Posting in Technology
New study shows this increasingly popular medical procedure is as effective as... saltwater.
Poof. A seemingly cure-all medical practice is found to have no legs upon which to stand.
According to the January 13 issue of The Journal of the American Medical Association, platelet-rich plasma therapy--thought to significantly decrease healing time for strains, pulls, tears and even fractures--is now found to be no more effective than saltwater.
The procedure, which injects portions of the patient’s concentrated blood directly into an injured area, had become so popular that professional athletes were turning to it for all sorts of injuries. Two Pittsburgh Steelers, Hines Ward and Troy Polamalu, used it before winning the Super Bowl last year, and Tiger Woods has used it with positive results. Professionals in baseball, soccer and other sports—and their amateur and weekend counterparts—have used it and raved about it as well.
The procedure had become so popular that it was even tested out by (self-described skeptical) New York Times medical reporter Gina Kolata, which she didn’t mention in her article yesterday about the new study. When she wrote about the treatment back in July, in Seeking Help for an Injury, at Any Price, she was suffering from a running injury—her tendon that holds the hamstring to the bone was 50 percent torn.
The lure of platelet-rich plasma therapy, known as PRP, is that doctors have believed that it would help regenerate ligament and tendon fibers, shortening the time for rehab. The Times reported that thousands of doctors and about 500 hospitals are offering the treatment.
Now, with news of this study, reports of PRP success are being questioned. The experiment, the first of its kind, studied 54 people with injured Achilles’ tendons who had been suffering for at least two months. Participants had either an injection of platelets or saline, and after six months, patients in both groups had improved, but there was no difference in improvement between the saline and platelet injections.
In her July column, Kolata wrote that although the idea of PRP working made some sense (since injecting blood into an injured body part stimulates the body to start repairing muscle, bone and tissue), she admittedly couldn’t find any studies comparing two versions of the procedure (a person’s whole blood versus platelets), and evidence in support of both were mostly anecdotal. But there were plenty of athletes, team doctors and hospital doctors willing to vouch for it. (An article last February in the Times quoted a team doctor who said his Major League Soccer players needed 25 to 30 percent less recovery time for an injury after PRP.)
Nevertheless, Kolata received the treatment, using her own blood (instead of platelets), and her insurer paid for it. She reported in an article earlier this month about physical therapy, (Treat Me, but No Tricks Please) that between the radiologist’s fee, an ultrasound and injection, the cost was $2,200. She noted that no matter the results, she would never know whether the injection made a difference or if her taking a break from running did the trick.
As Kolata said in her piece last summer, it’s a story “that showed me why and how health care costs can easily go out of control.”
And now we know that expensive health care fads—if that’s indeed what this was, and if future studies will support what this one found—can go out of control, too. Of course there are more studies to be done, but this first study alone should give us pause. Perhaps it’s obvious that we shouldn’t pay heed to medical endorsements from professional athletes, but physicians? Have patients and insurance companies just spent millions of dollars on treatment that wasn’t necessary?
Jan 13, 2010
I am very interested in the PRP and its ability to improve mobility of rotator cuff tears. Four years ago I had surgery for a torn rotator cuff and by my definition, it was not successful. I cannot lift one pound over my head or raise my arm more than 45 degrees over my head. One doctor diagnosed my arm as having avascular nercrosis. Now a PRP doctor is telling me he wants to take my bone marrow inject in my arm and in conjunction with that and my platelettes, he believes he can get 80% improvement. It would be a miracle for me if that is the case, but you can understand my skeptism. I welcome any and all opinions.
As a physician and orthopaedic sports medicine specialists, I would like to comment on this practice. First, I do not routinely promote or use PRP as a therapy but have recently considered it as an option for a special situation. In otherwords, I do not have an financial conflict of interest favoring the use or disuse of PRP. The study in which PRP and saline were compared is potentially just as flawed as antidotal reports can be. Simply because it has "double blinded controlled trial" in its heading and design, does not ensure there is not an existing design flaw to the study. In this particular study one can only safely conclude that there probably is not a benefit to treating chronic achilles tendonitis with PRP. That is all one is allowed to conclude based on simple logic. Expanding this conclusion in a broader sense to say that PRP is a hoax and and no better than saline for any condition is utterly and truly absurd. It maybe that PRP simply isn't good a treating this particular condition. In fact as an orthopedic surgeon I would predict that PRP would be useless for the use on chronic achilles tendonitis and this is based on simple knowledge of anatomy. AMA physicians are generally not surgeons, do not perform surgery, and are by percentage comprised of primary care physicians (family medicine, internal medicine, pediatrics, and more). If you have ever performed surgery on an degenerative achilles tendon, one would know that this tendon is thick, is usually degenerative and tendonosed from lack of an adequate blood supply and chronic wear. I can not perceive that any injection could allow for adequate regeneration of a tendon that lacks a sufficient blood supply to heal itself. PRP in theory works best for injuries with the potential to heal. Chronic achilles tendonitis generally has poor regenerative capabilities. Acute tendon injury is a completely different physiologic model. The basic idea behind the use of PRP is to promote faster healing and to improve the potential of recovery in a situation where recovery is possible. I believe that the money for this study should have been used to study a better model such as post surgical healing of tendon surgery for example. PRP is not a miracle drug. I believe it may be useful in situation wear a good healing potential exists and application of PRP in these situation might improve an outcome. For example, tennis elbow, rotator cuff repair, ACL graft healing, acute muscle strain or tendon strains, and others. To dismiss PRP as a total hoax and no better than a placebo based on this study would be a mistake. I am certainly in favor of more studies and well designed studies on PRP. I personally am not totally committed to the use of PRP as a treatment adjunct but I am encouraged by it basic science, antidotal reports, and well designed studies. Much more work is needed and is currently in the process. Results of some excellent studies will be coming out in the next few years, even months.
