Joseph Aiello, D.O.

Christina Martinez, N.D.  


San Diego Center for Integrative Medicine

619 670-8028

PRP Research

Mishra Study-Tennis elbow.

Kon Study-Patella tendinosis.

Kon Study- Knee osteoarthritis.

Barrett Study-Plantar fasciitis.

Peerbooms Study-Tennis elbow.

Research has been ongoing with PRP for years.  With respect to animal studies, PRP was shown by Hammond, et al to heal acutely injured rat muscle faster than without1.  In another model, rabbit patella tendon was injured by carving a gap in it and filled in with PRP.   This study showed the tendon to heal better, faster with PRP and had more angiogenesis earlier in the healing.  The fibers that grew had more elasticity2.

Human studies have been done on tennis elbow, patella tendon and planter fasciitis.  Mishra showed healing of tennis elbow in 2004 in patients that had recalcitrant lateral epicondylitis for longer  than a year3.   Kon, et al showed healing in patella tendon injury.  The patients had the injury for more than 1 year and had been through many different therapies which had not helped.  After 2 treatements of the patella tendons in these 20 patients resulted in 85% healing4.  Plantar fasciitis is healed better with PRP according to Barnett5.  Finally, Peerbooms in the Netherlands this year, in a study of lateral epicondylitis has shown much better healing with PRP compared to cortisone in a double blind study of 100 patients.   His definition of success was no further treatment for 1 year and a reduction in pain of 25%.  He showed the PRP to have a 73% success rate compared to 51% in the cortisone treatment arm.  He noted that the cortisone patients got better more quickly but then plateaued whereas the PRP patients continue to improve with time6.  This is expected considering the healing cascade that the PRP initiates when it is injected.

With respect to my experience with PRP, I have done a retrospective study on Medicare patients which included 36 patients.  We sent out a survey to 63 patients and got 36 responses.  This was a 57% response rate.  The age range for the patients was 57 to 90 years old with an average age of 73.9.  The average number of shots per joint was 1.56.  The average percent improvement was 62%.  Number of patients needing more than three shots was only three patients.   The joints that were treated were 21 lumbar, 14 knee, 6 shoulder, 7 hip, one cervical, and one ankle.  58% of patients were very satisfied with 17% being somewhat satisfied and 22% being satisfied.  Only 2.8% or one patient was not satisfied.  Only 11 percent or 4 patients got less than 20% improvement with the PRP.  Eight patients or 22% were considering surgery before the PRP.  Patients had pain anywhere from a couple months to 30 years with an average time of five years and three months of pain in the affected joint before having the PRP injection.  Several patients had surgery on their joints prior including lumbar laminectomy with plates and total knee replacements.  With respect to activities of daily living people described less pain, able to walk better, able to sleep better, able to do more activities around the house such as gardening and housecleaning with much less pain.  Also they described recovery being quicker compared to before when they had done activities.  I think the important factor here for Medicare is that these patients overall improved with PRP treatment which is very safe and effective and minimally invasive.  Moreover, eight patients who were considering surgery for their joints are now able to live an active lifestyle with much less pain and avoid the surgery with all its complications and costs, both for the medical system and  for the patient.

More research data: This was compiled from April 2009 through April 2010.  It includes 112 patients ranging in age from 18 to 90.  This was a 66% response rate.  The average age was 59.  One hundred twenty nine joints were treated comprising 43 lumbar spines, 40 knees, 18 shoulders, 14 hips, 5 ankles, 3 wrists, 2 thumbs, 2 cervicals, 1 thorax and 1 achilles. 

The patients were asked to fill out a retrospective questionnaire that included the following information:

1.       Age

2.       Amount of time in pain before the PRP injections.

3.       Number of shots per joint.

4.       10 scale of pain before and after injections.

5.       Percent improvement.

6.       Satisfication with the procedure.

7.       And would they recommend the procedure.

The data showed an average age of 59.  The patients were in pain ranging from  a couple months to 50 years.  The average time in pain was 57 months. 

The average number of shots per joint was 1.94.  On a scale of 1-10, the patients started out with an average pain of 8.0 and finished with an average pain level of 3.6 after injections.  Time to relief was a couple days to a couple months.    When the patients were asked to rate their percent improvement, they gave an average of 57% improved.  When asked to rate their satisfication, 53 patients(50%) were very satisfied, 27patients(25%) were satisfied, 11 patients(10%) were somewhat satisfied, and 16 patients(15%) were not satisfied.  Finally, 87.5% would recommend the procedure, 10.7% would not recommend and 1.8% were not sure.

More research Data: 1 year follow-up

Surveys sent out based on results of the above surveys.

88 respondents out of 112=79%

Sites

         -Lumbar-36%

         -Knee- 31%

         -Shoulder-13%

        - Hip-8%

        -Elbow-6%

        -Ankle-6%

        -Plantar fascia-1%

Average time since last PRP injection= 14.3 months

On a scale of 1-10

Pain at end of last PRP injection=3.4.

Pain at time of survey=2.7.

Activity level

        -Increased-52%

        -Same-33%

        -Decreased-14%

     Had surgery=7 for 8%

 

Bibliography

 

1. Hammond Jason, et al.  Use of Autologous Platelet-rich Plasma to Treat Muscle Injuries, American Journal of Sports Medicne 2009;10:1-8.

2. Lyras D, et al.  Immunohistochemical study of angiogenesis after local administration of platelet rich plasma in a patellar tendon defect.  International Orthopaedics 2009;11 February: online.

3. Mishra, Allan et al.  Treatment of Chronic Elbow Tendonisis with Buffered Platelet Rich Plasma.  American Journal of Sports Medicine 2006;10:1-5.

4. Kon, E. et al.  Platelet rich plasma: New clinical application. A pilot study for treatment of jumper’s knee.  Injury,  International J. Care Injured 2009;40:598-603.

5. Barret, S  et al.  Growth Factors for Chronic Plantar Fasciitis.  Podiatry Today 2004;November:37-42.

6. Peerbooms, J. et al.  Positive effect of an Autologous platelet concentrate in lateral epicondylitis in a double blind randomized controlled trial:platelet rich plasma versus corticosteroid injection with a 1 year follow-up.  American Journal of Sports Medicine 2010; 38: 255-262.

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