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Pro athletes, others try PRP and stem-cell injections for joint pain

Date (2017-01-03)

Dr. Jason Tucker of OrthoBiologix uses an ultrasound to check the progress of Bernie Zeledon weeks after having Bilateral Stem Cell treatment of the knees during a followup visit on Aug. 4. David T. Foster III / The Charlotte Observer / TNS

CHARLOTTE, N.C. — It’s been 18 years since Bernie Zeledon injured his knee while playing soccer with his kids. His doctor recommended surgery, but Zeledon didn’t want to risk infection or face a long recovery. So, he put up with the pain, took ibuprofen several times a week, and walked around “like a little old man.”

But in July, Zeledon, now 60, read about a new clinic in Charlotte, iOrthoBiologix. It offers nonsurgical therapies for joint pain, including injections of platelet-rich plasma, derived from a person’s own blood to promote healing of tendon and muscle injuries and arthritis.

Zeledon knew the treatment was popular with professional athletes, such as Tiger Woods, Kobe Bryant and Peyton Manning. So, he called for a free consultation.

Two days later, Dr. Jason Tucker treated both his knees on the same day. And two weeks later, the swelling around Zeledon’s knees was down, he walked steadily with braces, and felt no pain.

Platelet-rich plasma therapy, known as PRP, first gained widespread attention in 2009 when players for the Pittsburgh Steelers — Hines Ward with a sprained knee ligament and Troy Polamalu with a strained calf — had the injections, recovered quickly and went on to play in the Super Bowl.

That news led to demand from weekend warriors. And sports medicine doctors obliged, even though research to support the therapy was still thin.

In Charlotte, a few orthopedic practitioners, who offered PRP even before that Steelers moment, have been low-key about it, careful not to over-promise on results. But in the past year and a half, PRP — and a newer injection therapy using stem cells — have taken on a higher profile in Charlotte.

New providers are marketing “regenerative” or “bio-restorative” medicine as an alternative to joint replacement surgery.

As hopeful as this sounds, these therapies remain controversial in the medical community. They are also expensive — maybe several thousand dollars per injection — and insurance does not cover them.

Dr. Pat Connor, an OrthoCarolina surgeon and team physician for the Carolina Panthers, the Charlotte Knights and Joe Gibbs Racing, offers PRP to some patients. But he warns, “It’s important to balance hope versus hype.”

Research in the United States and Europe has produced contradictory results. Some show symptom improvement; others show the treatment is no better than placebo. Even doctors who believe PRP and stem cell injections relieve pain disagree whether it can regenerate tissue.

“The marketing gets ahead of the science,” said Dr. Scott Rodeo, an orthopedic surgeon at the Hospital for Special Surgery in New York City. “There is great potential there. But we need more data. … I’ve seen a number of disappointed patients who’ve spent a lot of money. … It may help, and it may not help.”

Dr. Sean Whalen, a Flexogenix cofounder who used to work in Gastonia, N.C., said there is “plenty of research that supports the effectiveness of PRP alone or in combination” with other therapies. Much of the skepticism comes from “old guard” orthopedic surgeons, he said, who are threatened by change that would reduce demand for surgery.

“Go back to (the introduction of) laparoscopic surgery,” Whalen said. “It was called the ‘snake oil of surgery’ at the time. Now, of course, it’s widely accepted, and it’s even the standard of care.”

Tucker, the founder of iOrthoBiologix, also disputes the doubters. He’s seen positive responses in patients, and cites a long list of studies, including his own, to support the benefits of PRP and stem-cell injections.

“People that say there is no evidence for this,” Tucker said, “are categorically wrong.”

Alternative to surgery

Tucker’s interest in PRP stems from a high school football injury that led to three shoulder surgeries and derailed his dream of playing quarterback at Michigan State. Instead of an NFL career, he set his sights on becoming an orthopedic surgeon.

In 2010, he learned about the emerging field of “bio-restorative medicine,” which offered a less invasive, more natural alternative to surgery. Tucker switched his specialty to focus on PRP and, more recently, stem-cell injection therapy.

In his new Ballantyne offices, Tucker proudly shows off his lab and its central feature, the centrifuge. He draws blood or bone marrow from a patient, spins it down in the centrifuge to produce stem cells or platelet-rich plasma, full of growth factors and anti-inflammatory substances, and then injects the concentrated substance into the patient’s joint and surrounding tissues.

With the centrifuge, he said, “We take out the bad and keep in the good.”

Tucker said he never offers a guarantee of improvement. And even if the therapy doesn’t work, he said, the option of knee replacement surgery is still available. “You haven’t burned any bridges,” he said.

At Flexogenix, Whalen said doctors offer an array of nonsurgical alternatives, including traditional injections of cortisone or hyaluronic acid as well as the “more exotic” PRP and stem cell injections.

Whalen said he doesn’t advise using PRP alone for osteoarthritis, commonly known as “wear-and-tear arthritis.” But he said PRP could be used in conjunction with hyaluronic acid, a substance that occurs naturally in the body and helps lubricate the joint.

Combining PRP with stem-cell injections is also beneficial for tendonopathy, such as tennis elbow, or partial tears of tendons, ligaments and cartilage, Whalen said. In this scenario, he likened stem cells to “grass seed” that won’t grow in the wrong environment. Adding PRP, he said, is like “adding fertilizer, sunlight and water” to help the grass grow.

Contradictory results

Elsewhere in Charlotte, OrthoCarolina, one of the nation’s largest orthopedic groups, offers PRP injections as an option for patients with joint pain — but without the marketing push of the newer clinics in the city.

“I have had anecdotal success with it, but I’ve also had anecdotal failure,” said Connor, the Panthers team doctor. “I use it sparingly. … We don’t think it would hurt.”

Connor said many small studies have been done on PRP for various injuries, and results are contradictory. For example, he said, one study of patients with hamstring injuries found PRP was better than physical therapy alone. Another found “absolutely no difference.”

Earlier this year, researchers in the United Kingdom reviewed previous studies of patients with tennis elbow, a layman’s term for elbow pain caused by overuse of muscles. Connor said it showed “PRP had slightly better results than steroid injections, but was no better than placebo.”

PRP therapy is difficult to study, Connor said, because of so many variables, such as the location of the injury in the joint or muscle, whether the injury is acute or chronic and the quality of processing the blood and bone marrow.

On the plus side, he said, PRP is safe, and “intuitively it makes a lot of sense” to use healing factors from a person’s own blood. Connor said he offers it to patients as an option, but makes sure they understand it’s in “the investigational phase of its evolution.”


Source : Duluthnewstribune