The discussion about stem cell injection or platelet-rich plasma (PRP) treatment is becoming a more popular topic by the minute. PRP treatment is being proposed as an alternative to normal orthopedic treatments that tend to be costly for the wallet and for your time. In a previous blog we looked at PRP treatments’ ability to handle orthopedic difficulties like ACL reconstruction, fractures, and osteoarthritis. This time, let’s shift our focus to: how PRP affects soft-tissue injuries.
For the purpose of this analysis we will look at how PRP affects knee meniscal repair, shoulder rotator cuff repair, and tendon healing.
Meniscal Repair
The evidence for how PRP affects meniscal repair is short, concise, and inconclusive. There is only one good study, which we can reference, that gives us any conclusive data about how PRP affects knee meniscus repair. This particular study examined animal models in which scaffolds were used for PRP injection. After 12 weeks it was concluded that PRP augmentation showed no significant difference from the control group in meniscal regeneration/repair. Thus, more studies are needed, perhaps in human subjects, to determine if PRP can aid meniscal repair.
Rotator Cuff Repair
Shoulder r-otator cuff tears are one of the most common injuries that orthopedic surgeons face. For this reason there has been much research focused on the biologics of these types of injuries. These studies are most concerned with the tear location, time to fixation, need for surgery, optimal surgery technique, etc. To see if PRP treatments can aid in the healing process of rotator cuff repair 5 randomized controlled trials (RCT) and 3 nonrandomized trials were completed.
In one of the tests, it was found that patients who received PRP augmentation saw higher retear rates of the rotator cuff. Furthermore, those same patients saw no significant difference in the healing process. Thus, according to this study it seems that PRP augmentation may have detrimental effects to the rotator cuff repair process.
In other similar studies it was also found that PRP use had no significant advantages after rotator cuff repair in relation to pain, motion, strength, or retear rate. However, there was a study in Italy that showed that PRP injections used in conjunction with a thrombin component did have some positive results.
Overall though it has been concluded that there is no clear benefit of PRP use in arthroscopic rotator cuff repair, if it is used alone. In fact, in two cases it proved to be detrimental to the effectiveness of the surgery. More studies are needed to determine the usefulness of PRP injections in rotator cuff repair.
Tendon Healing
Although there has been little positive evidence suggesting use of PRP found in meniscal or rotator cuff repair, there have positive outcomes in relation to tennis elbow and Achilles tendinopathy.
Normal treatment of tennis elbow is a combination of bracing, physical therapy, and steroid injections. In three different studies the steroid injections were substituted for PRP injections. In all three studies the group that received the PRP injection noticed significantly less pain and faster healing time. Thus, it can be concluded that PRP injections can help the healing of tennis elbow.
Achilles tendinosis is another soft-tissue injury that has been treated using PRP injections. Normally this condition is treated nonsurgically with rest, pain medications, physical therapy, bracing, orthotics, and ultrasound. PRP use here aims to improve and speed the healing process. In two studies no significant healing improvement was found when PRPs were used compared to saline injections. One study did show that the use of PRP did slightly improve functional outcomes of Achilles tendinosis, there is not enough statistical evidence to suggest that PRPs are effective in aiding the healing of Achilles tendoinosis. Thus, more research is needed.
Conclusions of PRP use for soft-tissue injuries
Even though PRP treatment is still a new and up-and-coming treatment in the orthopedic world, and it may hold much promise. In relation to meniscal and rotator cuff repair it is extremely evident that much more research is needed. Different combinations of PRP need to be tested for efficacy if there is any hope of this treatment becoming successful for soft-tissue injuries. On the other hand there has been some success in treating tennis elbow and Achilles tendinosis.
Although the measure of success has been small in these areas, it leaves hope that PRP treatment for orthopedic injuries could one day be the norm. Thus, doctors and scientists must push on in their research for the best PRP treatment, backed with proven evidence of success.
