Perspective of PRP in Musculoskeletal Disorders

posted May 15, 2013, 3:26 PM by Arockia Doss   [ updated May 30, 2013, 7:01 AM ]

Platelet Rich Plasma and autologous mesenchymal stem cell treatment for OA have generated considerable interest in the recent past due to the concept of using a natural agent from ones own body for pain relief. 

PRP is obtained by separating and concentrating natural growth factors in our blood. PRP works by stimulating the natural healing cascade. PRP contains growth factors that reduce inflammation, promote matrix gene expression and promote collagen deposition. 

Once the pain generator is identified, PRP is delivered into the painful area e.g: tennis elbow, golfer's elbow, tendonitis, tendon tear, cartilage tear, arthritis etc.

To date there are a number of follow up studies and a handful of Level 1 randomized controlled studies that show a favourable effect of PRP in osteoarthritis and tendon disorders. A recent study confirmed that PRP is effective in Osteoarthritis of the knee compared to saline (placebo control) injections. Another study in tennis elbow shows that PRP is effective out to two years in comparison to other treatment options. PRP injection and needling under ultrasound guidance in rotator cuff tendon lesions showed benefit when compared with just needling alone in a small study. These studies add evidence to the use of PRP in selected cases.

However much more is needed. For example, we do not know the type of PRP, optimal dose and frequency in each condition for a particular patient profile. For example, gel or plug like PRP has different properties to liquid PRP and studies using different PRP for the same condition give opposing results. This is seen with PRP in rotator cuff disorders. We also do not know the beneficial or bad effects of PRP with or without other white cells (leucocytes). Some white cells lend the antibacterial properties in PRP. However other white cells secrete pain substances.

There are unknown long term risks and outcomes. For example, we do not know the real risk of growth of unwanted tissue such as fibrous scars or new spurs. This is because to date there is no data longer than 5 years in musculoskeletal conditions. Consolation however is that PRP has been in use since the 1970's and there is no such data from this period. However this may only mean that adverse effects were just not documented.

Overall, PRP is widely accepted as very safe with some benefits. This forms the basis of its role as another treatment option in place of current treatment options of cortisone, synvisc or surgery.

The bottom line is, there is no magic bullet for chronic musculoskeletal pain generators. Each condition in a particular patient has to be offered treatment options tailored to the individual needs on the basis of current evidence.