Platelet-rich plasma (PRP) (also known as blood injection therapy) is a medical treatment being used for a wide range of musculoskeletal problems. Platelet-rich plasma refers to a sample of serum (blood) plasma that has as much as four times more than the normal amount of platelets.
In some conditions, this treatment has been shown to enhance the body’s natural ability to heal itself. It is used to improve healing and shorten recovery time from acute and chronic soft tissue injuries. 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.
One area where the use of PRP has been questioned is in the treatment of chronic musculoskeletal problems like chronic tendinopathy. Some of the other uses (e.g., spinal fusion, tendon-to-bone grafts, bone fractures) have come under closer investigation. So what do we know about the effectiveness of PRP in treating these various problems?
To answer this question, a group of 50 experts in the area of PRP therapy met and discussed their findings from clinical use (with patients) and from research efforts. They made the following key observations:
PRP results are not consistent when used with chronic tendon problems. Four out of six large studies had a favorable report. Two did not.
PRP seems to work best when used along with other treatment such as Physical Therapy, rest, and antiinflammatory therapy.
RP therapy seems to work best when applied to the middle of the anterior cruciate ligament (ACL) tendon or ligament. Application of PRP close to the tendon attachment to the bone did not enhance healing or improve biomechanics of the knee.
Results of application to other ligaments and differing locations of that tendon (middle versus ends) have not been tested and reported.
Using PRP instead of bone graft material has not panned out either. If anything, PRP slows down and may even stop bone growth.
Evidence that PRP helps with fractures comes only from animal (not human) studies. Benefit in humans has yet to be demonstrated.
One of the best uses of platelet-rich plasma (PRP) to be reported lately is with cartilage degeneration. Injecting PRP into a joint (the knee) has been shown to reduce knee pain, increase function, and improve quality of life. That could be good news for osteoarthritis sufferers.
Future studies with PRP are needed to find ways this treatment tool can be used most effectively. Identifying specific patients who can benefit from PRP or the conditions that will respond most favorably are important goals.
One new idea for the use of PRP is as a sealant for total knee replacements. Early reports indicate there is less blood loss during surgery, less use of narcotic pain relievers after surgery, and fewer number of days in the hospital. One study has even shown that PRP can reduce the number of certain types of bacteria that can cause infections.
And finally, there is a need to produce PRP that will yield the same concentration of product and the same results from study-to-study. Scientists are also trying to understand how and why PRP works. They can use this information to target patient groups that would benefit from PRP and thereby develop more effective treatment plans.
Reference: Kaye Daugherty and Mary Ann Porucznik. Treating Tendons, Bones, and Cartilage with PRP. In AAOSNow. July 2011. Vol. 5. No. 7. Pp. 1, 17.
