Written by Kim O’Brien Root
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[dropcap]Four years ago, the NFL’s Pittsburgh Steelers were on a roll, sure to end up in the Super Bowl, when two of their star players suffered injuries that could have left them on the sidelines.[/dropcap]Instead, Hines Ward and Troy Polamalu decided to try a treatment that wasn’t well known—having their own plasma injected at the site of their injuries to help them heal more quickly.
For both players, the treatment was successful, allowing them to return to the game in time to help the Steelers win the 2009 Super Bowl. It’s since been used by other professional athletes, including golfer Tiger Woods, basketball player Kobe Bryant and baseball player Alex Rodriquez.
Despite its success, Platelet-Rich Plasma (PRP) injection therapy still isn’t quite mainstream and studies are ongoing to help refine the treatment. It’s also not usually covered by health insurance companies, making it not always a viable option for some patients.
But some orthopedic doctors in Hampton Roads who perform PRP therapy think it’s only a matter of time before the medical community catches up and the treatment is accessible to anyone who wants a safe, more natural method of healing tendon injuries and osteoarthritis.
“I think it’s going to keep getting bigger and bigger,” says Dr. Ernesto Luciano-Perez, an orthopedic surgeon with Virginia Orthopaedic & Spine Specialists, a medical group affiliated with Bon Secours Hampton Roads.
With an injury such as tennis elbow (lateral epicondylitis), there are several treatment methods that doctors can use—such as medication, cortisone injections and in serious cases, surgery. PRP injection therapy is a method that uses a patient’s own blood, rather than any artificial means.
The treatment falls in a newer health sector called “orthobiologics,” which combines cutting-edge technology with the body’s natural ability to heal itself. The Orthohealing Center, a Los Angeles-based medical facility that specializes in non-surgical orthopedics and sports medicine, calls PRP therapy a “promising solution to accelerate healing of tendon injuries and osteoarthritis naturally without subjecting the patient to significant risk.”
PRP therapy involves taking about 50 milliliters of the patient’s blood (about enough to fill a shot glass) and spinning it in a centrifuge to separate the different components including platelets, red blood cells and the liquid component of blood that suspends blood cells—plasma. A highly concentrated amount of platelets—about 3 ccs worth—is then combined with the plasma (thus the term platelet-rich plasma) and injected into the patient.
“In that 3 ccs is all the healing powers of blood,” says Dr. Saunora Prom, a sports medicine physician with Tidewater Sports and Osteopathic Medicine in Chesapeake, part of the Tidewater Physicians Multispecialty Group.
Platelets have growth factors, says Dr. Luciano-Perez, who has been performing PRP injection therapy in his Suffolk office and at Bon Secours for the past few years. When the platelets are out of the body, they become activated and release proteins that induce other cells to divide and differentiate into other cell types.
“It can enhance the production of collagen,”
Luciano-Perez says. “That’s how you heal tissue, by introducing collagen.”
PRP injection therapy has been around for about 20 years, when it was used in the dental field to enhance wound healing in cancer patients who had jaw reconstruction, according to the Orthohealing Center. Its applications have since expanded, with use in many fields of medicine.
Prom has performed the procedure for tennis and golfer’s elbow, tendonitis, rotator cuff tears and osteoarthritis. In a knee damaged by osteoarthritis, he points out, “you put these healing platelets back into the knee to try and replace some of the cartilage that isn’t there anymore.”
What appeals to Prom, as well as to his patients, are the natural aspect of the treatment, he said. A cortisone injection can be very helpful, but it’s really just an anti-inflammatory medication.
Patients who chose PRP therapy want to avoid surgery, Prom says. “They want to try everything else before they go to surgery,” he adds. “They like the idea of self-healing. They like that the body is healing itself. … People like the idea of trying to heal the underlying issue, instead of just using a steroid and covering up [the issue] until the next time you need a steroid.”
Luciano, the medical director of sports medicine for Bon Secours Sports Medicine, has first-hand knowledge of PRP injection therapy — he’s had it himself. An avid golfer, Luciano suffers from medial epicondylitis — golfer’s elbow. He treated his elbow with cortisone and a brace before having PRP therapy. His elbow got 95 percent better, allowing him to avoid surgery.
His last PRP injection was about a year ago, Luciano says. He was back on the golf course three weeks after the injection, and says the pain has been manageable ever since. He’s been able to play without any restrictions.
“This is not an artificial substance,” Luciano says. “This is something that’s introduced to try and stimulate the body to heal.”
The half-dozen patients Luciano has treated with PRP therapy so far this year have done well, he says. Of the six, five haven’t needed a repeat injection; the sixth’s condition was advanced enough that it required surgery.
PRP therapy continues to be studied, with some promising results. One study that measured cartilage growth in the knee showed growth over a four-week period, Prom says.
In 2010, a study published in the American Journal of Physical Medicine & Rehabilitation found improvement in pain and symptom relief in patients with knee osteoarthritis who had PRP therapy. Researchers who performed the study at an orthopedic clinic in Santa Monica, Calif., concluded that the positive trends they found could be used to inspire a larger clinical trial.
In July 2012, research presented at the annual meeting of the American Orthopaedic Society for Sports Medicine showed that PRP therapy was a safe and effective method to treat cartilage tears.
And earlier this year, a study published in the American Journal of Sports Medicine said PRP therapy was more effective at relieving pain and improving function than hyaluronic acid—a common injection treatment for osteoarthritis.
Right now, however, the cost of the therapy can be high, and most insurers don’t yet cover it. A single treatment can run into the thousands of dollars. Prom says he charges about $450 for the procedure.
There are only a handful of doctors in Hampton Roads performing PRP therapy, including those at Prom’s and Luciano’s practices. APM Spine & Sports in Norfolk and Virginia Beach also offers the treatment.
Prom says he believes that eventually, the research will catch up, protocols will be established and PRP therapy will be more routinely used. Until then, doctors are using it as they see fit.
“It’s just another tool in the toolbox,” Prom says. “I think it’ll have its place.”