The Scalpel or the Needle Saturday, June 25th, 2011 In the final day of the National Athletic Trainers’ Association Meeting and Clinical Symposia at the Morial Convention Center, three experts who deal in biological therapies presented the latest research on using stem cells and platelet-rich plasma (PRP) in treating sports injuries. Sports medicine professionals around the country are beginning to use patients’ own blood matter — platelet-rich plasma and/or stem cells retrieved from the patient, and injecting the healing-rich material into injury sites to promote faster and more effective healing. The most headline-grabbing example of this was Pittsburgh Steelers wide receiver Hines Ward, who was injected with PRP to jumpstart the healing process on his knee injury heading into the Super Bowl. He recovered enough to play in two weeks. Tiger Woods was injected after his 2008 knee surgery. Baseball players Carlos Beltran, Cliff Lee and other professional athletes also reportedly have had PRP therapy. The procedure is allowed by the four major professional sports leagues, not regarded as a performance-enhancer any more than a knee brace. And it now has considerable buzz because of the star power using it. The simplicity of the PRP procedure and the safety of it make it attractive to athletes who would rather try it than a traditional surgery or invasive treatment. It is still considered experimental by the medical insurance world, so most people pay out of pocket for the procedures. It’s a simple process that begins with blood drawn from the front of the elbow — just as traditional blood samples are taken. A citrate is added to the blood to inhibit clotting, and then the blood vial is placed in a centrifuge, which spins the matter into several components: plasma, platelets, white blood cells and red blood cells. The plasma is then injected back into the patient at the injury site, usually with the aid of ultrasound guidance to make sure it is deposited in the optimal location. The healing properties of the platelet-rich plasma go to work, supposedly fanning the healing process. Stem cells work similarly, only they can be extracted from the patient, cultured and multiplied outside the body before re-injecting them. “You have lots of different tools, and those tools can be enhanced and used to help different areas,” Dr. Chris Centeno, a panelist who uses stem cells and PRP in his practice. “You can move cells from point A to point B and make more of them and use those to try to heal you.” There is even talk about young athletes farming away their stem cells retrieved from bone marrow aspiration to have for use in future injuries. The use of stem cells in the medical world isn’t new, but it is new to orthopedic medicine. “We started doing some research in 2005, and in late 2007 we became convinced it was working and started offering it to our general surgery population rather than just research subjects, ” Centeno said. His patients saw great reduction in pain and bounced back quicker than those who went for more traditional surgeries. Centeno said he is on a team that submitted a study for publication that includes 250 patients, and that study is encouraging for the field. “I think PRP is exciting; I think it’s a new thing, ” Gerald Weniger, a certified athletic trainer althleticwho administers such injections in his Harrisonburg, Va., clinic. “Before we were doing it in our clinic, we had people coming to us and asking us to do it because they were so excited about what they were seeing in the news. We only got into it because people were asking us to do it.” The problem is, there isn’t much research in the area. Adding to the cloud of uncertainty is that there is no standard methods of collecting the material or administering it. So comparing one study that used volumes of PRP material and injected it into a human shoulder might not make an easy comparison to another study that used teaspoons of it in a rat’s leg. “I think we’ve got to slow down because there’s not a lot of research on it yet, ” Weniger said. “I think the research that’s been done is pretty (vague). There is a lot that shows PRP has a beneficial effect, and there is a lot that doesn’t show anything. I think we have to hash that all out. I think we certainly have to keep doing it so we can figure that out and keep trying on different things so we can narrow things down and get indications on whether it should be ligaments or muscles or tendons, and whether it should be used in acute settings or chronic settings.” Corey Oshikoya, an athletic trainer with the Denver Broncos who sat on the panel as well, said his profession is trying to make up rehabilitation schedules on the fly as more and more players come in after PRP injections. If these athletes are recovering quicker, do you up their rehab schedule? So far the answer to that is no. He advised caution in ramping up rehabilitation steps. “There is very little literature out there that displays or approaches how you should treat an athlete that has had PRP therapy, ” he said in his lecture. “We’re all kind of searching for answer.
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