The current hot topic within the field of orthopedics is biologic injections (i.e, PRP, stem cells). There is a great amount of research and marketing behind such injections, especially given the potential to help treat joint disease and tendinopathies.
What is PRP?
Platelet rich plasma (PRP) is an autologous blood product that is used in an attempt to accelerate the healing of injured tendons, ligaments, muscles and joints. Usually performed in the clinic, physicians or nurses drawn blood from the patient, and then spin it down in a centrifuge to concentrate the growth factors. This solution can then be injected into the joint or tendons.
PRP has been found to significantly enhance the healing process, and using a PRP injection for shoulder pain caused by rotator cuff tears, for Achilles tendon ruptures and for other soft-tissue injuries is becoming more common. It has also been demonstrated to improve function and reduce pain in people who have tendonitis or chronic tendinosis conditions such as tennis elbow.
We think that PRP achieves positive results due to several factors. Foremost, PRP has a strong anti-inflammatory effect. It may also work on pain receptors to decrease the amount of pain felt at the area of pathology, and the concentration of growth factors in the platelets can enhance healing.
Stem Cell Treatment
Stem cells are basic cells with the ability to differentiate, divide, and change into any type of specialized cell found in the body. Stem cells for treatment are usually derived from bone marrow aspirate concentrate, which is the spongy tissue inside bones. When this area is aspirated, we acquire a rich concentration of medicinal signaling cells. This solution is then spun down in a centrifuge to concentrate and is then reinjected into the damaged joint or tendon.
This procedure, which can be performed in the clinic or in the operating room, stimulates a natural healing response. When successful, stem cell treatment can possibly eliminate the need for surgery.
What does the research show?
The most promising effects of PRP are demonstrated in the setting of knee arthritis and elbow tendinopathy. Recent studies show that PRP can produce successful outcomes for mild or moderate knee arthritis to at least one year post injection follow-up. It also has benefits over conventional steroid injections, which can damage cartilage when given repeatedly. In addition, PRP has been shown to provide pain relief for patients who suffer from lateral elbow tendinopathy, better known as tennis elbow. With regard to bone marrow aspirate concentrate, most of the evidence again focuses on knee osteoarthritis. With both treatments, however, there are studies with mixed results. There is a need for further randomized trials to better understand the utility of such therapies.
How much do these treatments cost?
There is a wide range of cost for these therapies. A recent study published by the University of Alabama at Birmingham Sports Medicine Division shows that the average national cost of PRP is $707 (ranging from $175 to $4973). The average cost of stem cells therapy $2,728 (ranging from $300 to $12,000). With such variability of costs coupled with mixed results in the literature regarding efficacy, consumers should exercise caution when seeking such treatments and discuss the realistic expectations with a board certified medical doctor.
I would encourage patients who are interested in such treatments to visit clinics staffed by board certified MDs and institutions that routinely engage in clinical trials.
Orthobiologic injections certainly have a role in the treatment of joint disease. Further research will help shed light on the best applications so we can return patients to their active lifestyles.
Amit Momaya, MD is an orthopedic surgeon and serves as the chief of sports medicine at the University of Alabama at Birmingham. He is team physician for UAB Athletics, Birmingham Legion FC, and multiple high schools.
