Tuesday, December 18, 2007
I recently launched a web site on PRP. It is another resource for health professionals & patients to learn more about this emerging therapy. Additionally, I will be hosting a conference in early May 2008, in Los Angeles to train other physicians on the use of PRP along with musculoskeletal ultrasound guidance.
The site will include testimonials as well as promote further communication amongst patients.
In a recent study from October 2007, a group from China was the first to document platelet rich plasma's ability to support chondrogenesis (cartilage cell growth). They took cartilage from the rabbit's ear, & mixed it with PRP and calcium chloride & thrombin (to form a matrix). Two months later, hard knobbles were found and seen on MRI, as well as histological analysis (cellular) and staining confirmed cartilage growth. Interestingly, there was no cartilage growth with the control group that received PRP alone. This study demonstrated successful formation of new cartilage with an injectable graft using PRP and cultured chondrocytes.
Sunday, December 9, 2007
Our practice was awarded the title of a FIFA Medical Center of Excellence. The Fédération Internationale de Football Association (FIFA) is an association governed by Swiss law founded in 1904 and based in Zurich. They oversee one of the world's largest international sporting events, The World Cup. FIFA hopes to reach out and touch the world, using football(soccer) as a symbol of hope and integration.
Our practice was selected after demonstration of clinical education, research, and injury prevention. Other centers chosen include St Marianna University School of Medicine in Kawasaki, Japan, The Adidas Sports Medicine Centre in Auckland, New Zealand, the Centre for Exercise Science and Sports Medicine at the University of Witwatersrand in Johannesburg, South Africa, and the Orthocentre of the Technical University, Munich.
There will be a ceremony at our facility Monday December 10th, 2007.
These designated centers are open to every soccer player looking for therapy or a second opinion on a specific injury.
My Colleagues, Bert Mandelbaum MD & Michael Gerhardt MD are team physicians for the US National Soccer team.
We have used platelet rich plasma on professional soccer athletes to accelerate recovery.
Sunday, December 2, 2007
After immersing myself in the study of Platelet Rich Plasma Therapy and the larger scope of "biologics," I have been drawn to the concept of maximizing the body's natural ability to heal itself. PRP does not create a new injury, to stimulate healing, but rather takes the body's normal reaction to an area & places it at the site of limited healing. After injection patients experience discomfort above baseline anywhere from 2-5 days. Clinical benefits are often not immediate, as the cellular changes take up to months. However, we have seen dramatic improvements in most cases.
Perhaps an earlier generation in the philosophy of promoting natural healing lies in shockwave therapy. Shockwaves are administered in an office setting for a series of 3treatments at one week intervals , lasting 3 minutes each. The concept is that by alternating positive & negative pressure, shockwaves induce microtrauma (minor injury) that sends a signal to the brain to stimulate healing to an area previously dormant & injured.
We know that after a few weeks, tendons are not inflammed, but rather form a scarred & thickened structure, with blood flow changes. This new understanding has flipped our approach to tendon injuries, now termed "tendonopathies." Treating a chronic tendon injury with cortisone or anti-anflammatory medications not only has adverse side effects, but doesn't make sense.
Shockwave therapy was initially developed to break up kidney stones. However, the Europeans have been using this treatment on tendon injuries for years. It is now FDA approved for use in the U.S.
I was given a free machine for a 6 wk trial. I treated 14 patients last Tuesday. Apparently, patients may experience an improvement following the second treatment. This modality is appealing, because it is less invasive than an injection, and results are more immediate (if they occur) than PRP.
Ultimately shockwave therapy may be uses along with PRP in a protocol to maximize therapy. My colleague, a podiatrist has seen terrific results in patients that have failed conservative treatments for heel pain(achilles tendonosis & plantar fasciitis). The procedure is generally well tolerated.
Attached is the web site to learn further. I will continue to post my experiences with this new treatment. There are only 60 machines in the U.S.
A study from Istanbul, Turkey looked at the effects of cigarette smoking on the viability of platelets. Platelets are very fragile and special care must be taken in preparing them for injection after increasing their concentration. However, research suggests that smokers may have increased free radicals that affect the oxidant/anti-oxidant balance, thus reducing platelet activity.
Future research should compare the platelet concentration & clinical effects of PRP in non-smokers Vs smokers.