HEALTH are very slow movers when they heal. I’m very careful to let patients know that this is not a quick fix. The PRP injection is just the beginning of the process and it can be six weeks to even three months before the tendon is close to its normal state. VS: How well does it work? DL: The literature shows that most patients respond—I think the percentages out there are somewhere between 66 and 75 percent. In my experience, that’s about right. But not everybody responds to PRP, and we’re not entirely sure why. Some patients aren’t able to rest after the procedure, which slows the process. Also, if they have more severe symptoms coming in, healing is harder. I’d say about three fourths will respond. VS: Do certain tendon injuries respond better? DL: Each tendon has its own challenges. The most common one might be the lateral epicondyle, which is the tennis elbow, the lateral part of the elbow, and the medial epicondyle also called golfer’s elbow. Those
seem to respond pretty well. I’d say the Achilles tendon and the rotator cuff tendon respond the least and are on the lower side of the percentages for healing. VS: How long do you need to be quiet? DL: After the procedure, we like to immobilize the joint for 48 hours. If we can get a patient to take a week or even two weeks off of any heavy manual labor, that’s very helpful. Sometimes it’s just not possible. Some folks need to go back to work after three or four days. After the procedure, I am careful to give them a note for work. They either get a sling or a knee immobilizer or a walking boot to keep that joint shut down for a few days. They also get a physical therapy referral, which starts at the two week mark, and that’s extremely important for the whole process. VS: Who are the best candidates? DL: Anybody with tendinosis is a potential candidate. We do, obviously, have a visit to discuss the procedure and also get a sense of how severe the tendinosis is. One thing
to consider, too, is that most insurances do not cover PRP except for Workers Compensation. One of the barriers, unfortunately, is cost. But we have worked hard to keep the cost of PRP down to help provide it for as many patients as possible. VS: Are insurance companies coming around on that? DL: At the moment, it’s still listed as an experimental procedure and as more and more literature shows a positive result, I think it will shift to a covered procedure. VS: How long has PRP been around? DL: It started in ’06 at Stanford University. The initial studies were only on the elbow and the studies were so positive that other scientists started looking at platelets a little more carefully. A lot of the studies on tendon repair are done in Scandinavia and a lot of those articles and experiments are extremely positive. It’s been around for over 10 years now and taken hold. I would say that almost everywhere in the country, there are folks using platelets to heal tendons.
VS: Can you use PRP for other injuries? DL: I do get asked to do PRP injections for injuries in places that have no studies or no literature to base that procedure on. For instance, most recently somebody asked to have PRP in the AC joint, the acromioclavicular joint, a smaller joint on the top of the shoulder. There really is no evidence for PRP to work in that region, so I wasn’t really comfortable taking that leap. VS: For the folks for whom it doesn’t work, what happens then? DL: It depends. If there’s a partial response and we’re just not quite where we want to be, sometimes we’ll try a second PRP. If we had absolutely no response to the platelets, then in certain instances, we do look into a surgical correction. But we do know that the surgery is for tendinopathies or for tendinosis is not 100 percent successful either. That’s why we like to do the noninvasive or minimally invasive procedures first.
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