Platelet rich plasma (PRP) continues to be the buzz when treating various musculoskeletal problems. It stimulates the body’s healing response for tissue repair at the site of injury. While the best applications so far are for chronic tendinosis and osteoarthritis, a recent national orthopaedic meeting presented even more positive studies on the effect of PRP in arthritis.
Initial studies demonstrated positive effects of PRP on horse tendons by stimulating gene expression and improved tendon synthesis. Multiple clinical studies reinforced this data by showing significant improvement in cases of chronic tennis elbow. Our study of 114 patients treated with PRP for either tennis or golfer’s elbow (tendinosis) showed a significant decrease in pain scores and a simultaneous increase in functional and sports/recreational activity scores at six months, one year and two years from treatment baseline. MRI in a limited number of patients compared to baseline demonstrated an improvement in appearance of moderate and severe tendinosis (58%) and partial tears (44%). Other studies have also showed the benefit of PRP in chronic patellar and achilles tendinosis.
In early research investigating PRP treatment for severe arthritis, clinical improvement is seen, as well as a positive effect on cartilage cells. In addition, multiple studies have followed patients for up to one year post treatment. We studied 22 patients treated with PRP for knee osteoarthritis, finding that pain scores significantly decreased, while functional and clinical scores increased at six months and one year from baseline. MRI evaluations demonstrated no progression of arthritis/compartment in at least 73% of the cases at one year. This is in contrast to some studies that suggest an annual decrease of up to 4-6% of cartilage volume (a worsening of arthritis) in knee osteoarthritis if left untreated.
So with PRP intervention perhaps we can delay some of the progression of arthritis. We have now treated over 350 patients with knee osteoarthritis with PRP and continue to see good results. The future looks bright for PRP and regenerative medicine. Tapping into your body’s healing response continues to be an exciting frontier.
Dr. Brian Halpern is a sports medicine physician at Hospital for Special Surgery. He “pioneered the non-operative approach to acute and chronic musculoskeletal problems.”