knee science or fiction

Monday, July 4, 2011

Medical breakthroughs make headlines almost daily, but the rest of the story is often hidden or never reported. It definitely gets people’s attention when elite athletes leave the country to get new treatments. So it goes with Kobe Bryant heading to Germany for platelet rich plasma (PRP) therapy for his ailing knees, following Tiger Woods’ lead of importing a Canadian doctor to get his knees injected at his Florida home. PRP is just the latest potential salvation for patients whose muscles, tendons and joints have been injured because of the stresses placed upon them by sports and work.

The platelet rich plasma therapy procedure is relatively simple. Take the patient’s own blood, spin it in a centrifuge to separate the red cells, white cells and platelets into different layers. Then inject the platelet rich plasma into the body area that is injured. Hopefully, according to the theory, growth factor (not growth hormone) secreted from the platelets helps repair damaged tissue. (There are now commercial preparations being formulated) Unfortunately, it is just theory and has yet to be proven to work.

There is a difference between anecdotal evidence and scientific proof. If a treatment works for one person, it may be coincidence, placebo or the real thing. The only way to know is to test the treatment and see what happens. The results are mixed for PRP. In a May 2011study published in the American Journal of Sports Medicine, Dutch researchers found that PRP therapy used for chronic tenditinis was no better than placebo in how patients functioned and how the tendon looked when evaluated by ultrasound. In the July issue of Knee Surgery, Sports Traumatology and Arthroscopy, the results of Spanish research supported the benefit for PRP therapy in hip injuries. But PRP did not work in helping inguinal hernia repairs heal in an April 2011study published in the Journal of Vascular Surgery and Endovascular Surgery.

PRP is a hot topic as research tries to find the holy grail of repairing damaged body tissue by using the patient’s own building blocks. The PRP search began 10 years ago with oral surgeons trying to get broken jaws to heal quickly so that patients could eat and chew sooner. But the answer is still not clear with the National Institutes of Health listing 51 ongoing PRP studies with half still recruiting volunteer subjects.

The difficulty with reading the sports pages for medical research news lies in the lack of transparency. An injured athlete may not want the world to know that an attempted treatment failed. If Kobe Bryant does get relief from his knee ailments, will platelet rich plasma be the reason or will it be the results of his ongoing conventional treatment? And how many readers will remember or care a year from now why Kobe can run and jump, just as long as he can.

Athletes are very much like cancer patients. Their time frame to compete is very short and every day lost to injury is one that can never be recovered. If conventional medicine fails them, they often seek experimental and unproven therapies because the alternative is to quit. This may take them to places around the world to find treatments that may not be approved in the United States. Anecdotal success stories increase the potential that others will follow. But as the numbers of subjects for each treatment grows, alternatives may become mainstream. It is expected and accepted that what we think we know now may be proven wrong in the future. Science and medicine just need to figure it out.

Lawlor, et al. The Role of Platelet-Rich Plasma in Inguinal Wound Healing in Vascular Surgery Patients. Vascular and Endovascular Surgery. 2011, 45:3

deJonge, et al. One-year Follow-up of Platelet-Rich Plasma Treatment in Chronic Achilles Tendinopathy: A Double-Blind Randomized Placebo-Controlled Trial. American Journal of Sports Medicine. 5/21/2011, online.

Guadilla, et al. Arthroscopic management and platelet-rich plasma therapy for avascular necrosis of the hip. Knee Surgery, Sports Traumatology, Arthroscopy. 6/22/2011, online.

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