ADAM’S JOURNAL
Have you ever had an Achilles problem? Well, Brad, one of our ace IT guys at the Oklahoma Medical Research Foundation, has been struggling for more than a year with pain in his Achilles tendon, the cord of tissue that connects the calf muscle to the heel bone.
Once an avid cyclist and runner, Brad has been reduced to almost total inactivity. After visits to several doctors, the problem has been diagnosed as a partial tear in the tendon.
Brad’s doctor offered him various options, ranging from wearing an immobilizing boot for a year to reparative surgery. But the one that has Brad intrigued is something that’s known as platelet-rich plasma (or PRP) injections. He asked me what he should do, and I reminded him that I’m no doctor. But I told him I knew a pretty good one that I’d be happy to ask.
DR. PRESCOTT PRESCRIBES
PRP emerged on the sports medicine scene in 2009, when Pittsburgh Steelers players Hines Ward and Troy Polamalu used it before winning the Super Bowl and Tiger Woods received the treatment following knee surgery. All reported that PRP cured their injuries. Since that time, PRP has become wildly popular among orthopedic patients, who typically pay $500 or more for each treatment.
In PRP therapy, doctors take a small vial of a patient’s blood, spin it in a centrifuge to separate the platelet-rich plasma from other components, then inject the concentrated platelets at the site of the injury. Achilles injuries would seem to be a great target for PRP. Due to a poor supply of blood to this region, when the tendon undergoes microscopic tears, the body has a hard time delivering healing or growth factors to the area. But concentrated platelet injections would seem to answer this need.
The only problem with this theory is that clinical studies have not borne it out. In a group of patients suffering from Achilles injuries, doctors injected half with PRP and half with a placebo of saline solution. After six months, both groups showed some
recovery. But there was no statistical difference between those who’d received PRP and those who’d gotten saline. When researchers followed up with the patients another six months later, they again were unable to distinguish between the two groups.
These studies, published in The Journal of the American Medical Association and The British Journal of Sports Medicine, do not exactly recommend PRP treatment. But there have been other studies showing better results in patients suffering from tennis elbow. And more research is ongoing.
In the meantime, if Brad wants to spend the money, I see no harm in trying PRP. Achilles surgery can be quite painful, and the recovery is extensive. Other than a needle stick and a lightened wallet, PRP has no downside. Indeed, even if the platelet theory does not hold, some have postulated that the presence of the needle itself in the tendon stimulates healing.
As all of those who have seen me on the golf course can attest, I’m no Tiger Woods. But if he were writing this column, I expect that he, like I, would tell Brad to just do it.
