Tuesday, December 29, 2009

Differentiating "Blood Doping" and "Blood Spinning"

Platelet-Rich Plasma Therapy (PRP) has begun to adopt the appropriate title of "blood spinning." This post aims to differentiate that label from "blood doping," a separate treatment performed for a completely different purpose. While a blood transufussion means of doping relies on an athlete's blood being spun in a centrifuge similar to PRP, the materials being extracted from the centrifuge are different in both procedures, with seperate uses and intentions. Simply stated, PRP aims to repair soft-tissue tears naturally, blood doping attempts to enhance red blood cell counts artificially.

PRP is the removal of a small amount of blood from a patient with a soft tissue injury (tendon, ligament, muscle, etc.). The blood contains healing components called platelets that release growth factors used by the body to grow and create cells. These platelets are not normally used by the body in large enough concentrations in such injuries. Patients' blood is thus spun in a centrifuge, which extracts these natural platelets. The platelets are then concentrated in a specific dose and injected directly into the injury, catalyzing the body's natural healing abilities. This entire process takes roughly an hour.

If you were trying to fuse a split 2 x 4 with a small drop of wood glue, it may stick momentarily, but when used, it would be unstable and likely break again. PRP gives the woodworker the entire bottle of wood glue to fuse the split wood. The process is very safe with almost no risk of side effects because the platelets are natural and come from the patient. The World Anti-Doping Agency (WADA) has approved the use of PRP in all soft tissue excluding intramuscular injection. When injected directly into muscle, it is possible PRP can enhance growth, thus creating a similar outcome to steroid use.

PRP has been widely used in professional athletics and deemed a legal form of therapy for soft tissue tears and tendinitis but the therapies true potential lies in healing injuries for the weekend warrior and the construction worker with a torn elbow tendon.

"Blood Doping" of the other hand has various means and a multitude of procedures, all with the same intention: to increase red blood cells in the blood stream. It has been deemed illegal by WADA, the International Olympic Committee and International Cyclist Union and can have life threatening side effects. Red blood cells carry oxygen to muscles and increases red blood cell count resulting in oxygen being taken to muscles more efficiently. This gives aerobic athletes a significant advantage over competition as they battle less fatigue.

While red cell counts can be increased naturally by training at high altitudes where less oxygen is present, blood doping gives athletes an increased and illegal boost. To gain the higher count through doping, athletes inject themselves with erythropoietin (EPO), a hormone that stimulates red blood cell production. EPO has been pervasive in the top levels of cycling for the past two decades. Because it thickens the blood, it has dangerous side effects such as blood clotting that can cause heart attacks and strokes. An abnormally high red blood cell count can also result in impaired blood flow and death.

Athletes can also have four units of blood removed a month prior to competition and spun through a centrifuge to remove the red cells. Three weeks later, the concentrated red blood cells are transfused back into the athlete. Thus, the blood spinning is inherent to this process but the material being collected is unique and for a different purpose.

If PRP is the wood glue that reconnects the severed 2 x 4 making it once again useful, blood doping is taking a pristine 2 x 4 and infusing it with graphite for artificial strengthening.

Where PRP is described as "blood spinning" it should not be confused with or categorized as "blood doping."

Monday, December 28, 2009

CNN's Platelet Rich Plasma and Tiger Woods Segment

Anderson Cooper and Dr. Sanjay Gupta explained PRP and the treatment of Tiger Woods on AC360 on December 17. The PRP segment is informative and easy to understand. Cooper and Dr. Gupta discuss Dr. Anthony Galea use of PRP in Woods' knee following surgery. Although Dr. Galea has been arrested for distribution of Human Growth Hormone in the US, there has been no indication Tiger had any association with this practice.

While PRP is "blood spinning," it should not be confused with "blood doping." This segment distinguishes blood spinning as acceptable and beneficial practice.

Wednesday, December 16, 2009

Monday, December 7, 2009

Ultrasound's Importance in Measuring Platelet-Rich Plasma Therapy Results

In a European PRP study using horses as test subjects, utilizing ultrasound to measure healing levels proved to be very useful. Ultrasound uncovered the improvement in tissue alignment during healing with PRP as opposed to placebo. Ultrasound also confined the healing course is more efficient using PRP (Bosch et al).

