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Jonathan Cluett, M.D.

Is PRP Hype or Helpful?

By April 26, 2014

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PRP injections are the latest, and by some reports greatest, of treatments available for overuse injuries.  Used to treat tennis elbow, patellar tendonitis, Achilles pain, and other orthopedic conditions, PRP has been touted by some to be the magic cure for these challenging-to-treat conditions.

Unfortunately, a growing body of scientific evidence is failing to demonstrate that PRP is better than other standard treatments, and may in fact be worse.  What's more, is that PRP is very expensive, and usually must be paid for by the patient as most insurance plans will not cover this unproven treatment.

A recent article in the New York Times recommended patients seek other standard treatments, rather than foot the bill for PRP injections.  They cite a soon to be published study that compared PRP injections with injections of plain blood for treatment of tennis elbow.  Proponents of PRP claim it works by concentrating the healing stimulants found in blood, and deliver these to the site of injury by injection.  Both whole blood and PRP contain these "growth factors," but the PRP has it in much higher concentrations.  One would expect the higher concentrations of growth factors in PRP to deliver better healing, but in fact, the opposite was found to be the case.

Certainly one study does not prove a treatment obsolete, but a growing number of studies are questioning how effective PRP is, and if it's better than other treatments more readily available.

Have you tried PRP?  Leave your comments below!

Source: "Does Platelet-Rich Plasma Therapy Really Work?" New York Times; January 26, 2011

Comments
February 15, 2011 at 3:25 pm
(1) Bryce Taylor says:

Although I have not personally experienced PRP, as an outpatient orthopedics physical therapist, I have explored several studies and I have to concur with you Dr. Cluett. Many treatments that medical professionals provide can be argued that there is not sufficient evidence to support the use but there is not even a positive lean with the accumulating evidence.
As with any alternative treatment, if you can afford it, try it if you want–it might work for you.

March 6, 2012 at 10:06 pm
(2) Allan R. Dunn, M.D. says:

PRP has growth factors which produce scar tissue and therefore it helps heal capsule and tendon injuries. It has no place to repair joint cartilage since the growth factores produce scar tissue, never cartilage.
Most drs are using it for the fees they can extract from unknowing patients: up to $900.00 a shot. The practice of using PRP should require special training of the practitioner and a license. It is best to use other more reliable treatments which are coveres byt most insurance.

May 4, 2012 at 2:25 pm
(3) Jerry Yates says:

Yesterday I underwent scoping of my knee, which revealed torn meniscus. Even though there is no scientific proof that PRP helps orthopedic injuries, as long as there was even a small chance that it might help, I was willing to pay the small amt. the surgical center charged for the PRP injection. Our insurance naturally would not pay, but at least I know I tried everything, and ultimately it might buy me some time and avoid knee replacment down the road.

August 28, 2012 at 11:36 am
(4) alberto padilla says:

PRP is not a magic procedure, is expensive and the results donīt justify the procedure. A shiper form to do it: I do a punture in the iliac crest and aspirate a bone marrow around 5-6 cc and I inject directly in the joint when I finish the artroscopy, is well tolerate you uso only one Jamshidi needle and xringe, andthe results are the same as PRP. I use the procedure in non union fractures, bening bone cyst.

August 28, 2012 at 12:34 pm
(5) kvinch says:

PRP may have benefits for some but it did absolutely nothing for me. I had four injections over several months and paid a small fortune and it did nothing. That is a major downfall because they cannot tell you with any level of certainty that it will work and of course they tell you to try at least four injections before deciding that it doesn’t work (which I think is just a way to get the money). I was extremely disappionted and felt it was a total waste.

February 4, 2013 at 5:57 pm
(6) Michael says:

I am going through injections at this time. I was told 2-3 injections never 4? Also, 4-6wks between. I have tried everything, but surgery. Most doctors just try to put me on some drugs. I will live with the pain before I destroy my liver. I went to three different doctors before I chose one. Some are doing it and have no clue what it does. The doctor I found has a vast knowledge of PRP and knows about all the research. He tells you how it is and trys to help. I go back for second treatment in a week, I am hopeful. I also believe some of these things take time.

