Prologue
This coming summer (2015), NBA superstar Kobe Bryant will be playing in his 20th season with the LA Lakers. Prior to the devastating achilles tendon rupture he suffered in 2013, Kobe was arguably playing his best personal basketball in the 2011-2012 and 2012-2013 seasons, despite being 35 and 36 years old respectively. So what changed? Much of the public accredited the success to the experimental treatment he had in the off-season after the 2011 season. His right knee had been operated on three times before, and the soreness had limited his in-game minutes along with practice time throughout the 2010-2011 season. That summer Kobe was seen flying to Germany for a non-surgical procedure to be performed on his right arthritic knee (Report: Kobe Bryant saw German doc). The following season, Kobe was able to play 5 minutes more, and scoring 2 more points per game. His on-court play was seen as a rejuvenation to his youthful days, with faster movements, and more aggressive cuts.
Treatment
The treatment Kobe had underwent is now publically known, as a modified manipulation of an FDA approved treatment called Platelet-Rich Plasma injection.
This procedure comprises of three basic steps, drawing blood from the patient, centrifuging the blood (to separate certain blood components) then injecting the necessary specified components to the affected site.
At first, it might seem silly to have one’s blood drawn out then injected back, but the key step is in the centrifugation. The substance injected, Platelet-rich plasma (PRP) as the name suggests, is a blood plasma that has been enriched with platelets. Platelets are a tiny a-cellular (lack of cell nucleus) component of blood originating from fragments of bone marrow cells. In the past, scientists and doctors determined that platelets’ function was a blood coagulant, necessary to stop a bleeding wound. Recently, with the endeavor of medical scientists, it was found that platelets actually contains granules that store a concentration of a large number of growth factors. Therefore it is not only a key player in blood clotting but also a spark to initiate the natural healing process. Theoretically then, if a massive amount of activated platelets could be delivered to injured or degenerative joints, tendons, ligaments and muscles, the healing process would be reinstated and boosted.
While PRP appears to be applicable to many common clinical problems, such as tennis elbow, heel pain, shoulder impingement, degenerative knees and spine, there is a paucity of endorsement from medical literature.
In line with reports published worldwide, it is also in our experience that PRP would not benefit all patients at all times. We believe, good subject selection and strict adherence to subsequent rehabilitation protocol will be the key to success.
There are areas that PRP was proven to be beneficial. Using PRP for tennis elbow is of Level 1 evidence. (Balasubramaniam U 2015) Its use in symptomatic knee degeneration is now of Level 2 evidence. (Chang KV 2014)(Khoshbin 2013)
Risk
There are two issues seldom brought up in the internet. The first is, when the acute repairing process sets in, the concomitant inflammation might bring in more pain, which may last for up to two weeks. Using anti-inflammatory drug to take off the pain, intuitively, would cancel out the inflammation set in. Thus the second is, NSAID (non steroidal anti-inflammatory drug) should be avoided.
Even though the success of PRP therapy in other areas is still questionable, the risks associated with it are minimal. (Moraes VY 2014) Through a careful selection process and , PRP is a very valid treatment option.
Reference (Review papers from PubMed medical literature database):
1. Balasubramaniam U. Efficacy of platelet-rich plasma injections in pain associated with chronic tendinopathy: a systematic review. Phys Sportsmed. 2015 Jan 20:1-9.
2. Chang KV et al. Comparative effectiveness of platelet-rich plasma injections for treating knee joint cartilage degenerative pathology: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2014 Mar;95(3):562-75.
3. Khoshbin A et al. The efficacy of platelet-rich plasma in the treatment of symptomatic knee osteoarthritis: a systematic review with quantitative synthesis. Arthroscopy. 2013 Dec;29(12):2037-48.
4. Moraes VY. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev. 2014 Apr 29;4:CD010071.
Written by Dr. Adrian Leung
