Health News Review

A paper in the Journal of the American Academy of Orthopedic Surgeons on platelet-rich plasma in orthopedic uses raises questions about the proliferation of that approach:  “for many conditions, there is limited reliable clinical evidence to guide the use of PRP. Furthermore, classification systems and identification of differences among products are needed to understand the implications of variability.”

In PRP, blood is drawn and spun in a centrifuge to separate the platelets.  The “platelet-rich plasma” is then re-injected back into the patient in the area of the damaged tissue.

A news release from Northwestern Memorial Hospital, home of the paper’s lead author, was entitled, “First the Hype, Now the Science: Evidence-based Recommendations for PRP.” Excerpt:

“The hype around PRP definitely came before the science,” said Wellington Hsu, MD, the lead author on the paper, spine surgeon at Northwestern Memorial Hospital and assistant professor in orthopaedic surgery and neurological surgery at Northwestern University Feinberg School of Medicine. “In medicine, we rely on scientific evidence to support best use of treatments, but with PRP that hasn’t been the case. Interest in PRP jumped way ahead of the research.”

Four years ago some of the hype was fueled when ABC’s Good Morning America and the New York Times had stories about PRP being used in Pittsburgh Steelers’ Super Bowl star receiver Hines Ward. We reviewed the ABC GMA story and gave it a 0 score. 

Three years ago the editor of the American Journal of Sports Medicine said that perhaps the approach should be called “platelet-rich panacea.” Sports Illustrated also raised questions about the therapy that year.

Two years ago we reviewed a Reuters story: “This short story about a small study doesn’t offer readers much of the necessary context to judge the significance of this potentially new treatment for tennis elbow.”

An article on the American Academy of Orthopedic Surgeon’s website more than 2.5 years ago, “Platelet-rich plasma: What’s behind the hype?” had this quote:

“Patients are seeing elite athletes, like Tiger Woods and Raphael Nadal, being treated with some form of PRP and are asking their orthopaedic surgeons to give them ‘what Tiger got.’ The problem is that we don’t know ‘what Tiger got,’ what happened to him before or afterwards, or what was used, and no one is publishing that data,” noted Dr. Allan K. Mishra.

“But all three major sports organizations—the National Football League (NFL), Major League Baseball, and the National Basketball Association—as well as the World Anti-Doping Agency, have declared that PRP is a reasonable treatment, despite the fact that we may all agree that there’s limited research to support the efficacy of its use,” he continued.

So, now that the cow is out of the barn, as often happens, comes a call for evidence-based recommendations.

Good luck with that.

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Comments

Daniel Pendick posted on December 17, 2013 at 2:18 pm

So far, whenever physicians have endorsed PRP in a conversation with me, they have been pretty honest that PRP is a “try it and see if it helps, but the evidence for this is not ironclad.” From an EBM perspective, that is not OK, but the patients themselves seem to be pretty comfortable with “try it and see.”

Does insurance pay for this? perhaps they shouldn’t.

Marilyn Mann posted on December 23, 2013 at 2:25 pm

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010071.pub2/abstract

Here is a Cochrane review on this.