The risks of being ahead of the curve in reporting on an experimental therapy: you never know when new information is going to shake loose from the scientific community. Tuesday, our Dr. FAQ series focused on platelet-rich plasma therapy, a treatment gaining popularity over the last year for a variety of sports-related injuries. J. Martin Leland, an assistant professor of surgery with our orthopaedic sports medicine team, explained the idea behind PRP therapy and the injuries it is currently being used on at the University of Chicago Medical Center and other health centers.
Leland also warned that PRP therapy remained experimental, without the double-blind, placebo-controlled trials that are the gold standard for proving that a medical treatment is effective. The day after I posted the videos, just such a trial was published in one of the leading medical journals, JAMA. The news was less than encouraging for PRP therapy. In a trial of 54 patients with an Achilles tendon injury called chronic achilles tendinopathy, PRP therapy in combination with a physical therapy technique called eccentric exercise was no more effective at reducing pain and increasing activity than a combination of placebo and eccentric exercise. News coverage of the research described the therapy as “no more effective than saltwater.”
The study itself highlights the difficulty of translating basic research into clinical application. Review articles, like this one, recommended the procedure based on promising results from lab-bench and animal studies, experiments which don’t always make the jump to the clinic. The authors also point out that invasive therapies, such as injections, can induce a potent placebo effect (even the participants in this study who received placebo showed significant improvement in pain and activity).
However, before PRP therapy is written off completely, it’s important to note that this study only tested the treatment in one specific kind of injury. After reviewing the JAMA, paper, Dr. Leland wrote the following statement to me about the current status of PRP therapy.
A Dutch study published in the Jan. 13, 2010 issue of the Journal of the American Medical Association (JAMA) found that an injection of platelet-rich plasma (PRP) performed no better than saline for chronic Achilles tendinopathy patients who were treated with eccentric exercises. This is an important study because it is one of the first of its kind regarding the effectiveness of PRP when used for the treatment of different issues in humans. However, this is only one of the first studies to come out and rash decisions should not be made based upon its findings alone.
I feel that physicians and patients should remain “cautiously optimistic” regarding the use of PRP. Over time, more and more studies will be published regarding the effectiveness of PRP. This study is a perfect example that PRP is not the solution to every problem. However, this is only one study on one specific disorder in the human body. Much more research is needed to determine if this study can be reproduced in other studies as well as what the effectiveness is of PRP on other parts of the body. In my opinion, the risks of PRP use are low and the benefits, in certain situations, may warrant its use. However, only research in the future will be able to specifically determine when and where PRP is specifically effective.
As the New York Times article linked above notes, a study showing encouraging effects of PRP therapy in combination with steroids for tennis elbow is forthcoming, and much more research is currently underway. So the story of PRP therapy is still just beginning, and it will be worth tracking which way the research tips on the procedure in the months and years to come.