Excerpt from Study:

"The effectiveness of new therapies to treat tendon injuries is difficult to determine and is often based on semi-quantitative methods, such as grey level analysis of ultrasonographic images or subjective pain scores. The alternatives are costly and long-lasting end-stage studies using experimental animals. In this study, a method of ultrasonographic tissue characterisation (UTC), using mathematical analysis of contiguous transverse ultrasonographic images, was used for intra-vital monitoring of the healing trajectory of standardised tendon lesions treated with platelet rich plasma (PRP) or placebo. Using UTC it was possible to detect significant differences between the groups in the various phases of repair. At end stage, over 80% of pixels showed correct alignment in the PRP group, compared with just over 60% in the placebo group (P<0.05). UTC also showed significant differences in the course of the healing process between PRP treated and placebo treated animals throughout the experiment. It was concluded that computerised analysis of ultrasonographic images is an excellent tool for objective longitudinal monitoring of the effects of treatments for superficial digital flexor tendon lesions in horses."

Researchers: Bosch G, René van Weeren P, Barneveld A, van Schie HT.

Article Title: "Computerised analysis of standardised ultrasonographic images to monitor the repair of surgically created core lesions in equine superficial digital flexor tendons following treatment with intratendinous platelet rich plasma or placebo"

Location and Publisher: Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.

Date Published: 2009, Nov 19

Implant Dentistry Reports Platelet-Rich Plasma Enhances Bone and Tissue Growth

At the American Academy of Implant Dentistry prominent researcher and Journal of Oral Implantology editor, James Rutkowski, DMD, PhD, reported the potential for accelerated healing of dental implants using platelet-rich plasma. While this is not an orthopedic study, Dr. Rutkowski noted its continued success in sports injuries and orthopedics.

Dr. Rutkowski said about PRP in dental implants, "...PRP treatments can jump start bone growth and implant adherence in just two weeks...Accelerated healing is a goal we've been seeking in implant dentistry and we now have treatment that activates the natural healing process. It is a very promising development..."

He estimated 10 percent of implant dentists have used PRP and that number will continue to rise.

It seems increasingly numbers of prominent doctors believe PRP is effective and that trend will continue.

Monday, November 23, 2009

Bob Kurtz's PRP Testimony

A Video Testimonial from former CNN sportscaster, current pastor and Guinness Book World Record holder for most consecutive golf holes played.

Thursday, November 19, 2009

Revolutionary Tendonitis Treatment Leads to Amazing Guiness Book World Record

At 68 years old, Pastor Bob Kurtz of Cullman, Alabama, beat his own world record in June by playing 500 consecutive holes of golf, an astounding feat that was aided by a revolutionary new tendonitis treatment called Platelet-Rich Plasma (PRP).

A group from Pastor Bob’s congregation at St. John’s Protestant Evangelical Church devised the concept of a golf marathon to raise money for children in Kenya. An avid golfer who spent his free time devoted to the development of his golf game, Pastor Bob was asked to be the “iron man” of the marathon as he does not have the typical background of your average pastor.

He began his career in broadcast journalism and twenty years later, at 45, was the top sportscaster for CNN. But his position lacked a spiritual connection. Kurtz believed the industry was too material-centric revolving around money, power, and egos. Following in his father Chuck Kurtz’s footsteps, Bob turned to the ministry. He devoted his energy to serving God and others as a pastor for more than 20 years. Then it was decided that Mr. Kurtz would become the ultimate golf iron man.

A standard golf marathon consists of 100 holes, but Kurtz’s love for golf and his philanthropic energy wouldn’t settle for the status quo. He completed three marathons of 168 holes and 220 holes, and, in 2008, broke the 401 hole Guinness Book World Record by playing 405 consecutive holes of golf.

“Then I thought I could do 500,” says Kurtz. “I had a year to get ready and I was ready except for one problem, and that was a torn tendon in my right elbow. That was a major concern.”

Kurtz had been hitting hundreds of golf balls per day to prepare for the ultimate marathon accomplishment and in his conditioning, acquired what is known as the golfer’s elbow: a soft-tissue tendon tear on the inside of his right elbow.

“I was physically strong enough to hit that many golf balls but was growing more and more concerned about the right elbow, the golfer’s elbow,” Kurtz continued. “It’s very, very painful.”

With the 500 hole marathon approaching, and an increasingly painful tendon tear, Kurtz sought help at Alabama Spine and Joint Center in Birmingham. With surgery requiring excessive recovery time and strength loss, Kurtz needed a medical treatment that could expedite the healing process and discovered Platelet-Rich Plasma Therapy (PRP).