March 21, 2013 at 8:00 pm
(7) Jodi says:

Hi, I am going for my very first PRP injection tomorrow morning. I have read alot of positive benefits of PRP and am a believer. I want to avoid surgery. I have to give this a try. I will be charged $250.00 and my Dr. will administer only 1 shot to a patient per year. I have Plantar Fasciitis and have tried everything over a year now. I feel it is less invasive as surgery and I need t try it. I have HOPE. To be rid of this awful 24-7 pain, I have to try! It is debilitating and now it’s affecting my hip from walking wrong with this pain. I have developed a bone spur too. Keeping my fingers crossed and I will try to remember to update this in about 6 weeks. Like one poster said, it will take time! Finger’s crossed and I thank my Dr. for at least trying to offer me something to help.

April 10, 2013 at 5:44 pm
(8) donna says:

i had the the prp done in my elbow and feel the same way i have been feeling is pain and its only been 9 days now.

May 3, 2013 at 5:15 pm
(9) Jodi says:

It’s been 6 weeks to the day! That I had my PRP injections into my heel for severe Plantar Fasciitis (it will be one year since it began last May)!!! And I have to say I FEEL BETTER!!!!!!!

I am SO impressed with the results! Happy. Happy. There is now a very slight sensation at the very END of my day… feels like a little bit of a pulse? in the damaged area… but I have no pain, when resting like I did. And I have no pain after stepping out of bed in the am and I can pretty much stand all day at work on the hard cement floors now!

I did wear a walking cast and was on crutches for the first 2 weeks in order to stay off the heal as much as possible. I did wear a night splint when sleeping and even if just sitting watching tv with my foot elevated. Hope this helps anyone questioning PRP! I would do it AGAIN! (It was pretty painful, my Dr. had a heck of a time freezing me up, so I did feel some sensation when he had the needle in there and “Peppered” the PF where it attaches to the heel. But, with these result.. I would definitely do it all over again :)

June 24, 2013 at 12:42 pm
(10) H N Rastogi says:

Dear Ms. Jodi thanks for updating your mail. I am seriously thinking of going for prp after one lady who swore by it and is Pain Free since last 4 yrs. (BTW she saw this Dr 1 day before she was going for a knee replacement.surgery) Incredible isn’t it? I have pain in both knees. Question is who decides that I want prp? Does the dr evaluate my condition as to what treatment is better for me or what?
Can you give me your dr’s contact tel #? I would appreciate very much if you can. Thanking you in advance..
Nalini

July 3, 2013 at 12:27 pm
(11) Marie says:

So many mixed reviews can be so confusing for a patient! I work in a orthopedic Sports Medicine practice in LA and have first hand knowledge that PRP is consistently working for the vast majority of our patient that have tried it! It is important to realize that all PRP is not equal and many variables exist that can effect the outcome. The concentration of platelets, the growth factor activation process, the surgeons skill/injection technique and the patient’s compliance with recommendations-all contribute to the effectiveness of the procedure. It is al vital to note that because of the specialized training required, the number of qualified physicians performing this therapy is somewhat limited.

July 15, 2013 at 1:34 pm
(12) Big T says:

I had severe “tennis elbow”. The Extensor Carpi Radialis Brevis was victim of a partial thickness (roughly 30%) tear. I couldn’t pick up a cup of water.

Tried months of PT, anti-inflammatories and so on. Decided to have a shot of depo.

After 2 separate shots of Depo Medrol, each about 8 weeks apart, I opted for PRP. The pain was as bad as ever.

8 weeks after the 2d depo shot I had the procedure. I was skeptical as can be. The shot hurt like you-know-what.

8 weeks later I was back at the gym.

Could be coincidence. But I’m sold on it.

July 26, 2013 at 7:52 am
(13) Sue says:

I had the procedure 4 weeks ago as nothing else was working and I was in severe pain. My right arm had become near useless.
I still have a few days to go but the pain is less and I have about 50% usage back.
I am starting to realise that it hasn’t completely healed it but it is better.
Not sure if it can be repeated or perhaps I can now move to something else considering it is not as bad.

September 2, 2013 at 6:26 pm
(14) yannick says:

I got PRP for the sacro illiac and it fixed it. PRP is amazing for most problems i am going to get it again for a labral tear of the hip.

September 9, 2013 at 7:40 pm
(15) Fitzy says:

In 2009 I tore my calf muscle playing tennis. An injury that was supposed to heal in 6 weeks never did- after initial physical therapy failed, and I was waking with a cane, I tried a cortisone shot. When that failed as well, I continued PT. At this point use of my right leg is about 50%. I went to a new dr at Hospital for Special Surgery in NYC and was told about PRP- I had my first shot in Feb of 2012, and it was the ONLY thing that worked for me. Use of my leg is at about 80% and I can go to the gym 5x a week. I am going for another shot next week hoping to regain full use of my leg so I can play tennis and/or run a 5k. It may be experimental but it definitely worked for me!

