Orthobiologics: PRP

Condensed points on PRP and Stem Cells:

• Most research has been done in animals. Few quality studies in humans exist
• The benefits are so far unproven
• Some studies show benefit, others show no benefit
• There are some studies which show possible harmful effects: http://www.aaos.org/AAOSNow/2016/Mar/Cover/cover2/
• More research is needed
• Insurance doesn’t cover the therapy
• The treatment is experimental and unpredictable
• Patient’s have to decide if the risks/expense are worth it
• It may be unethical for physicians to promote this therapy without the above disclosures

Here’s a March 2016 article: Current Research on Pharmacologic and Regenerative Therapies for Osteoarthritis (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772471/)

In summary, since the late 1990s, PRP and stem cells have been used safely in a variety of conditions with promising implications. Unfortunately, most studies to date are anecdotal or involve small sample sizes. Undoubtedly we are seeing increased clinical use of PRP and stem cells, however more clinical trials are certainly needed. Little is documented in the literature regarding the expected timeframe of tendon healing after stem cell therapies or PRP injection. Also, there are no studies to date that review the need of post-PRP injection rehabilitation, nor are there widely accepted standard protocols. However, it is assumed that Physical/ Occupational therapy and restoring the kinetic chain will help facilitate recovery post injection.

Proponents of these regenerative medicine therapies are currently expanding PRP / stem cell injection applications from tendon injuries to other persistent ailments including greater trochanteric bursitis, rotator cuff tears and knee osteoarthritis with mixed results. Further understanding of this treatment is required to determine which particular diagnoses are amenable to PRP / stem cell therapy.

The use of autologous growth factors in the form of PRP and stem cells is known as ‘‘orthobiologics.’’ First generation injectables such as visco-supplementation have been partially successful in the treatment of pain for patients with osteoarthritis of the knee. Similarly, these injections have had mixed reviews, with some studies showing benefits and others not. The consensus opinion is that it is unclear. Meta-analysis of the benefits of chondroitin sulfate and hyaluronic acid (viscosupplement) injection therapy has shown no consistent benefit. There are also may placebo effects in place.

A second generation of injectables is being investigated. These therapies, although inadequately tested, are focused on growth factors like TGF-beta and growth factor BMP 7 (OPI). Future generations of biologic injectables may target specific cells, rather than providing an assortment of non-specific healing properties. Bone marrow aspirate stem cell injections are seeing increased clinical use as well.

The FDA in the USA has more stringent criteria for approval, controlling and ultimately pricing these therapies. Politics and Science are involved. Clinical trials of intra-articular use and soft tissue applications of PRP and Bone marrow aspirate stem cell injections are underway. Nevertheless, we are seeing increased clinical use of these therapies while we wait for more research. Some of this increased use may be financially motivated.

Stay tuned to our BLOG for updates. Ultimately, stem cell therapy represents the greatest biologic healing potential.