Platelet-rich plasma debated as treatment for joints, tendons

A treatment for "boomeritis" may just be in your own blood and not a drug.

Even without strong clinical evidence, three veteran orthopedic surgeons in Charleston are optimistic about the use of platelet-rich plasma as a new tool in healing degenerative joints and tendons without surgery or to speed recovery following surgery.

According to medical journals, the platelet-rich plasma is derived by putting the patient's drawn blood into a centrifuge, spinning it to separate the platelets from the red blood cells and then injecting the "PRP" into the problematic area of a joint or tendon.

After an initial inflammatory response, the solution stimulates the growth of collagen in tissue that had been degenerating and heals the joint.

The treatment, used in head and jaw surgeries since the 1990s, received national attention for a sports injury in 2009 when Pittsburgh Steelers wide receiver Hines Ward had it done on a knee injury two weeks prior to the Super Bowl. He came back and played a key role in the Steeler's championship win.

Studies still are under way for the treatment, but most are showing positive results, according to the October 2009 Journal of the American Academy of Orthopaedic Surgeons.

The journal article examined studies in six nonsurgical uses and six surgical uses. It offered this summary: "Given its excellent safety profile and ease of preparation, the use of PRP in sports medicine will likely continue to grow."

However, it also said that clinical use should proceed cautiously because there is little, if any, high-level clinical evidence supporting its therapeutic value.

Because of the lack of scientific evidence, insurance doesn't pay for PRP.

Dr. David Geier Jr., director of the Medical University of South Carolina Sports Medicine, calls PRP, "one of the more innovative ideas to develop over the past 10 years" and that the department has started using it.

He expects its application to expand in the coming years, especially if studies prove it works and that it provides an affordable alternative to surgery.

"The problem with it right now is not the technology and science behind it, but that insurance won't currently pay for it and that patients don't want to pay out-of-pocket for it without more evidence that it works," says Geier.

Despite that, a growing number of orthopedic physicians already are employing the treatment in their practices.

Dr. Bright McConnell of Charleston Sports Medicine says that PRP is part of the "emerging, exciting field" of orthobiologics and is useful in a range of injuries, including tennis elbow, jumper's knee, rotator cuff tears, Achilles tendinitis and plantar fasciitis.

He has been treating certain patients with PRP for nearly a year.

McConnell says that while this may help baby boomers return to sports, it has implications for other job-related overuse injuries, too.

The benefits include forgoing the expense and recovery of a major surgery.

"We are allowing the body the opportunity to heal itself," says McConnell.

A 'miracle' cure?

Patients treated by McConnell with PRP in the past year are trumpeting it to varying degrees, so far.

"I think it's a miracle," says Andy Tedesco, 54, an avid runner who lives in Mount Pleasant.

In March 2009, he had a $17,000 surgery to repair tears in his left knee. After it healed, he returned to normal activities but still couldn't do the activity he loved most: running.

In October 2009, McConnell told Tedesco that he had two basic choices to make: have another surgery with no guarantees or have the $700 PRP shot, also with no guarantees.

Tedesco chose the latter. Three weeks after treatment, McConnell gave him the OK to start running again. By December, Tedesco returned to winning age group awards at road races.

Last March, he broke 40 minutes, specifically 39:35, at the Cooper River Bridge Run 10K for the first time in his life.

"I'm running more mileage and faster than I was before I got hurt," says Tedesco.

Susan Bowers, 46, of Daniel Island has been playing tennis regularly for about 10 years. About two years ago, she started developing tendinitis in her elbow.

"I played through the pain," recalls Bowers, who resorted to getting cortisone shots in October 2008 and again in April 2009. Then in August 2009, she tore the tendon while picking up a coffee cup.

Later that month, McConnell injected her with PRP, and after recovery and some rehab, she was back to playing tennis in January.

Bowers says that while she occasionally has bouts with arthritic pain in the elbow, she no longer has radiating pain.

She views PRP not as the solution, but as a second chance.

"The long-term fix is that you have to listen to your body, strengthen the body part affected and correct your mechanics and make sure you have good equipment," says Bowers.

Jay Noce, 47, of Daniel Island recalls his knees bothering him so much that one day when he chased his three young kids across the yard he "felt like a 90-year-old."

The wear-and-tear started early for Noce, who played tennis for Randolph-Macon College and continued with an active life of karate and running.

After hearing about PRP, Noce went to New York for his first injection a year and a half ago, then had another with McConnell.

He says, "I think the jury's still out on how many shots are required for certain joints and tendons."

But since getting the treatment, he passed his black belt exam in karate and has resumed running. And even better, he can chase his kids again.

"It's given me the ability to enjoy my kids' childhood again," he says.

Proof and who pays

Despite the testimonials, science takes a while to provide evidence and many studies have been small.

Some of the larger ones included one at Stanford University Medical Center that looked at 140 patients with chronic elbow tendinosis.

Eight weeks after PRP treatment, 60 percent noted an improvement versus 16 percent in a control group. The study concluded that while further evaluation is warranted, PRP should be considered before surgery.

In another study of the elbow, published in the Journal of Bone and Joint Surgery in 2009, researchers studied 100 people with severe tennis elbow, or chronic lateral epicondylitis, to compare injections of platelet-rich plasma in 50 of the patients to injections of corticosteroids in the other 50. They concluded that PRP has a significant better effect on tennis elbow than injections of corticosteroids.

While Dr. Robert Lowery of Charleston Bone & Joint stresses that PRP is still under review, he's optimistic about it as one alternative between conservative rehabilitation methods and surgery.

"The good news is that it's fairly inexpensive and it doesn't cost a thousand dollars to give it a try," says Lowery.

Reach David Quick at dquick@postandcourier.com or 937-5516.

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