I am a college student at the U of M Duluth. I have researched Autologous Platelet Concentrate (AKA:Platelet Rich Plasma), and platelet gel thoroughly. In my sophomore year I conducted research on Platelet Gel and found it to be effective in eleven out of twelve mice in healing wounds made to the neck of each mouse. I myself went to St. Louis to a private clinic to have Platelet Concentrate Treatment used in conjunction with a GE Logiq e ultrasound to guide treatment to a partially torn UCL ligament and nerve. The treatment worked and my once half torn UCL is now 100 percent. Prior to tearing my UCL i threw 86 MPH as a junior. After tearing the UCL my velocity dropped to mid 70's at best, after the APC injection I am now throwing 90 MPH. The APC machine used to treat my arm and for my undergrad research was manufactured by Harvest Tech. The main lesson I have learned from all of this is MEDICINE and MONEY are prioritized equally. Platelet injection therapies should have been made common place years ago. I hope the AMA and Drug Company owners rot in hell, this treatment could be helping save people from needing surgery, and also help aid healing from life threatening conditions.
Everyone needs to know that the AMA and Drug companies are going to fight this as they have in the past. Chelation Therapy is an example. I,ve had several IV treatments, I feel better and have a better quality of life than I've had in years. My blood pressure is back to normal,I'm off all meds, my colesterol went from 274 down to 145 in 4 months. The AMA says it's dangerious !!!! DAA !!!!JOS, age 67 Alabama
It's about time a controlled trial was conducted for evaluating this practice. My daughter has plicae which can cause inflammation in the knee when overexercised and these have hurt her soccer playing. To avoid the knife, we tried PRP based on rave reviews and testimonials (including the treating MD). After three treatments, no gain but almost 9 months of time lost by not receiving the proven treatment (surgery). One slightly imperfect, well controlled, double blind study is more valuable than a thousand testimonials.
Don't be so quick to dismiss this therapy. First of all there are many well controlled studies in animals which demonstrate a clear benefit and superior healing characteristics. Second, this one and I mean one human clinical trial which demonstrated no difference with respect to pain in patients with chronic tendonapathy. Pain is certainly one measure, but it isn't an indicator of tendon healing, collagen strength etc. Had they performed US or MRI comparisons (it would be difficult to perform biopsies) the study would carry a bit more weight. Basically, this is one junk study on which no conclusions can be drawn. Don't be a fool one way or another.
Even if it didn't work that how you make the break through,and understanding the science is a very complex thing. You have to know how long it normally take for you to heal, the reaction from me is more studies. Again trying never hurts new ideas are expensive let the athletes pay for it. William www.peedabo.com
This is not a surprising finding. As Stephen Colbert likes to say, it sounded "truthy". Someone tried it in uncontrolled conditions, made a connection that wasn't really true, but what is generally known about the human body seemed to make the practice made sense. Add in that nobody was harmed (we hope) and several athletes and doctors who know the human body reasonably well, decided it was good. I think, as humans, we want things that work without pain and that make pain go away faster. We are just not good at scientific method thinking which would have prompted people to ask, "was it the plasma, the physical therapy, a combination, or rest?" and test each variable on it own to make sure the right conclusion had been reached.
Hello Doctor, Thank you so much for your input on this subject. I am scheduled for a partial knee replacement in 4 weeks time and I've decided to try one more specialist before going for the knife. The doctor that I saw this morning does prolotherapy, PRP and stem cell therapy neither of which is covered by my insurance plan since they are considered 'experimental' therapy. I guess the insurance co. would rather pay tens of thousands of dollars for surgery, but not a mere $3000 for this type of treatment. That one escapes me... Anyway, this particular Doctor I just saw used to be an orthopedic surgeon as well according to him. So, he knows both sides of the coin at it were. After testing my knees, looking at my X-rays and reading the MRI report for the knee scheduled for surgery, he definitely said that I do not need surgery. I just wonder how come 3 orthopedic doctors/surgeons before him told me I need the surgery and he flat out said that I don't need it and that the PRP will indeed help me.