Platelet-rich Plasma - Tendinopathy

Biotechnology of the future being practiced today at Australian Osteoarthritis Clinic

How PRP is used to treat musculoskeletal injuries/conditions at  Australian Osteoarthritis Clinic - Part One

Tendinopathy

Tendon injuries account for between 30% - 50% of all musculoskeletal injuries. At Australian Osteoarthritis Clinic we treat such injuries. They cause significant pain and activity restriction in not just the elite athletic population, but also the recreational athlete and even the more sedentary patients, affecting their daily activities. As past modalities such as intra-tendinous cortisone injection have now been shown to result in poor long-term outcome, PRP has become a new option at Australian Osteoarthritis Clinic in the treatment of tendon injuries that fail to respond to more conventional rehabilitation therapies.

Looking at the tissue effects of platelet-rich plasma, we can hypothesise that it has relevance to tendon healing through growth factor modulated pathways. Certain molecules like VEGF may be relevant in stimulating appropriate healing. Other factors like PDGF and TFGβ1 along with cell adhesion molecules have relevance in healing tendon cells and in production of a tissue (collagen) network.
 
But does the theoretical science match the clinical outcome? This is perhaps the greatest weakness in the argument for use of blood-based products such as PRP where the theoretical and laboratory evidence has not been supported by clear controlled clinical treatment research. Numerous case series studies suggest a therapeutic benefit of PRP in the treatment of common tendon injuries (like tennis or golfer’s elbow - many of which have been treated at Australian Osteoarthritis Clinic) though, unfortunately, without appropriate control and/or placebo groups there remains a question of what is producing the improvement in outcome measures. Is it the PRP or just the technique of dry/wet needling that is the stimulus for improvement? Is it just that the patients perceive an active management of their condition, and the result is best explained by a ‘placebo effect’?

Studies to date have not provided compelling evidence of the success of PRP treatment. We see good results empirically (by observation) but still do not have hard evidence from randomised controlled trials.

Those using PRP in a clinical setting would likely agree that its value is best seen in patients who have failed traditional tendon loading therapy and that multiple injections are often required to achieve improved long-term outcome. Treatment of tendinopathy diagnosed on clinical evaluation and on ultrasound examination can assist in determining a patient’s suitability for PRP therapy.

Finally, the PRP preparation technique used is important, hence the PRP ‘recipe’ is crucial. We have discussed this in a previous Australian Osteoarthritis Clinic blog.

Should you have any questions regarding PRP and whether it may be of benefit to your condition, please contact our administration team on 03 9270 8080.