Platelet Rich Plasma Therapy

Sunday, January 13, 2008

A need to Clarify Platelet Rich Plasma use in International athletes

A new article from the British Journal of Sports Medicine Nov 07, reviews PRP (Platelet rich Plasma) use in sports medicine. After a good thorough review, they point out that using growth factors is considered a doping violation by the WADA (World Anti-Doping agency). THE WADA created in 1999 to promote, coordinate, and monitor the fight against doping in sports. The WADA prohibits use of a particular growth factor, Insulin like growth factor (IGF-I). However scientific literature has shown that IGF-I is not increased in PRP. This misunderstanding of PRP may create an ironic situation where this cutting edge technology may be available to the weekend warrior, but not the Olympian. Keep in mind that "growth factors" are different from "growth hormones."

As PRP use increases so does the need for the scientific community to comprehend it's applications & mechanism of action. Hopefully the application of PRP will be recognized as a natural and safe alternative to promote healing in high level athletes and the weekend warrior alike.

Growth Factor Delivery Methods in the Management of Sports Injuries:The State of Play http://bjsm.bmj.com/cgi/content/abstract/bjsm.2007.040071v1

Thursday, January 3, 2008

Ultrasound Guided Platelet Rich Plasma Injections

A growing number of physicians are using musculoskeletal ultrasound to guide various injections. As a leading imaging technique in Europe, ultrasound is safe, economic, convenient, & effective in diagnosing many injuries. The technology has dramatically improved and allows us to visualize nerve & tendon fibers. While the quality is not quite MRI caliber, ultrasound allows for dynamic (motion studies). In other words, ultrasound allows functional evaluation of an injury with movement, whereas MRI takes a still image. Also, ultrasound has color doppler that shows areas of blood flow changes (called neo vascularization). This allows us to deliver the PRP within a millimeter of the target site, or even discover other regions that are affected.

Ultrasound technology continues to grow. I just upgraded to this Sonosite portable machine with color doppler.

Tuesday, December 18, 2007

New Platelet Rich Plasma Web Site

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.

www.PRPinjection.com

The site will include testimonials as well as promote further communication amongst patients.

Platelet Rich Plasma Cartilage/Arthritis Study in Rabbits

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.

http://www.joms.org/article/PIIS0278239106021070/abstract

Sunday, December 9, 2007

Santa Monica Orthopaedic Group Awarded FIFA Center of Excellence

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.

http://www.fifa.com/aboutfifa/developing/releases/newsid=653724.html

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.

http://prpinjection.blogspot.com/2007/10/cbs-news-with-katie-kouric-prp-feature.html

Sunday, December 2, 2007

Extracorporeal Shockwave Therapy to Encourage Natural Healing in Tendon Injuries?

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.

www.dolorclastmethod.com

Cigarette Smoking May Limit Platelet Activity in PRP

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.

www.blackwell-synergy.com/doi/abs/10.1080/13556210020077046

Future research should compare the platelet concentration & clinical effects of PRP in non-smokers Vs smokers.

Wednesday, November 28, 2007

Superkids Charity

A friend of mine back in NY told me about a wonderful charity. Her brother and sister in law (Stephen and Janet Fink) started this organization after they adopted their daughter from China.

Superkids is a non-profit organization that sends physical therapists and volunteers to the Shanghai Children’s Home. They work directly with the children, donate equipment to the orphanage, and work in partnership with the orphanage staff to incorporate easy, fun therapeutic exercise games in the children’s daily routines. These kids range in age from infant to teen and their medical problems range from minor to serious. Most of the children have mild and routinely correctable problems such as club feet and cleft palate. More serious problems include cerebral palsy and spina bifida. Because of their medical conditions, most of these children show delays in motor and/or speech development.

Special needs orphans are also called "waiting children." Their age and medical conditions make them difficult to place. They wait longer to find homes. Many are never adopted.

Janet and a group of occupational therapists returned from Shanghai 3 weeks ago and met four teen orphans with spinal cord injuries. She has been trying for months to get them the appropriate wheelchairs.

Wheelchair companies will not donate or give discounts. Charities that can donate wheelchairs do not have the appropriate type of chair. These teens are already starting to develop scoliosis and breathing problems because they are not in good chairs. They have found a company that will make good, pediatric wheelchairs for only $3,000.

They are trying to raise money to purchase chairs for all four teens. If they can raise the money and have the chairs shipped to the orphanage, Janet will go to the orphanage in china with the therapists to make sure that the chairs are fitted properly to these children.

Please spread the word about these terrific kids and their need for good wheelchairs. If anyone is interested in making a donation, log on to the Superkids website http://www.superkidscharity.org/

Sunday, November 18, 2007

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.

Autologous Blood Use in Horse Osteoarthritis

Another subset in "biologics" is the use a (ACS) Autologous Conditioned Serum. This treatment primarily used in Europe, invlolves production of a substance known as IL-1Ra that attacks the effects of arthritis. While this specific treatment is not approved in the U.S., similar treatments using PRP (Platelet rich Plasma) are being used here to address knee arthritis.

