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December 09, 2013

Questions & Answers -- Platelet-Rich Plasma (PRP): Recommendations for Treating Bone and Joint Injuries

Interview with the Authors: Questions & Answers

Orthopaedic surgeons Scott R. Rodeo, MD and Freddie H. Fu, MD answer questions about PRP treatment.
Question: Before patients “decide” they want PRP treatment bone and joint injuries/pain, what are some questions that they should be asking?
Fu: Patients should be asking what the available scientific evidence is to support the use of PRP in treating their injury. They should also ask if there is any risk of complications associated with PRP treatment.
Rodeo: Another issue is whether the cost of the PRP treatment is covered by their insurance carrier, as this can become quite costly.
Question: How would patients know that PRP is for them?
Rodeo: Patients should realize that the existing data for PRP is quite limited. There is some limited evidence of efficacy for chronic tendon problems, such as tennis elbow, as well some evidence for short-term symptomatic relief in osteoarthritis. PRP is generally used as a second line treatment, after more standard treatment options have failed.
Fu: We are still learning a lot about the basic science, including how it will react in various biological environments. In fact, even the time of day can affect how the PRP is made. In short, the decision to use PRP as a treatment strategy must be made between the physician and patient with both risks and benefits discussed in detail.
Question: How common is the practice of PRP?
Fu: It all depends on where you go. In some places, it is seen as a panacea for all orthopaedic injuries and even such things as hair loss! In others, the use is approached much more cautiously. The truth probably lies somewhere in between—there may be some injuries or pathologies where PRP can be useful in the healing process whereas in others, it may not be. This all must be determined through rigorous scientific investigation.
Rodeo: Some practitioners use PRP liberally, although there is often very little data for these applications. It is probably used too frequently for conditions for which there is very little evidence.
Question: What ought to be the thought process of the orthopaedist? A patient’s?
Rodeo: Patients and physicians should consider the evidence for PRP for specific indications. The physician needs to consider the specific formulation of PRP, as there is significant variability in different PRP formulations. As there is some (limited) positive data on PRP, the physician should consider the specific formulation that was reported to be successful for a given condition. If a physician uses PRP, they should consider analyzing a small sample of the PRP in order to understand and document the specific composition.
Fu: We as orthopaedists must ask ourselves whether the use of PRP is truly an improvement from the current standard of care treatment strategy for the given injury. In addition, PRP is costly and this must be factored in to any decision. The thought process should be similar for the patient, too.
Question: What is the key takeaway of this research for the general public?
Fu: PRP has become popular as a result of widespread media attention and its use in elite athletes. Despite this, the scientific evidence supporting its use remains scarce. We still have a lot to learn and the key is to define the appropriate orthopaedic indications in which PRP may play a role in the healing process. This work takes a long time. We are making good progress in the laboratory in terms of understanding the potential mechanisms and formulations of PRP. From there, it is a challenging process to translate these models clinically and determine their efficacy.
Rodeo: PRP is a promising treatment option; however, further data is clearly needed before PRP can be recommended for widespread use. Further research should help identify the specific type and formulation of PRP that is effective for various conditions.

About the Orthopaedic Surgeons
Scott R. Rodeo, MD
Dr. Scott Rodeo is Professor of Orthopaedic Surgery at Weill Medical College of Cornell University and is an Attending Surgeon at the New York-Presbyterian Hospital and the Hospital for Special Surgery, where he is Co-Chief of the Sports Medicine and Shoulder Service. He is Associate Team Physician for the New York Giants Football Team. Rodeo served as a Team Physician for the United States Olympic Team in 2004, 2008, and 2012. Rodeo graduated cum laude from Stanford University, where he completed his undergraduate work while on an athletic scholarship. He completed medical school graduating with honors from Cornell University Medical College.
Freddie H. Fu, MD
Dr. Freddie H. Fu is the David Silver Professor and Chairman of the Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine and Head Team Physician for Athletic Department. In 1999 he was awarded an honorary Doctor of Science degree from Point Park University, an honorary Doctor of Public Service degree from Chatham University, and in 2010 appointed Distinguished Service Professor by the University of Pittsburgh. Dr. Fu graduated summa cum laude from Dartmouth College in 1974, and received his BMS in 1975 from Geisel School of Medicine at Dartmouth. He earned his MD in 1977 from the University of Pittsburgh and completed his general surgery internship at Brown University. He then returned to Pitt for an orthopaedic research fellowship and completed his orthopaedic residency training. In 1988 as an ESSKA-AOSSM Sports Medicine Travelling Fellow he visited over 30 sports medicine centers in Europe which led to the conception, oversight of the design and construction of the $80 million UPMC Sports Performance Complex, a 60 acre state-of-the-art sports medicine complex. The complex is used as a model in more than ten countries and has been a magnet for more than 600 visiting surgeons and fellows from over 50 countries in six continents. Dr. Fu also oversees one of the top and most ethnically and gender-diversified orthopaedic residency training programs in the country which attracts the best and brightest young surgeons/researchers from the US and abroad. For his efforts he received the 2011 American Academy of Orthopaedic Surgeons Diversity Award.
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