"PRP" and Orthopedics: Hype vs. Fact

The acronym "PRP", for Platelet Rich Plasma, has gained the interest of the general public in the last few months, with reports of medical use for musculoskeletal injuries in high profile athletes such as Tiger Woods. PRP is one of the many newer ""biologics" increasingly studied and used in medicine these past few years. In Orthopedics and Sports Medicine, this involves the use of so-called "bioactive proteins" and "growth factors" to assist in repair and healing of bone and soft tissues. These chemical compounds are naturally found in the body and are intimately involved in growth and healing. Generally, the idea is that we might be able to use these factors to enhance healing. There has been an explosion in interest along with basic science laboratory studies followed by mostly early and limited actual clinical studies in people. Unfortunately, as is usual, some caregivers have “jumped the gun” in their enthusiasm, offering and marketing these treatments without much evidence. There has been concomitant hype and excitement in the public domain.

"PRP" therapy involves taking a small amount of the individual's own blood, typically less than 1 ounce, and then centrifuging this to concentrate and separate the platelets from the majority of the blood. This is variously further prepared to create products ranging from liquid for injection to gel-like "gummy bear" product which can be actually sutured or otherwise fixed into the injured area. The platelets provide multiple concentrated growth factors to the area. Obviously, this is very appealing, because we would be using natural and powerful healing stimulants, easily obtained, with no risk of disease transmission

However, as with other "biologics" there are some issues and challenges with the use of "PRP". We really don't know which growth factors to use, the best method of delivery, timing relative to the injury or surgery, proper dosing, appropriate indications or how to control the effects. Also, as is true with most new therapies, this is relatively expensive as yet.

Therefore, the rampant enthusiasm and somewhat indiscriminate use of "PRP" should be reined in for now while we further refine our associated knowledge and clinical skills.

The use of "PRP" and and other "biologics" is sure to play a bigger role in the future. Promising early results have been demonstrated in Orthopedics and Sports Medicine including arthroscopic surgery. Locally we have started to use this very sparingly in special situations in the knee and shoulder. We are excited about the future of this developing technology.

Dave Shenton, MD Ortho Montana