DEAR DR. GOTT: I would like your opinion about platelet-rich plasma (PRP). I have an impingement in my shoulder and was told I need surgery. Do you think the PRP is an option?
DEAR READER: There is an increasing demand, and rightly so, for the use of autologous (self-donated) blood products that aid the healing process. Blood contains red and white blood cells, platelets and plasma. The platelets are responsible for the production and revitalization of new connective tissue. Let me briefly discuss PRP, and then I will try to answer your question.
During the procedure you are considering, about 30 to 60 milliliters of a patient’s blood are drawn and spun down in a centrifuge for 15 minutes. From that draw, between 3 and 6 ccs of PRP become available. The concentrated platelets are then injected into the patient at the site of the injury.
The process was first used and documented in 1987 by a physician who performed open -heart surgery. However, it has been only about a year since it has been used in conjunction with sports-related/overuse injuries. Perhaps because tendons get very little blood, injury sites heal slowly. The thought process behind PRP is that concentrated platelets injected into the injury site should speed recovery.
A Journal of the American Medical Association (Jan. 13, 2010) reported the use of PRP for Achilles tendinopathy and indicated the PRP injection, compared to a saline injection, did not result in greater improvement in pain and activity. Keep in mind this report was for chronic Achilles tendinopathy, not shoulder impingement. I state this only because there is little, if any, information regarding the shoulder.
The New York Times covered the topic on Jan. 12, 2010, stating the treatment has become so popular that patients are willing to pay $1,000 or more out of pocket for PRP — especially after hearing that Tiger Woods had his knee injected and two football players, Troy Polamalu and Hines Ward, received injections, all with positive reports. Thousands of doctors and about 500 hospitals are offering the service today. However, the first rigorous study found that platelet injections are no more effective than saltwater. Again, this report extracted from the JAMA report is related only to acute Achilles tendinopathy.
In defense of the procedure, another study in the American Journal of Sports Medicine due out soon concludes that platelet injections may help tennis elbow, but some indicate the study has a design flaw that leads them to question its conclusions. This may be worth watching for final analysis.
As you can see, the jury is out on this one, and I am a member of the jury. Thank heavens testing continues. My problem is that PRP is in its infancy and has been used for sports-related injuries for only about a year. I’m not daring enough to be on the cutting edge, nor am I willing to step up to the plate and take a stand. It’s simply too soon for my endorsement.
Only you know your physician’s qualifications. Perhaps a second opinion at a large sports-medicine center or teaching hospital is appropriate. Good luck.
To provide related information, I am sending you a copy of my Health Report “An Informed Approach to Surgery.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
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