Platelet-Rich Plasma?

Abstract

Platelet-rich plasma (PRP) is rapidly becoming a prominent method of treatment among sports medicine professionals. Yet research examining the efficacy of PRP has yielded mixed results. The type of PRP, along with the appropriate timing and number of injections, must be considered to assess treatment outcomes. In addition, post-PRP protocol must be implemented properly to yield positive results. Muscle, ligament, and tendon injury account for a significant loss of playing time among athletes. Moreover, these injuries account for more than 100 million office visits per year.1 As sports medicine professionals, our top priority is to find and develop methods that allow our athletes to heal quickly and return to the playing field in record time. Recently, there has been a significant increase in the use of platelet-rich plasma (PRP) to help accomplish this goal. But is PRP the magic bullet we have been waiting for? The answer, simply, is we do not know yet. The conflicting evidence that surrounds the use of PRP treatment stems from a variety of reasons; as such, we will discuss a few of the variables that seem to play a major role in determining the outcome of PRP treatments in athletes and the general outpatient population. Over the past 2 years, sports medicine physicians at the University of North Carolina at Chapel Hill have been using PRP with some good results; however, the published data are inconclusive at best. Two recent journal articles have demonstrated mixed results. Peerbooms et al2 randomized 100 patients with lateral epicondylitis experiencing pain for more than 6 months into 2 groups. Patients in the first group (n = 51) were treated with autologous PRP injection, and those in the second group (n = 49) were treated with a corticosteroid injection. A similar injection technique for both procedures was delivered directly into the patient’s most painful area. Successful treatment was defined as a 25% reduction in pain using the Disability of the Arm, Shoulder, and Hand (DASH) Outcome Measure score and the visual analog score (VAS). After a 1-year follow-up period, Peerbooms et al2 found that patients in the PRP treatment group experienced greater treatment success in VAS and DASH scores compared with the corticosteroid group. These differences were found to be statistically significant (P , .001 and P = .005, respectively). Of note, the steroid injection group showed a more favorable response 4 weeks after treatment. However, the PRP group continued to improve throughout the year, whereas the steroid group showed a regression.2 In a second study, de Vos et al3 examined the use of PRP in Achilles tendinopathy. This doubleblinded study randomized patients experiencing pain for more than 2 months into 2 groups. Participants in one group (n = 27) received a single injection with autologous PRP, and The authors are from the Departments of Sports Medicine, Orthopedics, and Family Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC . The authors have no financial or proprietary interest in the materials presented herein. Address correspondence to Harry Stafford, MD, University of North Carolina Chapel Hill, Departments of Sports Medicine, Orthopedics, and Family Medicine, 590 Manning Drive, CB #7595, Chapel Hill, NC 27599; e-mail: harry_stafford@med.unc.edu. doi:10.3928/19425864-20110629-03 © iS to ck ph ot o. co m