Is platelet-rich plasma right for your patient?
Many pro athletes claim that platelet-rich plasma has improved their performance and saved their careers. But is it right for your patients? And if so, which ones?
We should keep in mind, too, that the evidence for many of the other treatment options for both tendinopathy and knee OA are similarly problematic, and these modalities are even more widely used than PRP. Given the systemic problems associated with nonsteroidal anti-inflammatory drugs, concerns about possible tendon rupture with corticosteroid injections, and the time and compliance issues associated with PT, PRP may be a safer alternative to more traditional treatments.
An off-label use. PRP does not pass through the standard regulatory pathway of the US Food and Drug Administration (FDA). As a blood product, PRP falls under the regulatory purview of the FDA’s Center for Biologics Evaluation and Research, which has approved PRP only for use in the operative setting to enhance bone graft handling properties.27 Therefore, office-based PRP injections are an off-label use of the treatment.
CASE 1 › You explain to Ms. T that PRP injections are not covered by insurance and that there is not a significant amount of evidence to indicate that an injection would appreciably improve her pain. She decides to proceed with a knee replacement and not to pursue a PRP injection.
CASE 2 › Given the time that Mr. H has invested in traditional conservative management strategies, his time away from work, and that he is not concerned with the out-of-pocket cost associated with PRP, you explain to him that there is some limited evidence that PRP might improve his symptoms. He decides that he would rather try a PRP injection than pursue surgery.
CORRESPONDENCE
Jordan White, MD, MPH, Department of Family Medicine, 111 Brewster Street, Pawtucket, RI 02860; jordan_white@brown.edu.
