When Platelet Rich Plasma Therapy fails: New research

Revision Knee Surgery

Dr. Marc Darrow PRP Therapy explained

Does Platelet Rich Plasma Therapy (PRP) work? In recent research doctors looked at the increasing popularity of platelet-rich plasma therapies for soft tissue injuries such as ligament, muscle and tendon tears and tendinopathies.

They noted that PRP can be used as a principal treatment (such as at our clinic) or as an augmentation procedure (application after surgical repair or reconstruction).

Platelet-rich therapies are produced by centrifuging a quantity of the patient’s own blood and extracting the active, platelet-rich, fraction. The platelet-rich fraction is applied to the injured tissue; for example, by injection (as we do here).

The doctors noted that platelets have the ability to produce several growth factors, so these therapies should enhance tissue healing. Note: It Should.

But they found that there is a need to assess whether PRP works because there is no standardization of the PRP preparation methods and the method of treatment delivery.1 In other words, people need to find doctors who know how to use PRP.

PRP treatments must be delivered by experienced hands

Most of the patients we see have had many failed medical procedures before they come to visit us, so there is of course skepticism about any therapy offered. Whenthey ask us “will PRP work for me?” We tell them that this can be best answered following a physical examination and a discussion of realistic expectation. Each patient is unique so each answer will be so as well.

In the many years since our office started practicing Prolotherapy, we saw many patients who had Prolotherapy that did not work for them. The main reason was because of the variation in technique. Some doctors did Prolotherapy one way, other doctors did it another way, there was variations in injectable solutions offered, varying time frame between treatments, etc.

When Platelet Rich Plasma Therapy fails

We find the same thing in Platelet Rich Plasma therapy and this IS Supported by research. There are many variations to PRP and the way it is performed by one doctor, may not be the same way it is performed by another doctor and without this standardization, the research cannot be clear. Read the findings:

“There are only a few studies of PRP treatment for cartilage on osteoarthritic knees. Different PRP products might be more or less appropriate to treat different types of tissues and pathologies. The clinical efficacy of PRP remains under debate, and a standardized protocol has not yet been established.” 2

Even when PRP is introduced in a surgical setting as an aid to speed wound healing: “In the field of platelet concentrates for surgical use, most products are termed Platelet-Rich Plasma (PRP). Unfortunately, this term is very general and incomplete, leading to many confusions in the scientific database.” 3

And in sports medicine: “Basic science and preclinical data support the use of PRP for a variety of sports related injuries and disorders. The published, peer reviewed, human data on PRP is limited. Although the scientific evaluation of clinical efficacy is in the early stages, elite and recreational athletes already use PRP in the treatment of sports related injuries. Many questions remain to be answered regarding the use of PRP including optimal formulation…4

PRP Treatments

When choosing Platelet Rich Plasma Therapy, many factors help determine the realistic outlook for success, including the experience of the doctor performing the treatment and experience in injectable therapies. As we write in our emails to patients asking for more information – Platelet Rich Plasma therapy can be practiced differently from office to office. Where one office may be successful performing these treatments in one fashion, another office may have less than hoped for results.

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1. (Cochrane Database System Review Dec 23, 2013)

2. Gobbi A, Karnatzikos G, Mahajan V, Malchira S. Platelet-rich plasma treatment in symptomatic patients with knee osteoarthritis: preliminary results in a group of active patients. Sports Health. 2012 Mar;4(2):162-72.

3. Ehrenfest DM, Bielecki T, Mishra A, Borzini P, Inchingolo F, Sammartino G, Rasmusson L, Evert PA. In search of a consensus terminology in the field of platelet concentrates for surgical use: platelet-rich plasma (PRP), platelet-rich fibrin (PRF), fibrin gel polymerization and leukocytes. Curr Pharm Biotechnol. 2012 Jun;13(7):1131-7.

4. Mishra A, Harmon K, Woodall J, Vieira A. Sports medicine applications of platelet rich plasma. Curr Pharm Biotechnol. 2012 Jun;13(7):1185-95.

About Marc Darrow MD, JD

Marc Darrow, MD, JD, is one of the leading physicians practicing Stem Cell Therapy, Platelet Rich Plasma Therapy, and Prolotherapy. Email with questions about this article to drdarrow@drdarrow.com