Platelet Rich Plasma (PRP) is the headline story of this month’s edition of The American Academy of Orthopaedic Surgeons (AAOS) publication AAOS Now. The article titled, “PRP: Does it Do Anything?” was written by senior author, Scott Duncan, M.D., MPH, MBA, who is the current chairman of the Department of Orthopaedic Surgery at Boston University Medical Center along with three orthopaedic surgical residents. As presented in the article, the optimal platelet concentration for PRP is believed to be 3 to 5 times that of whole blood. This does appear to be consistent with other published review articles. Concentrations higher than this may actually pose a detriment to healing. Previously discussed by PRPPROLOTHERAPYTAMPA and duplicated in this article, the literature continues to slowly expand with high quality investigations, but the biggest problem remains in trying to compare studies. Significant differences in PRP preparation, injection technique and treatment protocols for a specific musculoskeletal condition presents challenges when trying to assess the evidence. In some cases, published studies have had a sound methodological plan, but have had small samples sizes. PRP has been used to treat a wide array of disorders, but again we have not yet truly defined what it is clinically appropriate for.
This article by Parisien et al does discuss the use of PRP for conditions including osteoarthritis, fracture care, lumbar fusion, and ACL reconstruction. The potential benefits of PRP along with selected studies including randomized clinical trials (level I and II evidence) in some cases, were presented but the general conclusion is that limited evidence currently exists to support use for these specific conditions. It was noted that there is some benefit shown for the application of PRP into the patellar and tibial plug donor sites in ACL reconstruction. Two quoted studies were used in this assessment which have shown improved postoperative VAS scores and decreased patella tendon gap on MRI 6 months post-operatively.
In the opinion of PRPPROLOTHERAPYTAMPA, this review article published in AAOS Now does paint a realistic picture of the current state of PRP use in orthopaedics. PRP is widely used to treat a multitude of soft tissue and bony disorders and may be an effective alternative treatment but we still do not have firm evidence to support this. Standardization of PRP preparations, administration, injection protocols and outcome measures are imperative if we wish to be able to define effectiveness and eventually produce evidenced based treatment algorithms. The overall conclusions published by the authors of this paper are very similar to that of the consensus drawn from the 2011 AAOS Now PRP forum.
- Parisien RL, Trofa DP, Dashe J, Duncan SFM. PRP: Does it do anything? AAOS Now. February 2016.