Some success using PRP
Not all sports medicine doctors, however, agree with Dr. Mall. One is Andrew M. Blecher MD, a Primary Care Sports Medicine physician and Medical Director of the Center for Rehabilitation Medicine at the Southern California Orthopedic Institute in Van Nuys, California.
"I have had great success using PRP for many different types of ligament injuries," says Dr. Blecher. " I have found treating partial tears [of the UCL] [1] with PRP is an excellent, minimally-invasive, office procedure which will allow for a quicker return to play than Tommy John surgery." In Dr. Blecher's view, PRP "may be an excellent option for the thousands of youth pitchers who suffer from this injury every year."
"I do agree with many of Dr. Mall's statements, including that PRP is expensive, not covered by insurance, may not be the most cost-effective first line treatment and is often used when all other conservative treatments fail," says Dr. Blecher. I also agree that much more research needs to be done in order to establish the optimal concentrations, protocols and procedure techniques for the various musculoskeletal indications for which PRP is being used." (for a companion article in which Drs. Mall and Blecher review the results of recent PRP studies, click here).
Early adopters v. late adopters
"As with any new medical technology or advancement, there will always be early adopters and late adopters," says Dr. Blecher. "The late adopters will continue to repudiate the new technology until there is so much overwhelming evidence in its favor that they would be below the medical standard of practice if they continued to reject it."
"On the other hand, early adopters run the risk of providing a treatment that, years later, may end up to be proven to be of no benefit or may cause harm. I believe that the use of PRP has clearly been shown to be safe and effective, and is actually a much healthier option than a steroid injection is for children (as Dr Mall suggests). I have personally seen hundreds of my patients who were either cured or significantly improved by the use of PRP, sometimes after all else had failed and they had nowhere else to turn. PRP often gets a bad rap because it is considered "unproven and expensive", but for many patients it has truly been a remarkable treatment."
1. Podesta L, Crow SA, Volkmer D, Bert T, Yocum LA. Treatment of Partial Ulnar Collateral Ligament Tears in the Elbow With Platelet-Rich Plasma. Am J Sports Med. 2013;20(10). DOI: 1177/0363546513487979.
2. Ahmad CS, Redler LH, Ciccotti MG, Maffulli N, Longo UG, Bradley J. Evaluation and Management of Hamstring Injuries. Am J Sports Med. 2013;20(10). DOI:1177/0363546513487063.
