Biological therapy holds promise for pro athletes and weekend warriors alike.
Can the rejuvenating powers of a biological therapy called platelet-rich plasma provide symptom relief for patients with knee osteoarthritis and help prevent re-tearing in surgically repaired rotator cuffs? Researchers, including Brian Cole, MD, MBA, a sports medicine specialist at Rush University Medical Center, are currently conducting research to see if it can — and they have reason to be optimistic.
Cole, who is also head team physician for the Chicago Bulls and co-team physician for the Chicago White Sox, has been using platelet-rich plasma for years to help patients heal after surgery, as well as to get professional athletes with muscle and ligament injuries back in the game quicker. In fact, National Basketball Association player Kirk Hinrich was treated by Cole with platelet-rich plasma injections to aid his recovery from a painful thumb injury and a chronic hamstring injury, as well as during a shoulder surgery Cole performed in summer 2011 on the former Chicago Bulls star.
With this therapy, platelets from a patient's blood are separated from the other elements in the patient's blood using a centrifuge that separates materials by their degree of density. The concentrated, platelet-rich blood is then injected into the surgically repaired area. Platelets are a natural source of growth factors — healing proteins that stimulate the development of new soft tissue or bone cells. Introducing a super-concentrated dose of the patient’s platelets into the location of an injury has been shown to help the body initiate a healing response faster than it would on its own.
"The growth factors don't do the healing; rather, they encourage the body to heal more expeditiously," Cole says.
This power to promote healing inspired Cole and colleagues at Rush to start looking at whether platelet-rich plasma can help to alleviate the symptoms of knee osteoarthritis and delay or slow the progression of the disease.
The team is comparing platelet-rich plasma to hyaluronic acid, a standard injectable treatment used to alleviate the pain, swelling and impaired function caused by osteoarthritis. In preclinical studies, they found that platelet-rich plasma was more effective than hyaluronic acid both at reducing the biological processes associated with inflammation and at improving joint lubrication. Based on these promising findings, they began a clinical trial comparing platelet-rich plasma to hyaluronic acid in people with knee osteoarthritis.
Preliminary results from the first 50 patients enrolled in the trial show that patients have a positive benefit to both therapies after six months, although Cole says it's too early to tell which treatment will ultimately do a better job of allaying symptoms and staving off disease progression. The team hopes to enroll another 50 to 60 patients in the trial in the coming months, and in the meantime they will continue analyzing the data they have already collected.
"Platelet-rich plasma therapy will not be a cure for osteoarthritis," Cole says. "But if proven effective, it could offer hope to active patients who find themselves candidates for joint replacement surgery because their condition is too advanced for other rejuvenative techniques, such as cartilage restoration. And because it is administered nonsurgically and has no side effects, patients tolerate it extremely well."
The Potential to Help Shoulders Heal
Another possible use for platelet-rich plasma: Helping to strengthen surgically repaired rotator cuffs to help prevent re-tears, which can occur after repairs of large or complicated tears, as well as in older patients.
Cole and several other sports medicine specialists from Rush, Bernard Bach Jr., MD, Greg Nicholson, MD, Nikhil Verma, MD, and Anthony Romeo, MD, are part of a multicenter team that recently completed a systematic review of literature looking at previous rotator cuff repair studies. Their review revealed that the re-tear rate for small and medium tears treated at the time of surgery with PRP was 7.9 percent, compared to a re-tear rate of 26.8 percent when PRP was not used. The results will be published in the Journal of Arthroscopy this summer.
"Many studies have shown no obvious differences in healing rates with the use of PRP following rotator cuff repair," Cole says. "But when we analyzed the data by tear size, PRP does appear to reduce re-tear rates by improving the biologic environment at the tendon-bone interface — the area where tendon healing occurs and where most rotator cuff repairs tend to fail."
More Information at Your Fingertips ...
Please Note: All physicians featured in Discover Rush Online are on the medical faculty of Rush University Medical Center. Some of the physicians featured are in private practice and, as independent practitioners, are not agents or employees of Rush University Medical Center.
If you enjoyed this article and are not already a subscriber, subscribe today to Discover Rush Online. You'll receive health information, breaking medical news and helpful tips for maintaining your health each month via e-mail. To subscribe, send email to DiscoverRushOnline@rush.edu.