In a recent article in the Journal of American Medicine (JAMA), a group from the Netherlands studies PRP VS saline injections under ultrasound guidance. The patients were studied for 6 months as a preliminary report. The study showed that both groups equally improved beyond baseline. The researchers concluded that the injection was no more than a placebo effect and that the eccentric exercises that both groups performed may have caused the benefits.
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
We were thrilled to have Satoshi Sobajima MD, an orthopaedic surgeon from Osaka Japan visit last week. Dr Sobajima spent time at the University of Pittsburg doing progressive research in regenerative medicine. Using stem cells, gene therapy, & PRP Dr Sobajima studied regeneration of intervertebral discs of the spine in animal models. Currently Dr Sobajima is looking at PRP & stem cells to regenerate cortical bone in Rabbit Femurs. This research could potentially influence surgical protocol around the world as we look for more cost effective, safer, and natural based alternatives. Dr Sobajima will be presenting his data at the Regenerative Medicine conference in Hiroshima in March 2010. Dr Steven Sampson will also be discussing his knee arthritis study and PRP experiences in Japan.
re complicated cases as well as from reasons we don’t quite understand yet. Therefore we are striving to incorporate the most state of the art technology to encourage the body’s ability to self heal. While it’s great that many doctors are beginning to explore with PRP therapy to promote it’s widespread use, after 3 years and hundreds of injections performed we are loking further.
A new article on PRP was published in the 
Following increased PRP use in Europe & the United States, physicians in Singapore are beginning to use PRP( Platelet Rich Plasma) to treat various musculoskeletal & sports injuries. The are establishing themselves as pioneers in biologics. Below is a recent press release which highlights the global use of platelet rich plasma therapy.
