Saturday, July 7, 2018

Basketball: Platelet-Rich Plasma

PRP. Secret sauce, magic juice that is platelet-rich plasma. Or not? 



First, a commercial...

Sports injury, inflammation, loss of function, and pain are common events. The quartet of RICE - rest, ice, compression, and elevation help many injuries, but they don't fix everyone. 

Who? Who should get PRP? There's no consensus on the use of PRP. If you've ever had tennis elbow, you know it's painful and annoying. A controlled, blinded study showed modest benefit at 24 but not 12 weeks after injection. 

There is some data showing benefit in maturation of ACL graft repair, patellar tendinopathy, and some patients with meniscus (cartilage) injury.

Early knee osteoarthritis subjects receiving PRP had relative disease stabilization with short-term (one-year) followup. 

Much of what you'll read is the upside, anecdotes of NBA players (e.g. Stephen Curry, Kobe Bryant) and how PRP got them back on the court. Also, when successful, PRP helps players avoid surgery, from which recovery takes longer. But some of these stories are promotional, for physicians or clinics who offer PRP at a hefty price. 

What? What makes it work? Platelets cluster at sites of injury to stop bleeding (but are also involved in contributing to circulation problems like heart attacks) and release 'growth factors' that promote healing. (You now know as much as most doctors about this.)

Why? Athletes and others want to be whole and able to return to competition or normal activity as soon as possible. PRP has been touted as a means to that end. The American Academy of Orthopaedic Surgeons summarizes its use

Where? Doctors have used PRP to treat joint, muscle, and tendon injury. 

When? This is the 64 dollar question. Patients hear that their favorite athletes got PRP treatment as part of their care. That inevitably leads to "why not me?" The first standard is "failure to respond to conventional treatment." Consideration then requires application for coverage and sometimes appeal of non-coverage (payment) by insurers. 

How? PRP therapy requires direct injection into a joint or tissue.


(from Shahid et al.) 

Payment for PRP injection therapy presents a moving target. Until a procedure is widely proven both effective and safe, insurers are conservative (don't pay). For NBA teams and players, the "relatively" small costs (thousands in players making millions) and relatively well-tolerated treatment makes dollars and sense. 

Note: I am not an Orthopaedic Surgeon and the information within is presented strictly for educational purposes. Contact your physician for management specific to your needs. 

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