AAOS: Uncertain Future for Platelet-Rich Plasma
published at MedPage Today… http://ow.ly/1nBpu
Clinicians are trying to determine where platelet-rich plasma (PRP) fits into the armamentarium of treatments for orthopedic injuries.
PRP is created by taking an individual’s whole blood, putting it into a centrifuge, concentrating the platelets, and injecting the platelet-rich mixture into a site of injury. While normal whole blood has about 200,000 platelets per microliter, PRP has about 2,000,000.
PRP is rich in cytokines and other growth factors, but studies have yielded mixed results regarding its effectiveness in repairing various types of injuries, including tendinitis, muscle strains, ligament sprains, and fractures.
The FDA has approved the treatment as a device, but its use is still considered investigational. So orthopedic surgeons are still trying to figure out where PRP will fit into clinical practice — if at all.
- A Dutch study presented here at the American Academy of Orthopaedic Surgeons meeting showed that injecting PRP into the elbows of patients with chronic lateral epicondylitis significantly improved pain, function, and disability through one year, compared with a corticosteroid injection.
- In the randomized trial, the proportion of patients reporting at least a 25% reduction in pain was significantly higher in the PRP group (76% versus 47%, P<0.001), according to Taco Gosens, MD, of St. Elisabeth Hospital in Tilburg.
- On the down side, another randomized study, presented by Stephen Weber, MD, of Sacramento Knee and Sports Medicine in California, however, found that PRP was not effective for improving outcomes from arthroscopic rotator cuff repair.
AAOS Bulletin “Clinical use of platelet-rich plasma in orthopaedics” by By Barbara D. Boyan, PhD; Zvi Schwartz, DMD, PhD; Thomas E. Patterson, PhD; and George Muschler, MD
The increasing use of platelet-rich plasma (PRP) in orthopaedics presents significant opportunities—as well as significant questions—about appropriate clinical applications for this developing therapy.
- The repair response
- Enriching a rich environment
- Effectiveness “depends”
- Use with care