“Mr. Kurtz opted for PRP, a developing treatment that has gained prominence for its potential to heal soft-tissue injuries, such as tennis elbow, golfer’s elbow, Achilles and knee tendonitis, quickly” says Dr. Kenneth A. Jaffe, an Orthopedic surgeon at ASJC. “It is very safe and there is almost no risk of complication or side effects. Due to its infancy in research though, it is still considered somewhat experimental.”

Mr. Kurtz’s treatment was a very simple, straightforward procedure to perform. PRP requires about an hour and involves removing a small amount of a patient’s blood and then rapidly spinning it in a centrifuge or filtration system. Healing components of the blood known as platelets are separated from red blood cells and re-injected directly into the injured area, where blood would rarely go otherwise. The platelets are naturally occurring, and normally used by the body in smaller doses. This procedure can catalyze the body’s natural healing response and uses a highly concentrated dose, from 3 to 10 times that of normal blood, of platelets.

“The healing components used by PRP are autologous, meaning they come from the patient’s own body. PRP injections are very safe and there is almost no risk of rejection,” says Dr. Jaffe. “The question is to what extent the injection will heal the injury.”

While a multitude of clinical studies are underway, the research to this point has concluded PRP can be beneficial and warrants further research. PRP has been used for over 20 years in the dental community and is finally making its way into the treatment of sports injuries and tendonitis. An October review in the prestigious Journal of American Academy of Orthopedic Medicine concluded the treatment continues to show promise and more research is needed to prove its full effectiveness.

“PRP tendon treatment is new and I believe patients should be well informed when facing treatment options,” said Dr. Jaffe. “Mr. Kurtz needed his body to perform at a high-level and was willing to be on the leading edge of this treatment for its sake.”

Many other athletes who also require frequent peak performances have turned to PRP. Hines Ward of the Pittsburgh Steelers credits his 2009 Super Bowl success to PRP. Ward became injured in the first quarter of a playoff game with a sprain to the medial lateral ligament in his right knee. Ward received PRP the following day. In the Super Bowl, two weeks later, Ward caught two passes in the Steelers victory over the Arizona Cardinals.

In a New York Times article, Ward stated, “I think it really helped me. The injury that I had was a severe injury, maybe a four- or six-week injury. In order for me to go out there and play in two weeks, I don’t think anyone with a grade-2 M.C.L. sprain gets back that fast.”

Many athletes have also successfully treated their injury and expedited their recovery, including Ward’s teammate Troy Palamalu, New York Giants Chris Canty, LA Dodgers pitcher Taiko Saito, PGA Tour golfer John Daly and recently, 2009 NBA draft, number-one selection Blake Griffin.

“It is not just professional athletes who may benefit from PRP,” Dr. Jaffe says, “the recreational athlete and elderly alike can have their injuries treated. It may eliminate the necessity for certain individuals to receive surgery as their only corrective means. It’s significantly cheaper and less painstaking than soft-tissue repair surgery.”

Mr. Kurtz agrees. “It wasn’t difficult at all. It’s kind of interesting because you can sit there and watch what they’re doing. It turned out to reduce a lot of the pain and gave me my confidence back. In all honesty, I never thought about it (the injury) the two days of the marathon.”

Following PRP, Mr. Kurtz completed the 500 hole marathon in June, by playing for two days and one night. When he completed his 500th hole, blowing away his previously held record of 405 holes, he had raised over $40,000 for children’s charities. The energetic and ambitious Mr. Kurtz was very thankful for the option of receiving PRP.

“This injection helped me out enormously. It exceeded my hopes.” Kurtz then chuckled, “We finished with the 500th hole and the last thing I thought about was an aching elbow. There were a lot of other things that ached, but not the elbow.”

Monday, November 9, 2009

Platelet Rich Plasma and Athlete Healing

The Chicago Daily Herald published an article about the potential benefits of Platelet Rich Plasma. The 11/9 article cites Eric Hedstrom, a Purdue offensive lineman, who has battled constant injury through his college career. Hedstrom missed the majority of last season with a shoulder blowout that required surgery. Following the initial surgery, it took Eric 3 months before he was able to remove his arm from the sling.

On the opening day of practice this season, Hedstrom re-injured the shoulder and was faced with the same situation from the previous season. This season however, he had a new treatment option: Platelet Rich Plasma.

Hedstrom opted for the therapy under the guidance of the Chicago Bulls and White Sox team doctor, Dr. Romeo. Since having Platelet Rich Plasma injected into his injury, Hedstrom has seen promising results. "So far," he says, "its healing a lot faster and a lot better." His arm is out of the sling and being strengthened after a month.

