Platelet-Rich Plasma Injections

Posted by Anthony Luke MD, MPH on November 20, 2012

The Starting Line: 

Can platelet-rich plasma injections cure achilles tendon pain?

Due to media exposure from many high profile pro athletes, platelet-rich plasma is currently one of the most popular and controversial treatments in sports medicine and orthopaedics. Platelet-rich plasma (PRP) is a concentrate of platelets and associated growth factors (GFs), obtained from centrifuging a sample of the patient’s own blood. Many practitioners are utilizing PRP to promote tissue healing in their practices, often in conjunction with ultrasound imaging.

There are many remaining questions surrounding the use of PRP, including its effectiveness. One review in the Clinical Journal of Sports Medicine identified eight studies showing positive results after the use of PRP following rotator cuff surgery, elbow and patellar tendon issues, and Achilles tendon injuries specifically with surgery after acute tear or revision surgery (re-tear).

However, two rigorous studies from the Netherlands by de Vos RJ, Weir A, van Schie HT, et al., do not show much benefit for PRP treating chronic degenerative tendon issues, also known as “tendinosis”. The first study showed that in a randomized control trial of platelet rich plasma versus placebo injections, symptoms improved similarly regardless of the type of injection after the 24 week study period. Both groups also engaged in an eccentric exercises for the calf. The same group published their ultrasound findings of the tendons showing that positive tissue changes were similar in both of those groups suggesting that there was no clear effect on the tissue structures or new vessel formation whether the tendon was exposed to PRP or placebo.

Further research into the effects of PRP is necessary to truly assess the effectiveness of this treatment before more scientifically sound conclusions can be made. There are a variety of recommended methods for PRP; such as activated or inactivated products, different spinning techniques (once or twice), as well as different concentrations based on the machine and process. There are also protocols based on how often and when the injections should be performed. PRP is sometimes combined with needling procedures that can stimulate healing, or ultrasound to help guide the injections. These procedures would most likely be done by orthopaedic surgeons, sports medicine specialists, physical and rehabilitation MD’s, or radiologists.

In summary, PRP is an interesting treatment possibility for chronic musculoskeletal problems, although most physicians still feel it is experimental. No technique is a silver bullet for long standing problems, and a careful recovery plan, including rehabilitation exercises, should be part of any treatment.

The Finish Line:

Platelet rich plasma has not yet been definitively shown effective for treating chronic achilles tendon problems. Eccentric exercises are clearly a beneficial intervention for runners suffering from achilles tendinosis.

References:

1. de Vos RJ, Weir A, Tol JL et al.No effects of PRP on ultrasonographic tendon structure and neovascularisation in chronic midportion Achillestendinopathy. Br J Sports Med. 2011 Apr;45(5):387-92. http://www.ncbi.nlm.nih.gov/pubmed/21047840

2. de Vos RJ, Weir A, van Schie HT, et al. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010 Jan 13;303(2):144-9. http://www.ncbi.nlm.nih.gov/pubmed/20068208

3. Taylor DW, Petrera M, Hendry M et al. A systematic review of the use of platelet-rich plasma in sports medicine as a new treatment for tendon and ligament injuries. Clin J Sport Med 2011 Jul;21(4):344-52. http://www.ncbi.nlm.nih.gov/pubmed/21562414

Photo credit: rpongsaj via photopin cc

 *Note: This general information is not intended to be a substitute for medical treatment or advice. Always consult a professional before making changes to your health and wellness practices. 

Feedback or suggestions for future topics? Let us know!