Bashir, MD; Alberto J. Panero, DO; Andrew L. Sherman, MD; “The Emerging Use of Platelet-Rich Plasma in Musculoskeletal Medicine”, The Journal of the American Osteopathic Association: JAOA; January, 2015, Vol. 115, Number 1, pg. 24-31
Over the last two weeks I have been reviewing the above article that discusses the use of Platelet Rich Plasma in non-surgical orthopedics. In this blog I review the clinical studies they discuss that used PRP in knee osteoarthritis:
“A pilot study of 14 patients with primary and secondary osteoarthritis of the knee, in which 3 PRP injections were administered at 4 week intervals, found statistically significant and near-linear improvements in knee injury and osteoarthritis outcome scores, including both pain and symptom relief. The Brittenberg-Peterson VAS scores showed many improvements, including reduced pain after knee movement and at rest, with the majority of patients expressing favorable outcome at 12 months after treatment.”
30 patients were randomized to 3 intra-articular injections of PRP in the knee at 3-week intervals vs. 3 intra-articular injections of sodium hyaluronate in the knee at 3-week intervals. “A 6 month follow-up analysis of the 2 groups scores on International Knee Documentation Committee, Western Ontario and McMaster Universities Arthritis Index, and Lequesne index demonstrated statistically significant improvements in the PRP group compared with the sodium hyaluronate group.
150 patients were divided into 3 groups in a prospective comparative study to compare the effects of PRP with high and low-weight hyaluronic acid. All groups showed statistical improvement at 2 and 6 month follow-up, with those >50 years old or those with higher-grade cartilage degeneration faring worse. However, only the PRP group showed progressive improvements between the 2 month and the 6 month follow-up.
So, it looks like PRP is now demonstrating its potential benefit in the treatment of ligament laxity, tendonopathy and even knee osteoarthritis. This is all great news. I have used prolotherapy in patients with ligament laxity and tendonopathy for ten years and had excellent results. However, these therapies up until now have NOT been covered by insurance companies so the patients must be able to afford the out of pocket cost of these procedures and treatments. I have found using proliferants such as P2G or sarapin to be affordable for my patients in the Mount Washington Valley of New Hampshire, which is a tourist driven economy and rural; but, the typical patient in my service area cannot afford $600-$800 per injection for PRP. PRP requires a blood draw and equipment to appropriately prepare and extract the Platelet Rich Plasma for treatment. This is an expensive process and cost prohibitive in my opinion for the patients I serve. I would love to hear other people’s thoughts/practices on these therapies.