Platelet-rich plasma promises pain relief and healing, but remains controversial

Orthopedics Today—April 18, 2013

The use of platelet-rich plasma remains controversial as treatment regimens and formula concentrations are not standardized, high-level studies proving efficacy are few and many health care systems hesitate to adopt the treatment due to lack of reimbursement.

"There is tremendous variability within platelet-rich plasma formulations," Scott A. Rodeo, MD, of Hospital for Special Surgery in New York City, told Orthopedics Today. "It is a compelling concept to isolate autologous cytokines and factors from blood, but we are still at the tip of the iceberg. It is in its infancy. We need to become more refined in the understanding of what we want to give to the patient."

The numerous brands, concentrations, doses and uses of platelet-rich plasma (PRP) create a challenge in determining the best formulations of PRP for patients, according to Rodeo. The mechanisms for healing of PRP solutions vary and are dependent upon platelet numbers and captures, the efficiency of those captures from given blood samples, activation techniques, leukocyte counts and specific growth factors or proteins.

"We say all these growth factors are good," Rodeo said. "That is a blanket statement. We need to know which of the hundreds of growth factors or proteins are important. That is going to vary for the tissue, situation or injury. The non-standardization and the variability is one of the biggest challenges in interpreting the data that exists in this area."

While many studies have shown significant pain relief in patients who receive PRP, Rodeo said researchers hope PRP will regenerate tissue and reduce the need for surgery.

"The biggest benefit would be as a nonoperative modality for conditions that are difficult to treat," he said.

Patients with tissue conditions involving poor cellularity, such as chronic tendonitis, arthritis or cartilage injuries, would benefit the most from these formulations, Rodeo said. "The hope would be for platelet-rich plasma to give more sustained benefit and regenerate tissue," he said.

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