Platelet-Rich Plasma - New therapy for an old injury

Cathy Cantway

by Cathy Cantway , Tough Girl Cycling

As a competitive cyclist and recreational sports enthusiast I am unfortunately quite used to being injured. I have had knee surgery for a torn meniscus, shoulder surgery for a torn labrum, and plenty of scrapes and bruises and soft tissue injuries. But loving an active lifestyle, and especially cycling, I have never let an injury keep me down for longer than necessary; two years after my shoulder surgery I upgraded to pro in mountain cross!

This past February however, I started experiencing pain in my left heel. If for some reason I stretched my ankle too far it felt like something was actually tearing off my heal. After an x-ray to rule out any bone problems, my doctors and I determined that I had Achilles tendonitis. This is not an unusual diagnosis for active individuals as tendon disorders account for 30-50% of sports related injuries1. The problem with this seemingly simple diagnosis is that traditional therapy does not quickly or easily resolve the problem. For months I tried taking anti-inflammatories, resting my ankle, and even got fitted for a walking boot to limit mobility of my ankle because nothing seemed to be resolving the tendonitis.

Finally in April, after cutting out almost all of my activities to avoid further injury to my tendon, but realizing that I had a mountain bike season quickly approaching, I called my orthopedic surgeon, Andreas Sauerbrey, in Steamboat Springs and explained my situation.
“You need PRP,” is what he told me.
“What is PRP?”

Dr. Sauerbrey quickly explained that PRP, platelet-rich plasma, is an injection of your own platelets, derived from your blood, into the injured tendon. The idea is that the platelets support the inflammatory process that is going on in the injured tendon and promote the formation of new fibrous tissue. Additionally, since you are injecting your own platelets into the injured site there is no chance of rejection from your body. He said if he were me that is what he would do, so I made an appointment.

Being a medical student I had to find out more about this new therapy. First, platelets are an integral part of the healing process. They are involved in blood clotting, inflammation, tissue proliferation, and tissue repair. Platelets secret a number of important growth factors that help direct proper tissue healing2. The idea behind PRP for tendonitis is that by injecting concentrated platelets into an injured tendon the platelets will facilitate and possibly accelerate tendon reconstruction and healing3.

Excited about the prospect of finally resolving my tendonitis I showed up at Dr. Sauerbrey’s office ready to experience this new therapy. The PRP process involves first having your blood drawn, then the blood sample is centrifuged in order to concentrate the platelets. It has been found that platelet-rich plasma preparations contain eight times the amount of platelets found in regular blood samples, and increased concentrations of platelet derived growth factors4. The portion of the blood sample containing the platelets is gathered into a syringe and injected into the injured tissue. First, Dr. Sauerbrey numbed the injection site with a little local anesthetic, and once that set in he injected the plasma. The plasma injection can be done with the guidance of ultrasound, but in my case there was a very specific point in my heel that was irritated that we used to direct the injection. In a few minutes I was done! My heel was very sore after the injection; there is not a lot of space around your heel for extra fluid so I did have to use crutches to move around for a few days.

Dr. Sauerbrey recommended that I rest my ankle for a few weeks in order to give the therapy time to work, so I continued to use the walking boot, and to slowly ease my way back into activity. The evidence to support the use of PRP as a therapy for tendonitis is variable. A study by de Vos et al. did show a significant improvement in pain and activity level in patients receiving a PRP injection for Achilles tendonitis, however these improvements were not significantly higher than patients receiving a placebo saline injection5. Another study by Creaney et al. did show a 66% improvement in symptoms of pain, activities of daily living, and physical function in patients receiving PRP injections for elbow tendinopathy. They also measured a 72% improvement in the same symptoms in patients treated with an autologus blood injection (blood not centrifuged to concentrate the platelets), however there was less conversion to surgical treatment after the injections in the group receiving PRP6.
Although the data is variable on the success of PRP treatment, my personal experience with the therapy has been amazing! At about 3 weeks post injection I slowly returned to my normal activities. I started cycling again, and started preparing for my mountain bike season. I did run in to a few bumps along the way. I think I got a bit to excited about getting back to being active and stressed my Achilles by hiking and overstretching it, so I limited my activities strictly to cycling for a few months and the soreness completely went away. Now I can do everything I did before the injury, cycling, hiking, yoga, and soon skiing!
Works Cited
• Järvinen TA, K. P. (2005). Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin. , 10 (2), 255-266.
• Eppley BL, P. W. (2006). Platelet-rich plasma: a review of biology and applications in plastic surgery. Plastic Reconstructive Surgery , 118 (6), 147e-159e.
• Mishra A, W. J. (2009). Treatment of Tendon and Muscle Using Platelet-Rich Plasma. Clinics in Sports Medicine , 28 (1), 113-125.
• Eppley BL, W. J. (2004). Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plastic Reconstructive Surgery , 114 (6), 1502-8.
• de Vos RJ, W. A.-Z. (2010). Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy: a Randomized Controlled Trial. JAMA , 303 (2), 144-149.
6- Creaney L, W. A. (2011). Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. British Journal of Sports Medicine , 45 (12), 966-971.

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