New Platelet Rich Plasma (PRP) review article for tendon injuries and arthritis

In a Jan/Feb 08 issue of Practical Pain Management, the authors describe PRP use in tendon injuries, spine conditions, as well as hip & knee arthritis. The article emphasizes a need for agreed upon nomenclature.

An interesting concept addressed is whether a gel matrix is needed for the platelets to adhere to the target site. Because of their structure tendons & ligaments may not require the gel, however it is not known if adding calcium chloride with thrombin to the PRP is needed in joint spaces like knee & hip arthritis. Further data needs to compare the usage with gel versus without.

The article showed x-rays post prp injection with subtle smoothing of a previously arthritic femoral head (hip bone). It is not clearly known how PRP acts on arthritis, however a particular growth factor found in PRP, TGF-B has been linked to cartilage growth (chondrogenesis). Furthermore, another study showed that PRP influences hyauloronic acid production which balances cell proliferation (angiogenesis). Also, the authors suggested a possible role in serotonin decreasing pain. Lastly, utilizing "stem cells" (the birth place of platelets and their precursors)may offer the most ultimate potential.

http://www.ppmjournal.com/abstract.asp?articleid=P0801F01

http://prpinjection.blogspot.com/2007/11/new-article-on-osteoarthritis-and.html

Multi Center Clinical trials of Platelet Rich Plasma Underway

Many trials are in the pipeline in efforts of obtaining FDA approval for PRP injections. There is a multi-center placebo controlled double blinded study underway looking at plantar fasciitis(heel pain) & lateral epicondylitis (tennis elbow).

http://www.biomet.com/patients/clinical_recruitment_recover.cfm

Also, Thanks to the many patients inquiring about info on docs around the country performing PRP procedures. Feel free to contact any of those listed in the link performing this particular study. At some point I may have a list of various PRP docs out there to help patients out. Please Continue to send requests.

On another note, we are currently examining the efficacy of Platelet Rich Plasma with osteoarthritis. We are collecting objective data on all patients injected.

New Article on Osteoarthritis and Platelet Rich Plasma

A European Study from Oct 07' by Anitua & Sanchez et al. injected 10 osteoarthritic patients with PRP & studied the cellular effects of PRP. They found an increase in hyaluronic acid concentration, balancing cell proliferation (angiogenesis). However, there was no effect on IL 1-B, which generally plays a role in osteoarthritis. This information gives us insight into how PRP may potentially benefit arthritis.

Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kem234v1

It's important that we better understand the mechanism that PRP may potentially benefit arthritis. New insights may direct more specific treatments in the exciting realm of Biologics.

New Spine article on biologics "Orthokine" Use in Lumbar Epidurals for Sciatica

A common treatment for a herniated Disc or "Sciatica" that fails physical therapy and conservative treatment is an epidural steroid injection. Nowadays they are performed under an x-ray machine, called fluroscopy which ensures proper needle placement and safety.

A study from Spine compared steroids/cortisone which is commonly used in epidurals to decrease nerve inflammation with Orthokine. http://www.orthokine.com/Orthokine is a biologic agent known as a Cytokine. It specifically blocks Interlukin-1, which plays a role in inflammation and pathology. Similar to PRP, whole blood is drawn from a patient and placed in a centrifuge aftrewards. However there is an additional step with incubation of the processed blood for 24hrs which creates IL1-RA an antagonist that blocks pain/inflammation.

The study suggests that after 3 months of receiving a series of 3 injections, those with Orthokine injections had more dramatic decreased pain scores than those with cortisone. Furthermore, there are less adverse effects associated with autologous blood versus steroids.

http://www.spinejournal.com/pt/re/spine/abstract.00007632-200708010-00002.htm;jsessionid=HflXqpy0GQGZYyvc3GpvY1NQ4QYjnk1xjNGmlLqmQpXN1BmjGKZV!1071114923!181195629!8091!-1

Orthokine and PRP are part of an emerging industry that combine modern technology while maximiizing the body's natural ability to heal itself. This field is known as Orthobiologics.

Platelet Rich Plasma Introduction

This blog site was created to establish a non-competitive forum for physicians performing PRP treatments & for patients interested in learning more about this emerging treatment. I was introduced to this treatment by my colleagues, Dr Bert Mandelbaum & Dr Michael Gerhardt; who are premiere orthopaedists responsible for treating numerous soccer athletes from all over the world. PRP is being used by many European professional soccer clubs, and is now making it's way to the U.S.

Initially we injected a few professional soccer athletes for MCL tears/sprains and noted accelerated recovery & earlier than expected return to play. Click link to see article:
http://www.mlsnet.com/news/team_news.jsp?ymd=20070417&content_id=89302&vkey=news_cdc&fext=.jsp&team=t120

Shortly afterwards we began treating weekend warriors with chronic non-healing tendon injuries including tennis/golfers elbow, achilles tendonosis, patellar tendonosis (jumpers knee). After a favorable response from patients and following discussions with other leaders in the community on PRP, we are now injecting PRP for other non-healing injuries including knee arthritis & hip bursitis.

PRP provides a safe and natural alternative to surgery using the body's natural ability to heal itself.