"Biological treatment" is a new buzz word in orthopedics. The concept is to use the body's own repair systems to improve healing and restore function. One such treatment is the use of "platelet rich plasma" (PRP). Platelets are tiny pieces of blood cells that are important for blood clotting. As it turns out, they also seem to be important for wound healing. Researchers are now starting to see whether it's helpful to spin down a few tablespoons of a patient's own blood, separate out a portion that is rich in platelets, and inject that platelet-rich plasma into injured parts of the body such as knees and elbows.
PRP therapy is already being used in Europe. In the United States, it is starting to take off. Dr. Allan Mishra, an orthopedist at Stanford University Medical Center, has been a pioneer in its use in the United States. He first started using PRP in 2001. I spoke to Dr. Mishra tonight and he pointed out that healing in the tendons and cartilages tends to be poor because of limited blood supply. With PRP, "you're taking a component of your own blood, concentrating the wound-healing components and injecting those back into your body into an area where you are not able to heal very well." In brief, he adds, "you're trying to take advantage of your own body's ability to heal itself."
Traditional treatment of tendonitis has concentrated on reducing inflammation with non-steroidal anti-inflammatory medications (NSAID's), steroid injections, or rest. But the goal of PRP therapy is to promote healing rather than just decrease inflammation. Dr. Mishra estimates that he's treated between 100 and 200 patients, and that across the United States several thousand patients have been treated for orthopedic injuries. Over the past 12 months he's treated about 60 patients – mostly with elbow tendonitis (tennis elbow), knee tendonitis, and Achilles tendon repairs. With tennis elbow, for example, "you see improvement within two to four months." Dr. Mishra says that so far side-effects have mostly been limited to pain and swelling at the injection site. The cost is about $1,500 per treatment.
The use of platelet rich plasma is not specifically FDA approved for use in tendonitis or cartilage injuries. Dr. Mishra is the director of a large, multi-center study looking into the effectiveness and safety of PSP for treatment of damaged cartilage, tennis elbow and inflammation of the foot (plantar fasciitis). He estimates the study will be completed in one to two years.