A Case For Bloody Optimism
Ever wonder why tennis elbow is the culprit for so much lost time in the injured worker? Or, why a pulled hamstring can lead to a significant amount of lost playing time for a professional athlete? Wouldn’t it be great if we could speed up the healing process in a way that is safe and predictable? The answer to these questions that have plagued athletes, laborers and physicians for centuries may lie within our own veins: platelets.
Platelets are small cells that circulate in our blood, and they play a fundamental role in healing injured tissues in the body. Many physicians are now discovering that it is possible to harness the healing potential of platelets by collecting a patient’s blood and injecting their own platelets into injured tissues. This novel approach to treating soft tissue injury is called platelet-rich plasma therapy or “PRP.”
When the body’s tissues are injured, platelets are stimulated into action as they help coordinate a healing response. Platelets secrete growth factors that recruit other important cells to the site of injury. Growth factors catalyze these cells into action, stimulating them to produce reparative tissue. Growth factors secreted by platelets also lead to new blood vessel formation, which makes it easier for all the necessary cells to come to the site of injury.
In PRP therapy a patient’s own blood is drawn and is then “spun down” in a centrifuge. Through this process, the patient’s platelets can be concentrated into a few drops of fluid. This fluid, or plasma, is rich in platelets, hence its name “platelet-rich plasma.” The plasma can then be injected into a site of tissue injury to stimulate a healing response.
Tendons and ligaments do not generally have a robust blood supply. So, when these tissues break down, getting them to heal can be very challenging for both the patient and physician. PRP treatment stimulates repair of damaged tissues and has been found to be useful in a variety of soft tissue conditions that may fail to respond to traditional treatment methods. Examples of such conditions include:
- collateral ligament injuries of the knee
- collateral ligament injuries of the elbow
- muscle strains
- tennis elbow
- patellar tendonitis
- plantar fasciitis
Dr. Browdy recently treated a collegiate softball pitcher with severe patellar tendonitis. Every time the player threw a pitch, she landed on her right leg; as a result of this repetitive motion, she developed severe patellar tendonitis and had substantial pain with every pitch. After failing two rounds of physical therapy, her only option was to consider surgery or give up softball. Dr. Browdy offered PRP therapy as an alternative to surgery. Four weeks after the injection, the player was pain free and began looking forward to pitching in her senior season.
Dr. Browdy has also had good success treating stubborn cases of tennis elbow with PRP. Tennis elbow is a common condition that can cause significant pain, making even trivial activities difficult for affected workers or athletes. Most cases of tennis elbow are treatable by traditional means, but, it can take up to two years for the condition to resolve. PRP may be very helpful in speeding up the healing process.
In order to deliver the healing cells exactly where they need to be, Dr. Browdy uses ultrasound guidance. Needle guidance with the use of ultrasound allows for precise placement of a needle into the site of tissue injury. Dr. Browdy has used the combination of PRP and ultrasound guidance to successfully treat a number of patients that would have otherwise required surgery.
While there is growing enthusiasm for PRP therapy, researchers are still in the process of gathering evidence that demonstrates the effectiveness of PRP. Scientific studies are graded on the strength of their evidence. A Level I study meets the most rigorous scientific standards and provides strong support for the study’s findings. On the other end of the spectrum, a Level V study often times represents one’s expert opinion.
There are no currently published Level I studies on the use of PRP in the sports medicine setting, however there are numerous Level II-V studies that show PRP therapy to be very effective. Multiple Level I studies are currently under way, and the early data on PRP therapy is promising.
PRP can be very helpful to treat selected soft tissue injuries that have not responded to traditional treatment modalities. The combination of ultrasound guidance with PRP allows for precise delivery of platelets directly into a site of tissue injury, and in many cases can prevent the need for surgery. Physicians who have seen excellent results with PRP therapy are encouraged by the early results of rigorous research.
To read more about the use of ultrasound, click here.
