 25% reduction in visual analog score or DASH score without a re-intervention after 1 year."

At one-year follow-up, 73% of patients in the platelet-rich plasma group were treated successfully compared with just 51% of the cortisone group. What was further significant: the corticosteroid group was initially better and then declined, whereas the PRP group improved steadily.

In conclusion, the study reported treatment of chronic lateral epicondylitis with PRP reduces pain and significantly increases function. PRP significantly exceeds the effect of corticosteroid injection for the same injury.

Currently, PRP remains a therapy for patients who have failed other non-surgical treatments. As cortisone injections are temporary pain relievers and can cause tissue damage, they have also been a final resort when other non-surgical therapies fail.

Based on this study, PRP could eventually be used as a substitute for cortisone injections. PRP is shown to be more effective and has the advantage of using patients' own natural components to heal soft-tissue tears. Cortisone as an outside agent introduced to the body, is designed to temporarily relieve pain, but can be further damaging to an injury. As evidence supporting PRP effectiveness continues to be published and insurance companies come to understand PRP's value, the substitution is likely.

View Abstract.

Platelet-Rich Plasma Arthritis Video

Susan Chamblee had tried just about everything to fix her extremely painful, arthritic knees. With her final option being total knee replacements, requiring a long, painstaking recovery and the added expense of surgery, she discovered platelet-rich plasma therapy (PRP) and opted to try it.

While PRP is in its infancy in development and has had both effective and ineffective research results, this video illustrates why PRP should be used in cases such as Ms. Chamblee's.

Watch this Video


Note: Ms. Chamblee was in no way compensated for her story and testimony.

Platelet-Rich Plasma and Arthritis

A recently published PRP study from the Rizzoli Orthopedic Institute in Bologna, Italy, found platelet-rich plasma (PRP) injected in knees with degenerative cartilage lesions (arthritis), can improve knee function.

The study, published in October 2009 by Kon et al, consisted of 100 patients and 115 knees affected by chronic degeneration. 150-ml of venous blood was twice centrifuge. 3 PRP units of 5-ml each were for the intra-articular injections. Patients were evaluated clinically at the beginning and the end of the treatment and at both 6 and 12 months following treatment. IKDC, objective and subjective, and EQ and VAS were used for clinical evaluation. Importance of sex, age, BMI and grade of OA was evaluated statistically.

The statistical results show steady improvement up to 6 months following treatment. The results at the 12 month follow-up were significantly worse, although higher than the basal level.

These results indicate intra-articular PRP knee injections produce favorable results on degenerative cartilage lesions.

Click here for summary of study.

Recent JAMA Platelet Rich Plasma article

A new PRP study from researchers in the Netherlands declared platelet-rich plasma is ineffective in healing moderate Achilles tendinopathy. Researchers had 54 patients gauge pain levels at 6, 12 and 24 weeks following treatment. One patient group was given a PRP injection and the other, a saline injection (placebo). The study published in JAMA (Journal of the American Medical Association) by de Vos et al, concluded PRP was no more effective than the saline injection when both groups added therapeutic exercises into their recovery routines.

The study has received extensive media coverage and has been quick to cite PRP as ineffective. It is important to view the controls of the study before conclusions are made however.

This study's data does support PRP's ineffectiveness after a 6 month period in only moderate Achilles tendinopathy. It does not include either minor or severe cases. This study was published at its midpoint. Researchers will follow up on patients' recovery in 12 months and it is possible PRP patients will continue to improve and the placebo group will not.

Importantly, no data is available on platelet concentrations given to the PRP group. As this study is one of many to come determining the proper use of PRP, platelet concentration levels in PRP groups will be crucial to disclose. If patients received too low a platelet concentration in their injection, results would likely vary in higher doses. This will be a vital component of determining the optimal formula of PRP.

Patients receiving PRP to treat plantar fasciitis and Achilles tendinopathy have been benefited by the use of a boot following therapy. This allows the injury time to heal without chronic tension and permits the growth factors to work without continued trauma. There is no data in this study on whether boots were used.

Legitimate studies are very important to further the understanding of PRP's effectiveness and uses and this study should be recognized as such. The study is however, incomplete. This must be taken into account before significant conclusions are drawn about PRP's effectiveness.

Regenerative Medicine in US and China

Regenerative Medicine is a developing interdisciplinary field of research and clinical applications aimed at repairing, replacing or regenerating cells, tissues, or organs. Regenerative Medicine uses a combination of approaches including gene therapy, stem cell transplantation, tissue engineering, and the reprogramming of cell and tissue types.

An article in this month's Regenerative Medicine Journal states, "China has been able to catapult itself into the forefront of regenerative medicine" (Thorsteinsdóttir et al). While Chinese investment in stem cell research has increased by over US$40 billion in the past 14 years, and has increased its peer-reviewed publishing from 37 in 2000 to 1,116 in 2008, the emergence is in large part due to the lack of regulation.

According to the Toronto Sun, there are over 200 cases of clinics and hospitals offering completely unproven stem cell therapies for profit, greatly tainting China's emergence.

Meanwhile, while the founding of US-based biotech companies has slowed due to the high-price of research and development and FDA regulation, the United States has awarded generous grants to to Universities and research teams in Michigan and California to help economic development through regenerative medical innovation.