September 26, 2013 at 4:06 pm
(16) CDJ says:

I have a number of knee and ankle issues that I have been receiving a combo of prolotherapy and PRP to treat. I am convinced I would not be walking now if I did not have the treatments. I have had several prolo injections over a year and at least one PRP injection in my Achilles tendon. The injections are much more effective if targeted by the use of a sonogram – with the use of the sonogram the injections are hit or miss. Also, relieve is not something you get over night – it is dependent upon many factors, such your age, how many issues need addressing, diet (too much processed food is an inhibtor to a healthy body state. For example sugar is an inflammatory which will keep your body in a state of constat inflammation). Also, there maybe other mechanical deficiences (flat feet, etc.) that may need correcting before you will feel positive results.

September 26, 2013 at 4:18 pm
(17) CDJ says:

I needed to correct/clarify what I said:

I meant to say with use of an ultrasound and NOT Sonogram. Specifically without the use an ultrasound the shots will be hit or miss. Also, your trating physician MUST be expereinced in using and reading an ultrasound picture. Ultrasound pictures are very difficult to “read” and doctors who are not expereinced with using ultrasound will not know what they are looking for or at – i.e. problem areas such as bone spurs (that need to be removed in conjunction with the prolo or PRP treatment). Secondly, if your doctor is just focused on the injections – s/he maybe missing other factors that might be contributing to the pain that alos needs to be addressed such as the need for custom orthodics, removal of bone spurs, etc.

What I love about my doctor is that in addition to the injections – he also works to address other contributing factors to help keep the pain form either recurring or under control.

September 26, 2013 at 4:21 pm
(18) orthopedics says:

CDJ,

Thanks for comments.

In regards to the statements about ultrasound injections, a hot topic for orthopedic surgeons these days, I will point you to this article:
Ultrasound Guided Injections

Regards,

Jonathan Cluett, MD
About Orthopedics.

October 8, 2013 at 2:06 pm
(19) than says:

I had prp on both knees for patellar tendonitis. I have to say that I was disappointed at first but almost 2 months after,it felt better. Like a switch. I went to bed one day and woke up feeling better. I am not 100 percent yet but I am improving everyday. Stationary bike is what I do for rehab. I am able to run now as before it would hurt after two steps of running in place. My advice would be to get the shot but be patient. I have read where people got the shot and in 3 weeks time,gave up and ended getting surgery. The main thing to remember is that this isn’t magic. It took me 2 months to really start feeling good.

October 24, 2013 at 10:32 am
(20) Rudy V says:

I had it done for very bad tennis elbow problem, severe pain. In 10 days I was 95% cured, That was 4 months ago, still fine, I love prp?

October 31, 2013 at 12:30 am
(21) Steve says:

As a patient, I’ve had great experience with PRP. I haas/have two partially torn rotator cuffs and a torn tendon in my wrist. Since the left shoulder was the most painful (very and often), I tried PRP on that injury first. The results were fast (serious pain for a few days, then subsiding over 3-4 weeks). More importantly, the treTment lasted. It’s been a year and I have no pain and practically full range of motion (with just a little stiffness) into left shoulder. With those results, I got PRP in my right shoulder and right wrist about three weeks ago. Again, very painful, but certainly less that surgery and PT, and a much faster recovery process. If it works in all three locations, I’ll be a true believer. As an FYI, I scoped out a doctor that has EXTENSIVE experience with PRP. All injections are ultrasound guided, which I’m told makes a huge difference. Wish me luck!

October 31, 2013 at 2:49 pm
(22) Marie says:

May I ask who your Dr. is and where? Thank you. I’m having PRP on Monday for plantar facitis, and it is not guided by Ultrasound… not sure if I should go forward. However the Dr. does have an MRI picture. Also, its almost 100% torn, not sure if PRP will help but I thought it would be worth a try before doing surgury.

November 16, 2013 at 10:27 pm
(23) Betty says:

Marie,did you have the prp treatment for PF? I have the same problem and am looking into it also? Was the injection very painful?

