Posts tagged PRP
Rupture Of Knee Tendon After PRP Treatment
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Platelet Rich Plasma (PRP) is becoming a popular treatment for muscle strains, arthritis/cartilage injuries, and tendinopathies, but the evidence behind its’ use is limited. Specifically there is a lack of large human trials with randomization to both placebo injections and alternative treatments. Consistent with alternative treatments PRP’s clinical utilization is outpacing the evidence leaving many more questions than answers. To date there is insufficient research to advocate for injections into injured tendons and in some cases (corticosteroid) authors have argued the risks outweigh the benefits. A recent research article highlights a risk of PRP.

A case report published in the Clinical Journal of Sports Medicine highlights a risk on the utilization of PRP for sports injuries (Redler et al. 2018). Authors describe a single patient with a degenerative patellar tendinopathy treated with a series of 4 PRP injections. Upon subsequent surgical examination authors reported a complete rupture in the patellar tendon with significant degeneration is the surrounding tendon. Although the results of this report must be taken in consideration due to its’ methodology, including a single patient, the authors state this report questions both the effectiveness and safety of using this injection in patients with severe tendinopathy.

Utilization of Platelet Rich Plasma (PRP) for Tendon Pain
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Overuse injuries to the upper and lower extremity tendons remains a common source of pain and lost activity for patients at our Boulder Physical Therapy practice.   Tendon injuries can be challenging to treat, but these injuries have been shown to respond to exercise interventions designed to appropriately load and promote healing (remodeling) of the injured tissue.  Often patients ask about additional interventions to accelerate the healing of injured tendons including platelet rich plasma (PRP).

PRP remains the most common biological injection provided by physicians to treat the injured tendon.  In short, blood is taken and spun (centrifuged) to concentrate the blood's platelets which are subsequently injected into the injured tendon in an effort to heal the injured tissue.  The effectiveness of this treatment is still being researched.  Authors have reported improvements in tissue structure, mainly in animal models, after PRP injections but improvements in clinical outcomes are less clear.  Improvements in tissue healing and remodeling may or may not correlate to improvements in patient's pain and function.  Further, multiple trials have not shown an additional clinical benefit of pain or improved function over a placebo injection.      

In short, more research is needed to compare PRP to placebo as well as comparing PRP to proven treatments for tendon injury including strengthening exercise.  The injections remain an expensive treatment option for patients and require more scientific inquiry before being used on a widespread basis.

Platelet-Rich Plasma (PRP) versus Exercise for Shoulder Pain
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Shoulder pain remains one of the most common reasons patients seek out the care of both their primary care physician and Physical Therapist.  The most common cause of shoulder pain remains subacromial impingement or the compression of soft tissues including the rotator cuff tendons within the shoulder joint.  Physical Therapy including joint manipulation and mobilization, as well as, upper body strengthening exercises remains the gold standard treatment for this condition.  Recently, injections of platelet-rich plasma or PRP have been proposed as an intervention to accelerate the healing and recovery from many orthopedic injuries.  To date, PRP has not been shown to be an effective treatment for these injuries and a new research article compared its' effects to exercise for the treatment of impingement.

Nejati and colleagues completed a randomized controlled trial of Physical Therapy exercises to PRP injections in the Orthopedic Journal of Sports Medicine (2017).  The authors randomized 62 patients with subacromial impingement to either two injections of PRP (at onset and 1 month post) or a Physical Therapy program supervised in the hospital once a week for 12 weeks complemented by a home exercise program.  Patients were re assessed for pain, range of motion, and strength at 1, 3, and 6 month intervals.  The authors reported both treatments improved pain, range of motion, and function in the shoulder, but superior gains were seen in the exercise group.  As expected, the exercise group was the only group to shown improvements in muscle force measurements.  The article concluded exercise therapy was more effective than PRP for patients with impingement.  

To learn more about how Physical Therapy can help your shoulder pain contact your local Physical Therapist.