Exercise Testing for Performance & Health

The Efficacy and Safety of Stem Cells in Treating Osteoarthritis

Point-of-Care Diagnosis: Extending the Clinical Examination One of the standout advantages of ultrasound in sports medicine is its ability to serve as an extension of the clinical examination, providing immediate, point-of-care diagnosis. This immediacy allows for a rapid understanding of an athlete's condition, enabling swift decision-making that is crucial in sports. Whether it's to confirm a suspicion, rule out possible injuries, or refine a diagnosis, ultrasound offers a non-invasive, accessible solution that fits seamlessly into the fast-paced environment of sports medicine. Its capability to deliver real-time insights directly influences treatment plans, rehabilitation strategies, and, crucially, recovery timelines.

In the realm of musculoskeletal medicine, PRP (Platelet-Rich Plasma) therapy has been riding a wave of both acclaim and skepticism. We have patients who have heard or read about PRP and want to rush in and have it done. My staff are sometimes inundated by patients who call to book in specifically for PRP, without even considering the appropriate consultation process, or my opinion on their best management. They understandably have usually tried everything else and feel like PRP is their last and final hope. This article aims to address some of the common questions around PRP- particularly the evidence around it’s effectiveness for common problems like tendon pain and osteoarthritis. In doing so, I hope to make it clear that while it may be a useful adjunct to rehabilitation measures, it is naive to think of PRP as a cure-all treatment. Hailed by some as a revolutionary treatment capable of healing and pain relief, especially for osteoarthritis sufferers, it’s been critiqued by others following recent studies that cast shadows on its efficacy, suggesting it might be no better than a placebo. This post delves deep into the evidence, peeling back layers of scientific research to reveal what’s really going on with PRP therapy. Understanding PRP Therapy At its core, PRP therapy involves injecting a concentration of a patient’s own platelets directly into the affected area, aiming to kickstart the body’s natural healing processes. The clinical pioneers of PRP were maxillofacial surgeons and dentists treating difficult implants. The theory sounds promising: harnessing the body’s own regenerative powers to treat conditions like osteoarthritis, which affects millions worldwide, causing pain and disability. Much of the basic science research for PRP appeared very promising in terms of generating tissue repair and healing. The Case for PRP Numerous studies have initially painted PRP therapy in a positive light. These pieces of research have documented how PRP injections can lead to improvements in pain relief and joint function, making a compelling argument for its use as a non-surgical option for those grappling with the daily challenges of osteoarthritis. The Case Against PRP However, the plot thickens with the advent of recent, high-quality studies that have put these claims under the microscope. These investigations suggest that when PRP therapy is pitted against placebo treatments, the differences in patient outcomes become negligible for Osteoarthritis of the knee. This revelation has stirred the pot within the medical community, leading to heated discussions about the place of PRP therapy in treating osteoarthritis and other musculoskeletal conditions. Suffice to say- any clinician that claims that PRP (or any other agent as at the time of writing this article) can reverse osteoarthritis or “heal cartilage”, is providing misleading information. Expert Opinions and Patient Experiences I have used PRP in my clinical practice for the last 10 years, but I have been keeping my finger on the pulse of the latest high-quality clinical trials to help understand whether it is truly effective (that is, more effective than placebo, when sources of bias are controlled). As a clinician, I acknowledge that I am not impartial, and therefore I must use quality research as well as our experiences to guide treatment. The recent trials that do not support PRP for Knee Osteoarthritis are extremely well planned and conducted. As the facts change, we must change our minds and our approaches. I published a case series in 2015 with my co-researchers at Sydney University, where we found that Rugby Players with high ankle ligament injuries were able to return to play 3 weeks sooner if they had a single PRP injection within the first 2 weeks after injury. In my clinical experience, PRP has provided good results for patients with ligamentous tears, and as an adjunct to strengthening exercises for a range of tendinopathies.