What it means to treat injuries using platelet-rich plasma therapy? It’s in the blood
Treating tendon and cartilage injuries usually involves rest, physiotherapy and, in severe cases, surgery. But one Dubai orthopaedic specialist has been helping residents heal their injuries through a procedure using injections of platelet-rich plasma, or PRP for short.
In this treatment, plasma, a component of blood, is injected into certain tendons and cartilage to encourage healing.
Dr Harold Vanderschmidt, who has treated up to 800 patients in Dubai using PRP since 2012, is quick to stress that it is still considered an experimental treatment and that it is not a cure for all types of ligament, tendon or cartilage injury.
“We use PRP in tendon disorders, and I use it for cartilage. It does not repair the cartilage defect fully, but the platelets contain healing factors and growth factors and it leads to cell generation, but not to a complete cartilage regrowth,” Vanderschmidt explains.
Currently, the procedure is primarily to treat patients with tennis elbow, golfer’s elbow, plantar fasciitis (inflamed ligament in the heel) and early-onset osteoarthritis.
“PRP works in [conditions affecting] areas where the tendon inserts into the bone, such as plantar fasciitis, tennis elbow, etc. We have done lots of studies with hamstring injuries and it doesn’t heal any faster than other treatments,” he says.
“It is effective for treating early osteoarthritis, which can be in the hip or any other joint, but the knee is the most common for pain. Until now, there is no evidence that it works for patients with advanced osteoarthritis.”
The procedure is relatively quick, taking around 20 minutes. Blood is taken from the patient using a special “double syringe”, which has a small syringe inside a larger one. The blood is then put in a centrifuge where it spins for around five minutes to separate the plasma from the red blood cells. The plasma, which contains the platelets, is sucked into the smaller syringe, which is then disconnected and ready for injection.
“The yellow serum [plasma] contains all the platelets at a concentration that is much higher than normal blood. Cartilage has no blood vessels and tendon has few good blood vessels so we are using it to bring the healing factors to areas where the body cannot bring it in. This is the concept of the treatment,” Vanderschmidt says.
The treatment is not a pain medicine, he explains, and, in fact, can result in more pain for up to two weeks after the injection. The overall healing process takes about six to eight weeks. “I give one injection and see how the patient develops. If there is improvement but the patient is not 100 per cent happy, then I would do a second treatment, but I do not plan two or three treatments in a row. I start with one injection and then see the patient again to see if a second one is required.”
Although Vanderschmidt says he has had great success with the procedure, it is not a first option for treatment. “PRP is a second line of treatment. We have to do the basic therapy first. Say with tennis elbow, I will prescribe physiotherapy and stretching exercises first – a lot of people respond to that treatment. I use PRP only when the patient has tried different treatment models and they are not working. If they respond to PRP, then good. If not, then we have to operate, but this is very rare. Only in about 3 per cent of patients is an operation required for tennis elbow.”
At this stage, most insurance companies do not cover PRP treatment because it is still considered experimental and while it is gaining in popularity thanks to its use by famous sports stars such as Rafael Nadal and Tiger Woods, Vanderschmidt insists “it is not the holy grail in medicine. It is like any other method – you must have the right patient and the right indication and it will work. Some doctors think it helps for everything and can be injected into any part of the body, but this is not real medicine. You have to have evidence-based studies and do the treatment properly for the patient.”
Dr Harold Vanderschmidt is an orthopaedic surgeon for Advanced Surgery at Burjeel Hospital in Dubai.