Platelet-rich plasma (PRP) therapy has been used as an adjunct in would healing in the dental community for more than 20 years. Since its recent approval by the FDA as a treatment device for some orthopaedic injuries, PRP has become well-known after being used on sports figures like golfer Tiger Woods and NFL player Hines Ward.

The therapy is still considered investigational, but is finding its place in specific areas of orthopaedic medicine as an alternative to surgical repair. Using the body’s own regenerative abilities to heal an injury leads to fewer complications and quicker recovery, says Kenneth A. Jaffe, MD, an orthopaedic surgeon with the Alabama Orthopaedic Center in Birmingham.

For more than a year, Jaffe has used PRP to treat tendinopathies, arthropathies, and wounds that won’t heal. He has seen an 80-percent success rate in these patients. “Regenerative medicine is much like the concept of ‘going green.’ You use the body’s own growth factors and biologic technology to heal and re-grow tissue,” Jaffe says.

Jaffe is also using PRP to treat knee pain caused by osteoarthritis. A recent study from the Rizzoli Orthopaedic Institute in Italy tested PRP and injections of hyaluronates to treat this pain. Results of the study indicated an improvement in pain scores and function with PRP.

PRP therapy is a simple process that takes about an hour in a physician’s office. The doctor removes about 55cc of blood from a patient, which is then spun in a centrifuge to extract the natural platelets. The platelets are then concentrated in a specific dose and injected into the injury, catalyzing the body’s natural healing abilities. “The platelets release growth factors that are used by the body to grow and create cells, but these platelets normally are not used in the body in large enough concentrations in such soft tissue injuries,” Jaffe says. “Where whole blood has about 200,000 platelets per micro liter, PRP has about 2 million.”

Jaffe adds that if the concentration of platelets isn’t high enough, the patient will not receive the maximum benefit from the therapy. To ensure that his patients receive the highest concentration, Jaffe uses the GPS III system from Biomet. This system adapts to the plasma/red cell interface with a floating buoy inside the tube that is used for centrifuge.

“Under the centrifugal forces, the buoy will “float” within the tube to the optimum interface point of the red cell/plasma layer, and all of the platelets are captured within a chamber,” Jaffe says. “We are able to extract all the platelets from this chamber, which ensures a consistently high platelet count for each spin.”

While many physicians are reporting PRP successes, the use of varying platelet concentrations has yielded conflicting results regarding its effectiveness. For example, a study published in the January 2010 Journal of the American Medical Association concluded that PRP injections for Achilles tendinopathy were no more effective that saline injections when both control groups added therapeutic exercises to their recovery routines.

“The study has received extensive media coverage and has been quick to cite PRP as ineffective,” Jaffe says. “It is important to view the controls of the study, however, before conclusions are made.”

Jaffe adds that the study does support PRP’s ineffectiveness after a six-month period in only moderate Achilles tendinopathy. However, it doesn’t include either minor or severe cases. “This study was published at its midpoint in January 2010,” he says. “Researchers will follow up on patients’ recoveries in 12 months, and it is possible the PRP patients will continue to improve while the placebo group will not. It is also important to note that no data is available on platelet concentration levels given to the PRP group.”

As this is one of many studies that will determine the proper use of PRP, Jaffe says it is crucial to disclose the platelet concentration levels in PRP groups in these investigations. If patients received a platelet concentration that was too low in their injection, results would likely vary in higher doses. This will be a vital component of determining the optimal formula of PRP.

“Legitimate studies are important to further the understanding of PRP’s effectiveness and uses, and this study should be recognized as such,” Jaffe says. “This study, however, is incomplete, and this must be taken into account before significant conclusions are drawn about PRP’s effectiveness.”

A recently published study by Taco Gosens, PhD of the Netherlands revealed that PRP injections were more effective than cortisone injections for chronic tennis elbow. At the one-year follow-up, 73 percent of patients in the PRP group were treated successfully compared to just 51 percent of the cortisone group. Of further significance was the fact that the cortisone group was initially better and then declined, while the PRP group improved steadily.

“Based on this study, PRP eventually could be used as a substitute for cortisone injections,” Jaffe says. “PRP has an advantage because it is biological and brings healing cells to the injury site continuously, so the patient gets better over time. That’s not the case with cortisone. It relieves pain better initially, but the injury worsens again as time goes on.”

With the recent flurry of reports on PRP’s success with sports injuries, the public is learning more about the technique. “Unfortunately, there are a lot of physicians advertising for these patients who are not trained in the field and don’t understand the natural history of the disease process,” Jaffe says. This can lead to negative implications.”

Besides the media hype, Jaffe adds that other concerns for this new technology include the small number of controlled clinical trials, abuse of indications, and no reimbursement codes from insurance companies. The cost for treatments can be as high as $1,200, Jaffe says, so it is important that studies continue so PRP can be recognized as a legitimate therapy in the orthopaedic field.

“While platelet-rich plasma therapy remains in development and currently should be offered as a last resort to invasive surgery, improving the flow of accurate information will bring future accessibility and sound judgment to the use of this therapy,” Jaffe says. “PRP has been widely used in professional athletes, but it has far more potential to one day save jobs and improve the lives of people in the general population.”