December 9, 2013 at 9:04 pm
(24) Jodi says:

Okay, it’s been since last spring that I had my PRP injections. It is now December. ….some of my pain is returning in my heel. Darn. It has been a very good few months….but now I am wondering if I can do it again. I don’t know. Waiting to hear back from my doctor.

December 18, 2013 at 9:31 am
(25) Marty says:

I am a dentist. I suffered for 3 years with tennis elbow. I tried physical therapy, drugs and acupuncture. My first PRP shot got me 80% better, a second one got me to 100%. That was 2 years ago. I haven’t had pain since. I know what the research says, but all I can say is it worked like a charm for me…. and yes, it hurt. The second injection was preceded be some local anesthetic, which helped a lot!

January 9, 2014 at 11:09 pm
(26) JB says:

I had 2 PRP shots in my right heel and after a year of nothing fixing a partial tear in the heel, the PRP shots worked a miracle! When my right heel was recovering I got plantar fascitiis in my left heel. I got 2 shots in my left heel (it’s been 8 wks since the last shot). Sadly I am not feeling ANY relief. Did anyone who got PRP in the heel find that it took a VERY long time to see improvement?!

January 11, 2014 at 1:13 pm
(27) Madeleine says:

I had PRP therapy last monday.The area of the injury felt better but I had an unusual amount of pain all over the foot with alot of swelling. I have very flat feet and other injuries that I have had for years in my feet, The pain was great and I couldn’t put pressure on my foot used a wheelchair around house and basically stayed in bed with leg elevated . It is now 5 days since the shot and I can finally walk alittle with discomfort on the outside of the foot. I see the Dr. on monday ,for another shot that I am not sure I want. Has anyone experienced swelling in other areas other than shot sight.

January 30, 2014 at 11:50 pm
(28) Sandi says:

I cut two tendons in my index finger 4 months ago and had repair surgery. Today I have quite a bit of scar tissue causing edema and stiffness in my other fingers. Is PRP something that could help?

February 27, 2014 at 3:45 pm
(29) kelly says:

OK….here we go! Been in pain for 18 years!!! I have had 5 surgical procedures done to my foot/heal. I have not worn a pair of regular shoes in over a decade. I have had to stop working and pretty much stop living an active lifestyle which i was accustom to. I had a four year fight with Social Security Disability in order receive benefits in order to just live. After all of my struggles I recently was introduced/informed about PRP. I have agreed to pay the extra money just for even a slight chance that this procedure will relieve some of the pain I go through on a daily basis. I am unable to walk for any length of time, and I am unable to just stand without being in pain. This procedure is a drop in a bucket to the dollar amount of all my surgeries and shots I have received over the years. BTW I am a fifty two year old man and being in constant pain takes its toll not only for me but on my family as well. I will keep u posted on my updates on how PRP is working for me. I have to believe that there is something out there that can help relieve my pain levels. i hope it is
PRP!!!

March 2, 2014 at 2:42 pm
(30) than says:

If I can give some advice. Get the shot as soon as you can. I waited a couple of months and in that time,I favored my knees so much that my back started hurting. First my lower back,then my upper back and neck. My posture was totally messed up. Now that my knees feel better,I am trying to correct my posture and movements. Believe me,when your knees,back and neck all hurt at the same time,you get really depressed fast. If I had to do it over again,I would get the shot right away to avoid other problems. The PRP shots definitely work!

March 11, 2014 at 9:24 pm
(31) higiniomalave says:

hello i m a medical doctor specialized in ortho , there have been a big rush , prp , i personally dont use it , but there have been patients who get better and some who have feel worst , my greatest concern is something goes wrong and youre facing a septic arthitis thats a problema big time

April 8, 2014 at 5:12 pm
(32) Sturla says:

than, I think you got trigger points in your back and neck after your knee pain. Exactly what happened to me when I favored my painful knees. By this book to treat yourself and spread the word!: http://www.goodreads.com/book/show/137795.The_Trigger_Point_Therapy_Workbook#other_reviews

May 6, 2014 at 8:08 pm
(33) Freda says:

I had PRP for a lateral and medial tear in my meniscus, and osteoarthritis in the knee (some chondropathy too) 8 weeks ago. So far I feel some improvement, but my surgeon wants to scope it because he doesn’t think PRP will do anything for my meniscus. My question is whether the scope will rub out any benefit to the knee so far. Or should I wait longer to see whether there is greater improvement, and perhaps have a second injection before resorting to surgery?

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