The article notes that it is not just high-level athletes Platelet Rich Plasma might benefit. The Therapy may benefit everyone from high school track runners to the elderly.

The mother of an injured high school athlete who received PRP in a bone injury and recovered, had this to say about those debating whether to receive the therapy: "I would say defenitely get it. Because its not going to hurt you, but there's always the possibility that it could help you."

To read the full article, click here.

Monday, November 2, 2009

The Doctors of Platelet-Rich Plasma Therapy

As an Orthopedic Surgeon, I help patients prevent and correct disorders of the skeletal system, muscles, joints and ligaments. I recently read an article about Platelet-Rich Plasma Therapy written by a neurologist who markets the general benefits of PRP. It is of concern that when doctors work outside of their area of expertise, they oftentimes make exaggerated claims for financial gain. Patients need to be mindful of the motives when seeking PRP Therapy in the community. It seems PRP advertisements can be disguised as a legitimate clinical documents from reliable sources.

Platelet-Rich Plasma Treatment simply stated is an injection of a concentrated dose of blood platelets into a soft tissue injury to catalyze the body's natural healing response and expedite recovery. These soft tissue injuries in which PRP has been shown to be effective, include tendons, ligaments, joints and muscles. The soft-tissue injury is treated by Orthopedic surgeons as Orthopedics is defined by MedicineNet.com as: "the branch of medicine that deals with the prevention or correction of injuries or disorders of the skeletal system and associated muscle, joints, and ligaments."

It is my contention that patients with injuries which could be potentially aided by PRP Therapy should consult physicians who specialize in treating those injuries: the Orthopedic Community, and not any doctor willing to administer PRP Therapy for monetary compensation. While research and clinical data show Platelet-Rich Plasma Therapy is very safe and has tremendous potential as an alternative to invasive soft-tissue surgical repair of the musculoskeletal system, it is important that the patient and treating physician know the facts behind the therapy when deciding if it is right for their injury. The question to be addressed is what is the probability that it will work for each condition? It is the understanding of when to use PRP or surgery that makes the orthopaedist a valuable resources to the patient.

The origins of PRP Therapy research for musculoskeletal conditions comes from the Orthopedic community. As this is our area of expertise, it is our community that should be handling PRP Therapy consultations. Patients interested in the receiving PRP treatment for musculoskeletal conditions should not be mislead into taking it from anyone outside the Orthopedic community. The Orthopaedist is an expert in the diagnosis and treatment of injuries with invasive or non invasive techniques. Doctors practicing hybridized medical specificity, such as "neuro-orthopedics," and looking to administer PRP Therapy, should be called into question, not for an appointment.

Saturday, October 31, 2009

Platelet Rich Plasma in Joint Injuries and Osteoarthritis

Arthritis specialists predict by the year 2030 there will be 67 million Americas with arthritis and Platelet-Rich Plasma injections may alleviate if not eliminate the pain arthritis will cause. An article in the Boston Globe centers around Josephine "Jo" Foster, a 79 year old Massachusetts restaurant hostess plagued by osteoarthritis in her knees, who opted for PRP injections as treatment.

"I haven't got time for arthritis," says Foster in the article. "That's old people, not me."

Disease trackers warn the number of young Americans with painful osteoarthritis will increase due to obesity as time elapses.

“It’s not at all uncommon to see severe osteoarthritis in people at age 40 because of the presence of obesity," says the Arthritis Foundation's chief science officer, Dr. John Harden said.

But for Jo, knee replacement surgery was not an option. She had both knees injected with PRP in September.

“My doctor said there may be pain so I went home and waited for the pain,’’ said Foster, who has undergone a variety of other noninvasive therapies unsuccessfully.

“There is no pain now,’’ Foster continued. “None whatsoever.’’

Foster’s physician, Dr. Joanne Borg-Stein, specializes in rehabilitation and sports medicine. Dr. Borg-Stein has treated about 175 patients with Platelet-Rich Plasma injections in the past year.

“I like to be honest with patients and tell them that we are just starting to get data in from animal trials, that we don’t have really good human data,’’ Borg-Stein said. “People have to be willing to accept that they are on the leading edge with this.’’

