In the summer of 2010, Nick Osterman was pitching for the Forest City Owls of the Coastal Plains League. With two out in the eighth inning of a baseball game against the Thomasville Hi-Toms, he threw a fastball for strike three and felt something give in his right elbow.
“It was like a tearing-away sensation,” said Osterman, a fifth-year senior at College of Charleston. “It felt like there was a needle in my elbow.”
Osterman, a graduate of Stratford High School, had suffered a partial tear of the ulnar collateral ligament in his right elbow. That injury sometimes requires repair through what is known as “Tommy John surgery.” Normal recovery time: One year.
“I wanted to get on the field for my senior year,” Osterman said. “I didn’t want to do surgery and sit out a year.”
Instead, Osterman opted for a relatively new treatment known as platelet-rich plasma, or P.R.P. On July 31, 2010, Dr. Bright McConnell of Charleston Sports Medicine withdrew some of Osterman’s own blood and spun it in a centrifuge, concentrating platelets and growth factors up to 500 percent. The P.R.P. was then injected into Osterman’s torn ligament, the goal to promote growth and healing.
Six months later, Osterman was back pitching for the Cougars. He appeared in 14 games and had two saves for Charleston last year, and this season is 2-0 with a 3.24 earned-run average in 11 games.
“He’s probably better now than he’s ever been,” said Cougars coach Monte Lee.
Osterman joined a list of celebrity athletes who have used P.R.P. to well-publicized effect, setting off something of a P.R.P. boom among sports medicine physicians. Scientific studies have not caught up to the anecdotal evidence on P.R.P — and most insurance companies are not paying for it yet — so weekend warriors should use caution when considering the procedure for their own aches and pains, experts say.
Science makes sense
The theory behind P.R.P. makes sense, according to Dr. David Geier, director of sports medicine at the Medical University of South Carolina.
“You take a small amount of the patient’s own blood, put it in a centrifuge and spin it off to get rid of the white and red blood cells,” he said. “What remains is the plasma, and that’s where the platelets and all the growth factors are. You inject that into the area you are trying to heal. What you are trying to do is stimulate an inflammatory response, which is what helps the injury to heal.
“In theory, the science makes a lot of sense.”
So much so that famous athletes such as Hines Ward and Troy Polamalu of the Pittsburgh Steelers, running back Ahmad Bradshaw of the Giants and golfer Retief Goosen have used P.R.P. for various ailments. Even Tiger Woods has reportedly used P.R.P. injections to help his ailing knee.
Rigorous scientific studies have yet to support anecdotal evidence as to how well P.R.P. works, Geier said.
“The problem is we started doing it a lot, and then came the randomized blind studies,” he said. “And people who had P.R.P. really weren’t doing any better than people who had a placebo or standard treatment.”
According to McConnell, one problem is that there is a wide variety in how and to what injuries P.R.P. treatments are applied, and in follow-up care.
“We are trying to get the orthopedic community to come together and define what it is that we are calling P.R.P.,” McConnell said. “One issue is, what concentration of platelets are you achieving? The companies marketing P.R.P. and centrigues, they are kind of all over the map. Some don’t concentrate platelets more than twofold, and the data is that you need at least four or fivefold concentrations to get the growth factors you need.
“Does it work for everything? Is it fairy dust? No. But in my experience is, and I think the literature supports it, P.R.P can be very positive with certain chronic conditions — tennis elbow, jumper’s knee, Achilles tendon problems, ligament tears for pitchers. The data is very strong for that.”
Geier said he suggests P.R.P. for patients who have exhausted other options.
“It’s almost never a first-line treatment,” he said. “There aren’t that many studies that show it helps, and insurance doesn’t pay for it. But for people who have tried all the standard treatments and still can’t play or do what they like to do, it’s potentially an option.”
Tommy John alternative
The Cougars’ Osterman and his coach, Lee, certainly are believers.
“We thought Nick was done,” Lee said, recalling when he was told about Osterman’s injury. “Any time you hear about an injury like that, you generally don’t come back from that, at least without surgery.”
McConnell informed Osterman of the P.R.P. alternative, and the pitcher went for a second opinion to Dr. James Andrews. He is a renowned orthopedic surgeon and top practitioner of Tommy John surgery, the ligament- replacment operation named after the former major league pitcher.
“Dr. Andrews said, ‘I wouldn’t operate on this,’” McConnell said. “He recommended the P.R.P. treatment. Ninety percent of the time with a problem like Nick’s, a partial tear where there is a scaffolding of tissue to work with, it heals them. The bottom line is, you can look at non-surgical management for this, unless it is a complete blowout that needs to be reconstructed.”
The P.R.P. treatment is not inexpensive, averaging between $600 and $750, and insurance companies are generally not yet paying for it, McConnell said. But compared with $15,000 to $20,000 for a Tommy John surgery, it can be quite cost effective. And a recent study by the Kerlan-Jobe Orthopaedic Clinic in Los Angeles reported promising results in using P.R.P. to treat injuries such as Osterman’s.
Osterman said his injections were not painful. He did not throw for six weeks to allow the ligament to heal, then began a six-week throwing program before returing to action.
“The recovery was quick, and I’ve been perfectly healthy ever since,” he said. “I’m really glad Dr. McConnell recommended it. I think it’s a good alternative to surgery.”