A recent study from Colorado State University published in The American Journal of Veterinary Research; demonstrated significant clinical improvements of Horse osteoarthritis affected joints with ACS compared to placebo.

http://avmajournals.avma.org/doi/abs/10.2460/ajvr.68.3.290?prevSearch=allfield%3A%28autologous+conditioned+serum%29

The process like PRP, involves drawing blood and spinning it down in a machine called a centrifuge. However, afterwards the blood is incubated at 37 degrees Celsius for 24 hours. The serum is then frozen until use.

This system, is used throughout Europe in professional race horses to treat arthritis. Also, it is used in Dusseldorf Germany on humans for osteoarthritis.

We are using a modified treatment performing a series of 3 PRP injections into the human knee joint under ultrasound guidance at 3 week intervals. We will be reporting on our findings.

Thursday, November 8, 2007

U.S. Professional Soccer Athlete Injected with Platelet Rich Plasma

In addition to chronic (long term) injuries, Platelet Rich Plasma is being applied to the high level athlete to accelerate recovery. Numerous professional athletes have received PRP for a common knee injury, an MCL (medial Collateral Ligament) sprain. While I'm not an elite athlete by any means, I received a similar injection following a surfing accident. I just ran full speed tonight without any limitations, now appx 9 wks post injection. http://prpinjection.blogspot.com/2007/10/prp-knee-injection-8-wks-post-injection.html

http://www.latimes.com/sports/soccer/chivas/la-sp-chivas15oct15,1,3735874.story?coll=la-sports-chivas
Another athlete was injected by myself & my colleague Mike Gerhadt MD. This positive outcome was reported on CBS Evening news with Katie Kouric.

http://prpinjection.blogspot.com/2007/10/cbs-news-with-katie-kouric-prp-feature.html

Bone Marrow Aspirate, Using Adult Stem Cells To Treat Osteoarthritis

Platelet Rich Plasma provides a potent delivery of the body's healing properties, called growth factors. However in some patients with severe cartilage loss and less viable cells, a stronger pool of healing properties lies in obtaining adult "mesenchymal stem cells" from the hip (iliac crest). In this procedure, Bone marrow is taken from the hip and like PRP is prepared for injection into an arthritic hip or knee. While further studies are needed, preliminary reports are encouraging. PRP is probably a more reasonable first line treatment, given it's ease of use. However particularly challenging cases may consider the marrow application. A blog on bone marrow aspirate is: http://www.autologousadultstemcells.org/blogs.html

Thursday, November 1, 2007

American Academy of Orthopedic Surgeons New Article on Biologics

"Orthobiologics" or "biologics" are quickly becoming recognized amongst the sports medicine/orthopaedic community as one of the fastest growing industries with tremendous potential. Merging our understanding of how the body heals itself with cutting edge modern technology, we are developing exciting alternatives to standard care.

In the Sept 07 AAOS (American Academy of Orthopedic Surgeons) Now Magazine, there was an article discussing this very subject matter. "Biologics in sports medicine: from BMPs to bone formation."

http://www.aaos.org/news/bulletin/sep07/clinical5.asp

The article describes this Field of "biologics" and cell based therapies to create new approaches to treating old injuries. Tems introduced include BMP (bone Morphogenic Protein and mesenchymal stem cells). These may be paramount to facilitating healing in various injuries including rotator cuff cuff tears in the shoulder and knee arthritis and meniscal tears. As the community of "babyboomers" and recreational ahletes grow, we are seeing younger patients with cartilage injuries that are too young (<60) years for knee replacements. Thus biologic solutions provide promise in this population base.

At my practice, Santa Monica Orthopaedic & Sports Medicine Group we are beginning to treat patients with knee arthritis with a series of PRP injections. I have been corresponding with Physicians from Bologna Italy to learn from their early experiences as well. There is a link to their data on my blog. We are conducting outcome studies on the many patients we have injected for various injuries. Furthermore we hope to perform a knee arthritis PRP study in the near future. In general we are seeing tremendous outcomes in patients that have failed conservative treatments and were considering surgery or activity modification.

http://prpinjection.blogspot.com/2007/10/new-studies-on-platelet-rich-plasma-and.html

New Platelet Rich Plasma Article in the American Academy of Orthopaedic Surgeons Now Magazine

As PRP use is increasing, we are seeing more articles surfacing discussing it's potential benefits. In a monthly publication for orthopaedists, the AAOS (Amer Academy of Orthopaedic Surgeons) released an article titled "Clinical use of Platelet-rich plasma in orthopaedics."

http://www.aaos.org/news/bulletin/sep07/research2.asp

In general, the article familiarizes the reader with the science behind it's uses and advocates is use in soft tissue and wound repair, while cautioning it's application in bone grafting. Once again, further research is encouraged.