It’s great that more & more evidence is emerging on PRP therapy. This study was a single center randomized blinded trial however it did have some limitations.

Here are my thoughts.

My published review article is referenced in the JAMA article. While the authors of this study should be commended by adding to a topic in need of controlled trials; there are some limitations to be mindful of before drawing indefinite conclusions.

 First, there was no gel matrix added which may have limited the duration of time the PRP was in the tendon. The injection graft was activated by direct contact with the tendon upon injection without an agonist. I currently use a PRP that utilizes a gel matrix by utilizing autologous thrombin combined with calcium chloride.

Secondly there were no laboratory platelet counts performed to determine what PRP levels were achieved.  There are numerous platelet separation devices available with varying concentrations of platelets & leukocytes & having definitive counts would have been insightful. 

 The authors unfortunately did not have a third control group to isolate the effects of an eccentric exercise program. It is unreasonable to assume that the eccentric exercises alone accounted for the substantial clinical improvement of VISA-A & satisfaction surveys in both groups. Moreover there is no discussion on the theory that the ultrasound guided needle procedure in both groups may have created microtrauma that could initiate healing.

 Also there is no long term f/u beyond 6 months. Follow up in 12 months may indicate a difference between the two control groups. Also there is no follow up imaging to determine if there is structural healing occurring.

The article provides good follow up data on a single injection, however for chronic Achilles tendinosis, a series of injections may be required.

 It’s terrific that more & more studies are emerging to better define how PRP is best indicated. In my experience chronic Achilles tendinosis is a very challenging condition with limited treatment options.  This study suggests that needling of the injured tendon under ultrasound guidance combined with an eccentric exercise program was effective initially for 6 months.  However long term follow up data & imaging is necessary to clarify interpretations. As with any treatment there will be pro & con articles. In the end we’ll continue better understand this treatment which is in no way a panacea.

Dr Steven Sampson

My PRP review article is now published in the Current Reviews in Musculoskeletal Medicine. http://www.springerlink.com/content/5708408818n30275/ The online version is available, and the printed version is coming soon. The article includes nearly 50 literature sources and provides a comprehensive overview regarding platelet rich plasma usage in orthopaedics and sports medicine. Also, the review discusses the promising realm of orthobiologics and describes experiences with using platelet rich plasma for cartilage disorders and osteoarthritis.

I have been conducting research on arthritis with encouraging results so far. I am planning on collaborating with other leading physicians and publishing many more articles to advance the field of orthobiologics.

 

The study looked at 50 patients who have had pain for > 6months & failed conservative treatments.

http://www.ejbjs.org/cgi/content/abstract/90/1/52

I have been treating many patients lately (more than 50, with various injuries including achilles tendinosis, plantar fasciitis, tennis elbow, & bicep tendonosis with favorable results. I have all patients complete questionnaires 6 weeks after their initial treatment to determine a useful role for shockwave in my practice.

Ultimately I invision a protocol implementing various modalities to maximize the body’s innate ability to heal itself. Furthermore, I am exploring the potential role of hyperbaric oxygen therapy.

I will soon post results from the 150 or so shock wave treatments I have done. However, larger studies requiring double blinded methods are required so that we can learn more about shockwave therapy.