If you haven't heard of platelet-rich plasma as a treatment for various musculoskeletal problems, let us fill you in! Platelet-rich plasma or PRP is the clear portion of blood (plasma) with the blood clotting platelets.
It is taken from the patient so doesn't require blood donors. The growth factors contained within the platelets enhance the body’s natural ability to heal itself. PRP is used to improve healing and shorten recovery time from acute and chronic soft tissue injuries.
It has been used for years after plastic surgery and surgery on the mouth, jaw, and neck. It seems to promote bone graft healing. Researchers have found a way to combine this substance with other chemicals to make it into a putty or gel that can be painted on a surgical site to speed up healing.
Blood injection therapy of this type has been used for knee osteoarthritis, degenerative cartilage, spinal fusion, bone fractures that don’t heal, and poor wound healing. This treatment technique is fairly new in the sports medicine treatment of musculoskeletal problems, but gaining popularity quickly.
In fact, there have been over 5,000 studies already published on this treatment technique. Recently, a group of 50 medical experts got together to discuss platelet-rich plasma (PRP) therapy. The goal was to review what is known about the use of PRP and what type of future research is needed.
One concern raised by the group is the lack of quality control over platelet-rich plasma. There is no way to standardize the product because the body simply doesn't produce the same amount of platelets every hour of every day in every person. What you eat, how well you sleep, medications you take, and even the exercise you get can all affect platelet levels in the blood.
There's more than one way to extract (remove) the platelet-rich plasma (PRP) and that can also affect the quality of the product. Other components of the blood (such as white blood cells) may get in the sample used and alter the body's healing response (not always favorably).
A closer look at the different studies highlighted some of the difficulties in comparing one study to another. That may explain why results can be opposite from study to study. One common theme seems to be that platelet-rich plasma may be most effective for chronic musculoskeletal injuries. It's not a given that the results obtained in one condition will be the same for another type of soft tissue injury.
Another problem is the wide range of tissue types being treated (e.g., cartilage, bone, tendons, ligaments, muscles). Results seem to differ within the tissue types so that how platelet-rich plasma affects a ligament in the knee may not be the same as the effects on a similar ligament in the ankle.
And a third major stumbling block in the research that's being done on platelet-rich plasma (PRP) is the way results are recorded. Some studies look at patient response in terms of pain levels and activities of living. Others are measuring strength after treatment or speed of wound healing during recovery.
The panel of researchers express concern over the fact that high-profile athletes are being treated with this tool in order to get them back into action as soon as possible. That's the case regardless of whether the athlete is a good candidate for the treatment and without knowing how soon it's safe to jump back into the game.
There may be a risk of graft rupture or reinjury if tissue repair isn't yet complete. Likewise, the tissue under repair may not be strong enough to withstand forces during full sports participation. But we don't know what those limits are yet based on any scientific evidence.
All that is to say, despite 5,000 studies on the topic of platelet-rich plasma, there is plenty of room and a real need for further studies to answer many questions. Who's a good candidate for this treatment? What kind of conditions can be treated effectively with platelet-rich plasma? How long should we wait after having platelet-rich plasma before resuming normal activities?
Engineering healing with platelet-rich plasma is an exciting area of research and study. If successful, it could result in fast, effective healing of all types of soft tissue injuries. Panels like the one that met to review this topic are important to keep research on track. We're not quite ready for any real treatment guidelines yet but we are a step closer to organizing and directing future studies.
Reference: Kay Daughtery and Mary Ann Porucznik. Platelet-Rich Plasma: What's Behind the Hype? In AAOSNow. June 2011. Vol. 5. No. 6. Pp. 12-13.
