What is platelet-rich plasma therapy?

Platelet-rich plasma therapy – a treatment for aiding the regeneration of ligament and tendon injuries – is helping to shorten rehabilitation time and often eliminates the need for surgery. Platelet-rich plasma therapy is part of a relatively new field of medicine known as orthobiologics that includes the use of stem cells and emphasizes employing the latest technologies along with the body's natural ability to heal itself. "One of our major goals is to make healing time faster for patients with soft tissue injuries," says Christopher S. Ahmad, MD, Director, Center for Pediatric and Adolescent Sports Medicine at NewYork-Presbyterian Morgan Stanley Children's Hospital. "For example, a patient undergoing elbow ligament reconstructive surgery, commonly referred to as Tommy John surgery, may take a year to recover. That's a long time. Recovery time for anterior cruciate ligament [ACL] surgery is approximately six months. So while we are very good at performing surgery to correct these injuries, we're now accelerating the healing by biologic manipulation. That's where platelet-rich plasma comes in."

Platelet-rich plasma therapy (PRPT) is a technique in which a sample of a person's blood is separated in a centrifuge into its liquid part (called plasma) and blood cells (which includes red blood cells, white blood cells and platelets). The plasma and the platelets (cells involved with blood clotting) are then injected back into the person at the site of the tendon problem or arthritis. This appears to stimulate the body's repair mechanisms. PRPT has been used to treat chronic tendon problems as well as acute injuries in athletes. Reports of success in treating professional athletes have spurred interest in the technique for treating tendon problems in others as well.

PRPT makes biological sense, since platelet-rich plasma contains growth factors and other proteins that aid in cell repair. Laboratory evidence as well as anecdotal reports also suggest improved healing. But a randomized, placebo-controlled trial published in 2010 in The Journal of the American Medical Association (JAMA) put the effectiveness of PRPT in question. Dutch researchers studied 54 people with chronic Achilles tendon pain. Half received PRPT, half received injections of salt water, and all performed rehabilitation exercises. After six months, there was no difference between the two groups.

This study isn't the final word, but it carries considerable authority, because it's a randomized controlled trial -- the gold standard of clinical studies -- and was published in a leading peer-reviewed medical journal. If you had Achilles tendinopathy, I'd recommend against PRPT and suggest that you stick with exercise. And in light of the JAMA study, I'm not enthusiastic about PRPT for other tendon problems, either.

At a meeting of the American Academy of Orthopaedic Surgeons, another group of Dutch researchers reported on a trial involving 100 patients with tennis elbow who were assigned to either PRPT or a corticosteroid injection and followed for a year. About 50% of the corticosteroid group and 75% of the PRPT group improved. But this study wasn't placebo-controlled (corticosteroids aren't a placebo) and it hasn't yet been published in a peer-reviewed journal. Besides, the treatment is expensive and most insurers don't cover it.