Does PRP work for knee injuries?

If you follow sports media, you have no doubt heard of PRP by now. Hines Ward made it popular in 2009 when he received PRP treatment for a knee injury just before the Super Bowl. Kobe, Tiger, A-Rod, and many other high profile athletes have reportedly received PRP treatments. But what is it? Why are these athletes receiving it? Can you get it, too? Let’s discuss.

I’ll begin with the basics. PRP stands for platelet-rich plasma. Platelets are part of your blood that are critical for clotting, but they also contain high levels of growth factors. It is thought that these growth factors are important in the healing process, which is why platelets are used. The procedure goes like this: the blood is taken from a vein (usually from the arm as if you’re giving blood) and placed into a centrifuge machine. The blood is spun in the machine until the platelets separate out from the other components of the blood. This layer of platelets is then injected into the injured tissue, preferably with ultrasound guidance.

The types of injuries and conditions thought to respond to PRP are many, but the most studied is probably tendinopathy, which is a chronic tendon injury. If you’re not familiar, tendons connect muscle to bones. For example, “tennis elbow” (or lateral epicondylopathy) is a tendon problem at the elbow, and “jumper’s knee”(or patellar tendinopathy) affects the patellar tendon at the knee. With overuse and/or injury, these tendon problems have a hard time healing themselves, and the PRP injections can help stimulate the needed healing response. Contrary to popular belief, cortisone injections are rarely indicated because chronic tendon problems are not inflammatory in nature.

Another example of PRP treatment involves ligaments. Ligaments are similar to tendons, but they connect bone to bone. Many of you have probably heard of the ulnar collateral ligament in the elbow, or the UCL. This is the ligament that is commonly injured, partially or completely, in baseball pitchers, and what is reconstructed in Tommy John surgery. In fact, Takashi Saito, a pitcher for the LA Dodgers (at that time), received PRP for a partial tear of his throwing arm UCL in 2008. He was able to return to pitching many months earlier than he would have been able to had he undergone surgery instead.

Recently we are seeing more individuals receive PRP treatments for osteoarthritis, which is a degenerative, or “wear and tear,” condition in the joints.  The goal is to decrease pain and improve function. The current thought is that the PRP helps stimulate growth of new, healthy cartilage. As we always say, more studies are needed, but so far it sounds promising.

One thing to keep in mind when you go running to your local sports medicine specialist is this: insurance companies are not paying for PRP treatments. On occasion, I have seen reimbursement after the fact, but this is rare. This means you are going to have to pay out of pocket for PRP treatment. This also means that physicians and physician groups can charge whatever they want for it. I’ve seen rates as low as $500 and as high as $2000. I’d advise running in the other direction, though, if someone tries to charge you $2K for one treatment. I’d also be wary of how many treatments are recommended. PRP is new enough that there is no standard protocol – for number of treatments, how far apart the treatments should be given, post-procedure rehab, etc.  However, it is reasonable to see how a tendon or ligament injury responds to one PRP injection before proceeding with another.

During my fellowship training, we would tell patients that about 80% of patients with lateral epicondylopathy would see great improvement with only one PRP treatment. Of course, it depends on the severity of the condition and how compliant the patient is with rest and rehab. So ask a lot of questions. I’m not saying one way is right or wrong, but it’s important that you get good information and that you trust what your physician is telling you. Especially if you’re going to be paying $2,000.

Mandy Huggins is a sports medicine physician who blogs on her self-titled site, Dr. Mandy Huggins.

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