To read this Boston Globe article, click here and scroll down to "Boston Globe: What a Pain"

Wednesday, October 28, 2009

Blake Griffin to receive Platelet-Rich Plasma Treatment

2009 #1 NBA Draft Choice Blake Griffin, of the Los Angeles Clippers, sustained a non-displaced stress fracture in his left patella and will undergo Platelet-Rich Plasma Treatment. Griffin was injured in the last pre-season game against the New Orleans Hornets on Friday, October 23. His MRI confirmed the diagnosis given by the Clippers team doctor and another specialist, Neal ElAttrache. Elattrache administered Platelet-Rich Plasma to Takashi Saito, pitcher for the Los Angeles Dodgers earlier in the year. Griffin is to return in action in 6 weeks following bone stimulation and PRP Treatment.

Read the Clippers blog post about Griffin's injury here.

Tuesday, October 27, 2009

Platelet-Rich Plasma Therapy Video

Former CNN Sportscaster and current pastor Bob Kurtz, set a Guinness Book World Record by playing an astounding 500 consecutive holes. His feat was nearly hindered by golfer's elbow. This is his story and a tribute to how effective this cutting-edge treatment is. To watch please click here.

Partial Tendon Tear Treatment Video

Former college athlete and current baseball coach, Scott Grissett undergoes Platelet-Rich Plasma Therapy for a partial tendon tear in his ankle. Hear his thoughts about the treatment in real time as he takes you step-by-step through the treatment. To watch this video, please click here.

Sunday, October 25, 2009

PubMed summary of new Platelet-Rich Plasma AAOS article

The following is a summary of the current AAOS article from the PubMed website. PubMed article ID: 19794217

Platelet-rich plasma: current concepts and application in sports medicine.

Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY 10003, USA.

"Platelet-rich plasma is defined as autologous blood with a concentration of platelets above baseline values. Platelet-rich plasma has been used in maxillofacial and plastic surgery since the 1990s; its use in sports medicine is growing given its potential to enhance muscle and tendon healing. In vitro studies suggest that growth factors released by platelets recruit reparative cells and may augment soft-tissue repair. Although minimal clinical evidence is currently available, the use of platelet-rich plasma has increased, given its safety as well as the availability of new devices for outpatient preparation and delivery. Its use in surgery to augment rotator cuff and Achilles tendon repair has also been reported. As the marketing of platelet-rich plasma increases, orthopaedic surgeons must be informed regarding the available preparation devices and their differences. Many controlled clinical trials are under way, but clinical use should be approached cautiously until high-level clinical evidence supporting platelet-rich plasma efficacy is available."

To view this go to PubMed.gov and type in the article ID number at the top of the post.

Thursday, October 22, 2009

Platelet-RIch: Defined

Question: What is contained in the Platelet-Rich compound that creates the "natural healing" element of the PRP therapy?

While Platelet-Rich Plasma Therapy is in its fledgling stages of development, "it has been shown in dozens of published studies to improve the healing of wounds, tendons and bone," according to ApexPRP.com, online home to PRP's leading developer Dr. Allan Mishra. The plasma is a concentrated dosage of platelets higher than the level your body would deliver to the injury on its own. This compound is created through a filtration system separating red blood cells from platelets that release proteins and other healing proteins. This separation process takes place following a small blood drawing from the patient. The red blood cells are rotated at high speeds by a centrifuge creating the division.

The Platelet-Rich Plasma is injected directly into an injury with a concentration of platelets 3-10 times higher than a blood stream can deliver on its own. Thus, the platelets are derived from the patients own blood creating an organic plasma compound that can most accurately be described as platelet-rich.

While the therapy is new, it has great promise and the majority of studies have concluded there is an obligation to discover the full healing potential of Platelet-Rich Plasma.

Wednesday, October 21, 2009

Platelet-Rich Plasma Therapy

Platelet-Rich Plasma Therapy continues to gain the focus of top clinical organizations and publications. The Journal of the American Academy of Orthopaedic Surgery (JAAOS) is a prestigious publication and JAAOS published an article on PRP in this month's edition. According to Dr. Allan Mishra, leading researcher and developer of PRP, this represents the acknowledgment of Platelet-Rich Plasma Therapy as a "regenerative treatment" (from Dr. Mishra's blog). The article highlights the growing use of PRP in sports medicine due to its potential to enhance muscle and soft tendon injuries. It also notes its reported benefit in rotator cuff and Achilles tendon surgery. It however cautions over exaggerated marketing statements that would yield reckless clinical use. A summary can be found at pubmed.gov or by clicking here.

Thursday, July 16, 2009