Palo Alto Weekly

- July 16, 2008

Platelet power combats tendon damage

Simple blood procedure helps the body heal itself

by Karla Kane

Tendon injuries that previously required surgery are now being healed with a simple injection of a patient's own blood.

The procedure uses platelet-rich plasma or PRP — blood that contains a concentrated amount of naturally occurring platelets — to promote cell growth and regeneration. The result is healing that costs much less than surgery, comes with a brief recovery time and has few, if any, side effects or risks, according to Dr. Allan Mishra of Stanford Hospital's Menlo Medical Clinic, who developed the procedure.

Extracting a small amount of blood from a patient, Mishra spins it in a centrifuge to separate the platelets and injects the platelet-rich portion into the injured area. New cell growth is stimulated, and the body repairs itself using only its own materials.

The best part for the patient: The procedure takes about an hour and can be done in Mishra's office.

Mishra likens the "ridiculously simple" method to the way skin heals after a cut. It was Mishra's understanding of platelets' role in wound healing that led to his development of the PRP treatment seven years ago. Platelets in white blood cells have high concentrations of growth factors, which are small molecules that initiate tissue regeneration. Mishra found platelet-rich plasma had a 93 percent success rate with an average two-year follow up. In comparison, the success rate for surgery is between 85 percent and 90 percent, he has written in research papers.

Unlike surgeries, which can be expensive and often come with health risks, long recovery periods and unpleasant side effects, PRP treatment is virtually risk and side-effect free.

"The risk is minimal because it's your own stuff. The worst thing that can happen is that it doesn't work," Mishra said.

The only known side effects thus far have been slight pain and inflammation at the area of injection — a result of the new cell growth and healing activity taking place, he said.

Mishra and his associates have used the treatment mostly on patients whose problems haven't responded to less invasive options, such as physical therapy and anti-inflammatory medications. PRP can be used to treat both acute and chronic tendon issues as well as to supplement traditional surgical methods, and has even been applied to injured racehorses, he said.

James McGillicuddy can attest to the power of PRP. The Stanford athlete, who ruptured a tendon in his right knee, feared his football-playing days were over. After two surgeries, extensive rehabilitation and weeks of not being able to walk, another doctor suggested he contact Mishra.

"It sounds kind of sci-fi. My blood can cure me? But I really had no other options left," McGillicuddy said.

There was little risk, so he decided he had nothing to lose. After receiving the PRP injection last September, McGillicuddy was able to rejoin the football team this spring.

James Centis, who suffered from a torn Achilles tendon, said he was referred to Mishra after several physicians recommended surgery, an option he was hoping to avoid. He was the first patient to undergo the treatment on the Achilles tendon. Mishra warned him results were uncertain.

"I work in research, so I like to try things. It's my own blood so I couldn't see how it could do any damage," Centis said.

Eight weeks later, an MRI showed the injury had healed.

"It was a good choice," Centis said.

Though his patients' experiences with PRP have been overwhelmingly positive, the treatment is not yet widely available, Mishra said. The treatment is not yet specifically approved for tendonitis treatment by the FDA.

Mishra and his associates are currently working with the FDA to conduct studies, but he said the approval process is slow. "It will take that FDA hurdle to prove PRP is legitimate," he said.

In the meantime, word of Mishra's discovery is spreading worldwide, as doctors from the international community report similar PRP successes.

Mishra is also hopeful that PRP can be used to treat other types of orthopedic issues, such as ligament, cartilage and muscle injuries. If he determines it can be applied to spinal disc problems, Mishra, a back-pain sufferer himself, added, "I'll be the first patient."

Another major goal is to bring doctors, researchers and patients together in an online forum to discuss tendon problems and treatment suggestions. Mishra has set up a Web site, www.totaltendon.com, for this purpose.

For McGillicuddy, summing up his PRP experience is easy.

"It worked — and with a lot less pain than having my knee opened up again," he said. "Now I'm a believer."

Editorial Assistant Karla Kane can be e-mailed at kkane@paweekly.com.

Comments

Posted by Karin Michel, a resident of another community
on Feb 17, 2009 at 2:52 pm

Athletes that need to get back into their respective sports after an injury should look into PRP and possibly avoid surgery. It would be a great asset to our medical society when this gets approved from the FDA.
It is cost effective and less invasisve .quicker healing time, the biggest hurdles are FDA and insurance regulations.


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