Platelet-Rich Plasma Therapy - Tegenkamp

I recently got a second opinion on my achilles tendonitis at the hospital for special surgery in NYC and he said that a PRP shot could potentially work for me. I had a similar type shot done, except the platlets were not seperated out and thus caused an inflamed reaction that has kept me from running for some time.

However, my problem of tendonitis and other pain is because of my Haglund's Deformity which was finally decided by another doctor in Baltimore yesterday needed to be shaven down.

The doctor in NYC thought that would probably be best when I talked to him, but suggested doing a PRP shot during the surgery could help in the recovery since there is some scar tissue on the tendon from years of wear and tear.

Anyone know how I can recommend my Baltimore doctor taking my NYC doctor's advice?

This therapy is pretty off the beaten bath- it's most studied uses have been chronic wounds/ulcers, and oral surgery. The results are inconclusive, no one knows whether this does anything that wouldn't happen with standard care/passage of time. The fact that a few high profile people are using this will likely only speed the adoption of this, which is too bad- for all we know it's hurting them.

Medicine is full of cases like this, where a promising and rational idea is widely implemented before the effects are well knowm, and only years later do people figure out that the therapy is actually hurting people. A prime example would be autologus stem cell transplant for breast cancer- in theory a great concept. Take stem cells, give high dose chemo to wipe out the cancer (doses that also fry the bone marrow), then give back your own stem cells to re-populate your bone marrow. This was widely practiced, then people actually studied it rigorously and it turns out it was killing more people than standard therapy. Oops. There are may more examples. Granted, this pratice probably won't kill anyone, but it might be prolonging the injury.

Below is the abstract of the review on this...

-dd

Efficacy and safety of the use of autologous plasma rich in platelets for tissue regeneration: a systematic review.Martínez-Zapata MJ, Martí-Carvajal A, Solà I, Bolibar I, Angel Expósito J, Rodriguez L, García J.

Iberoamerican Cochrane Center, Epidemiology and Public Health Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

mmartinezz@santpau.cat

BACKGROUND: Autologous plasma rich in platelets (PRP) is a derived blood product whose application in clinical practice is growing. A systematic review was conducted to evaluate its efficacy and safety. STUDY DESIGN AND METHODS: A search was performed in electronic databases. Randomized controlled clinical trials (RCTs) in adult patients were included and assessed for methodologic quality. The main outcomes were "tissue regeneration" and "safety." Relative risks (RRs) and standardized mean differences (SMDs) were calculated to show pooled estimates for these outcomes. When the results heterogeneity was more than 50 percent, a sensitivity analysis was performed. RESULTS: Twenty RCTs were included (11 of oral and maxillofacial surgery, 7 of chronic skin ulcers, and 2 of surgery wounds). Four RCTs evaluated the depth reduction in gingival recession in chronic periodontitis; the SMD was 0.54 (95% confidence interval [CI], 0.16 to 0.92) mm, favorable to PRP. Three RCTs evaluated the clinical attachment level in chronic periodontitis; the SMD was 0.33 (95% CI, -0.71 to 1.37) mm. Six RCTs assessed the complete skin epithelialization in wound ulcers; the RR was 1.40 (95% CI, 0.85 to 2.31). Only 6 RCTs reported adverse effects without differences between groups. CONCLUSIONS: PRP improves the gingival recession but not the clinical attachment level in chronic periodontitis. In the complete healing process of chronic skin ulcers, the results are inconclusive. There are little data about PRP safety. There are several methodologic limitations and, consequently, future research should focus on strong and well-designed RCTs that assess the efficacy and safety of PRP.

Sounds interesting, but I'd like to see more research first. I did my Master's thesis on enhancing bone recovery with whole body vibration training (which we found to be effective), so I'm a firm believer in mechanical stimulation for enhancing healing and shortening recovery time. Totally believe in barefoot running as a cure-all. Heck, even healed a fractured rib in 3 weeks because I kept training through it and ate a lot of beef! It would be interesting to see how this stacks up with tradition treatment methods.

jaguar1 wrote:

Heck, even healed a fractured rib in 3 weeks because I kept training through it and ate a lot of beef!

Please tell me you're joking or, at minimum, you don't plan to reproduce.

My question is whether or not the actual injection would cause scarring if done repeatedly (similar to cortisone shots).

Don Veggie Burrito wrote:

jaguar1 wrote:

Heck, even healed a fractured rib in 3 weeks because I kept training through it and ate a lot of beef!

Please tell me you're joking or, at minimum, you don't plan to reproduce.

No, I'm serious. There was a knot the size of half a tennis ball. We taped up the right ribcage, and I ran easy every day (100-110 mpw at the time). The knot and pain was gone after 3 weeks, and I ran my first marathon after 8 weeks. Your ribs are non-weight bearing, so the light mechanical stimulus of the surrounding muscles (= blood flow w/growth factors) + greater IGF-1 from meat heals bone faster. Ate lots of fruit too (potassium citrate) and sleep.

From the article: "It is thought that introducing autologous blood into an area of inflammation will initiate the inflammatory cascade and promote healing in an otherwise degenerative process such as tendonosis or fasciosis. In 2004, Dr. Barrett discussed the misnomer of using the term plantar fasciitis. He suggested that the condition is not an inflammatory entity and points out that researchers have been unable to find inflammatory cells microscopically in cases labeled fasciitis. He suggested that the condition is rather a degenerative condition of the fascia. He points to a landmark study performed by Lemont in 2003 and termed chronic conditions of heel pain as plantar fasciosis (see article Coblation Technique in the Treatment of Plantar Fasciosis ). Barrett et al also reported on the use of injectable Autologous Platelet Concentrate (APC+) for the treatment of plantar fasciosis. The hypothesis was to injecting APC+ into recalcitrant, symptomatic plantar fascia in an attempt to cause a reparative effect leading to a resolution of symptoms. He termed this technique plantar fasciorraphy. His study included 9 patients who enrolled in the study. The patients agreed to forego steroid injection treatment within 90 days of the study and not undergo any therapy, NSAID treatments or wear orthotics. All patients had thickened fascial hypertrophy on ultrasound examination confirming plantar fasciosis. 20 cc’s of the patient’s blood was withdrawn and using the Smart Prep® System (Harvest Technologies), 3 cc’s of APC+ was obtained for injection. A posterior tibial and sural nerve block was then performed and under ultrasound guidance using a 25 gauge needle, 3 cc’s of APC+ was then injected into the most hypoechoic areas of the plantar fascia. The patients were then placed in a below the knee cast immobilization boot and advised to avoid weight bearing for 48 hours. Patient could then resume ambulation over the following days. Patients were monitored at varying intervals post injection phase. Using ultrasound measurement, an overall reduction in the thickness of the fascia was demonstrated post injection. Of the 9 patients enrolled, 6 patients reported complete relief of symptoms post injection. At one year post study, 7 of the 9 patients had complete relief of symptoms (about 77.8%). Barrett stated the results were comparable to the Edwards study."

There is a fantastic practice that implements PRP in NY.

call 718-544-1444 or 845-425-7997