According to the American Academy of Orthopedic Surgeons, “PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual.”
To use PRP as a treatment, platelets from the patient’s own blood are separated from the other blood cells. The platelets undergo centrifugation and filtration to increase their concentration, and the platelets are then mixed with the plasma again.
Evidence Suggests Compounded PRP Could Be Beneficial
In reviewing the results of my PRP data base, we observed reduced pain in the knee at one year. Assessment included using the Visual Analog Scale (VAS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC), respectively as well as the Knee Society Score.
After one month, the PRP group had significantly reduced VAS scores and WOMAC pain sub-scores. At six months, VAS scores remained low in the PRP group, and all WOMAC parameters were significantly lower compared to the placebo group. We did not measure Cartilage thickness.
A study, published in the Journal of Orthopaedic Research, evaluated whether cartilage thickness played a role in outcomes for knee OA patients undergoing PRP therapy. This trial included 59 patients who underwent PRP with a low-leukocyte autologous conditioned plasma (ACP) system. Patients underwent MRI prior to treatment; researchers collected patients’ Whole-Organ MRI Score (WORMS), which determined knee OA level based on 14 parameters: integrity of the cartilage, affection of the bone marrow, subcortical cysts, bone attrition, osteophytes, integrity of the menisci and ligaments, presence of synovitis, loose bodies, and periarticular cysts.
“The findings of the current study suggest that positive effects of intraarticular injections of PRP might improve quality of life and reduce the pain of patients suffering from osteoarthritis of the knee joint independent from the level of cartilage damage.”
The largest Orthobiologic meeting of the year is taking place this Thursday, Friday and Saturday in McCormick Place. I will be serving as faculty and in preparing for discussions and debate; I reviewed our outcomes using proprietary Platelet Rich Plasma compounded interventions. I believe the take home message to be that joint restoration, the absence of pain and improved function is not dependent on cartilage regeneration that might be seen on an MRI.
To schedule a consultation call (312) 475-1893.
We read about it in the sports pages every day; the player presenting after twisting a knee, feeling a “pop” and going down in a heap. The knee is swollen, the first indication that bleeding has occurred inside the joint. Physical examination of the knee to test the ligaments leads to a suspected tear of the anterior cruciate ligament; the MRI is ordered and confirms the diagnosis.
Because of its poor blood supply and location inside the knee, the ACL has little healing potential. It’s an unfortunate reality, as they are occurring at increasing rates over the past two decades. In part, it’s because more children are playing competitive sports and doing so at a younger age while we seniors are still skiing or playing and competing all year. What are the future implications of a torn ACL? Lindsey Vonn came back after ACL surgery; so did Tiger Woods, Julian Edelman, Tom Brady and Derrick Rose to name a few. so how bad can it be? The truth is that surgery can restore knee function, but it does little to diminish the risk of arthritis 10 to 15 years down the line or less. Lindsey Vonn announced retirement five years later because of arthritis. Kids who tear their ACL today are often left with 60-year-old knees when they’re 30; and as has been recently stated, Knee Replacement is not necessarily a panacea.
Secondary damage may occur in patients who have repeated episodes of instability due to ACL injury. With chronic instability, a large majority of patients will have meniscus damage when reassessed 10 or more years after the initial injury. Similarly, the prevalence of articular cartilage lesions increases in patients who have a 10-year-old ACL deficiency. It is common to see ACL injuries combined with damage to the menisci, articular cartilage, collateral ligaments, joint capsule, or a combination of the above; the “unhappy triad,” especially in football players, soccer players, basketball players and skiers.
Certainly, modern ACL surgery means it’s no longer a career-ender, but recovery ranges still vary widely. In cases of combined injuries, surgical treatment is warranted and generally produces better outcomes. As many as half of meniscus tears may be repairable and may heal better if the repair is done in combination with the ACL reconstruction. Some athletes come back in as little as nine months, while it can take well more than a year for others. Then comes the mental battle, that is the silent war waged after tearing an ACL. Derrick Rose, we are watching you.
Recent clinical evidence suggests surgery is not your only option; interventional or cellular orthopedics may be a non-surgical alternative that uses your own cells to repair the incompletely damaged ligament. A cellular orthopedic intervention for those who meet the inclusion criteria may substitute for surgery. Those who offer the non-operative option when appropriate, use Bone Marrow or Adipose Tissue harvested from your skeleton or abdomen, process the recovered cells and growth factors with particular attention to FDA compliance, and inject the concentrate into the remaining Anterior Cruciate Ligament cumented incomplete tears with success in returning athletes to a sport.
While intervention and cellular orthopedics may have a role in a torn ACL at times, Joint Restoration, perhaps even Regeneration adjuncts at the time of an ACL repair or for the ensuing arthritis have an absolute evidence-based role. To schedule an appointment call (312) 475-1893. You may visit my web site at www.sheinkopmd.com
Tags: ACL, ACL Injury, anterior cruciate, arthritic knee, cellular orthopedic