There has been much debate about the beneficial effects of platelet-rich plasma (PRP). While a Dutch study stated that PRP was no better than” “placebo” for the treatment of chronic Achilles tendonitis, the “placebo” was a standard tenotomy protocol which is an effective therapy. So the fact that PRP was only a little better than an effective therapy doesn’t say that PRP is not effective.

What was neglected by much of the media was the technique used to administer the PRP- not a technique that is favored by those of us who use PRP a lot. And the type of method used to prepare the PRP. Unless the protocol definitely produced a platelet concentration 4-5 times baseline, the treatment was not going to be effective.

Also, another more recent Dutch study did show PRP was very effective for lateral epicondylitis (tennis elbow) and an Italian study showed favorable results in osteoarthritis of the knee.

So… if you’re a prospective patient with a tendonitis problem, how do you ensure you get the right type of treatment?

First, make sure the physician who administers the PRP has done at least 200 cases.

Second, make sure the physician is skilled in the use of diagnostic ultrasound. Unless ultrasound is used, the PRP is essentially wasted.

Third. What type of protocol is used? Find out the exact machine used and what the platelet concentration above baseline is administered. It must be at least 4-5 times above baseline.

Fourth. Make sure you don’t have any of the conditions that might make a PRP procedure less than effective. These include:

– Anti-platelet / anti-inflammatory medication (i.e. Coumadin, ASA, NSAIDS, heparin, and High dose fish oil)
– Bleeding / clotting disorder
– Anemia / low platelet count
– Cigarette smoking
– Nutritional / Hormonal deficiency

Here is a list of potential areas where PRP has been shown to be effective. This list is provided courtesy of Dr, Jonathan Fenton.

Hip/Pelvis
– Hip osteoarthritis
– Hamstring origin/ischial tuberosity
– Symphysis pubis / pubalgia
– Adductor / gluteal tendinosis

Knee
– Patellar tendinosis
– Quadriceps tendinosis & tears
– Collateral / cruciate ligament tears
– Meniscal tears
– Osteoarthritis
– Patellofemoral
– Post ACL repair
– Pes bursitis / tendinosis
– Proximal tibfib joint laxity / OA

Ankle/Foot

– Achilles tendinosis
– Peroneal tendinosis & tear
– Tibialis posterior tears & tendinosis
– Plantar fasciitis
– Osteochondral defect talus
– Sinus tarsi syndrome
– Ankle ligament tears and laxity
– Bunions
– Osteoarthritis ankle, foot, toes
– Sesamoids

And this is only a partial list.

When PRP is given it should be done after a percutaneous needle tenotomy is performed. This is a procedure where the damaged or diseased tendon is peppered with multiple small holes using ultrasound guidance.
Why?

The procedure helps to breaks up scar tissue, abnormal blood vessels, and degenerative tissue. It also stimulates bleeding and creates a favorable condition for PRP.

Tenotomy also leads to remodeling of tendon in a way that restores many of its normal mechanical properties.

At the Arthritis Treatment Center, we have had enormous success using PRP for the above areas and highly recommend it for patients in whom chronic tendonitis is a problem.

Author Bio: Nathan Wei, MD FACP FACR is a board-certified rheumatologist and nationally known arthritis authority and expert. For more info: Arthritis Treatment and Arthritis Treatment Center

Category: Medicines and Remedies
Keywords: PRP, platelet-rich plasma, tendonitis treatment, arthritis treatment