I’ve written several times previously regarding the use of platelet rich plasma in the treatment of musculoskeletal problems, primarily commenting on its uses in the foot and ankle (See also my recent article in J Musculoskeletal Medicine on Plantar Fasciitis, and upcoming comment on PRP in Achilles Tendinitis). A recent new article appeared in the AAOS (American Academy of Orthopedic Surgeons) newsmagazine AAOS Now. It describes a presentation done by Dr. Raymond Monto, M.D. at the 2012 AAOS annual meeting entitled “PRP is more effective than cortisone for chronic severe plantar fasciitis”. Unfortunately, while I was at the meeting, I did not get the opportunity to see this presentation.
According to the article, Dr. Monto reported on 40 patients randomized into treatment with cortisone injection or PRP. He followed these patients for a year. Initial function scores were approximately 44 initially. At three months, those in the PRP group were at 95 while those in the cortisone group had function scores of 81. At the conclusion of the trial, the PRP group continued to have scores that were 94, while those in the cortisone group had scores around 58. It should be noted that Dr. Monto disclosed an association to Exactech, Inc., a company that, among other products, does sell equipment that makes PRP. No mention in this article was made regarding whether the patients were blinded to their treatment.
While this study is encouraging, it should be noted once again that several other studies have failed to definitely show an improvement in other forms of connective tissue damage, such as recently Achilles tendinitis. This study has many limitations and caution should be used until it is confirmed by other larger studies. PRP continues to be poorly covered by most insurances.
The need for the slow incorporation of this new product into general treatment is highlighted by another article in the same issue of AAOS Now which discussed the disappointing results of BMP (bone morphogenic protein) in operations used to make bones fuse. The large industry-sponsored trials used to evaluate the substance showed it to have no bad effects, but this did not prove true with further study. They stated that “shortfalls, including poor design and reporting bias in peer review/publications, ‘may have promoted widespread, poorly considered on-and off-label use, eventual life-threatening complications, and deaths.’” The history of medicine is littered with these stories.
In medicine, what seems a logical, safe, easy, and common-sense approach to a problem may in the end be ineffective and possibly even dangerous. Safe, non-operative methods of treating plantar fasciitis exist. Stay persistent and consistent and often it will pay off. Avoid the temptation to resort to unproven methods such as platelet-rich plasma (PRP).
–Brett Fink, MD. Co-author of The Whole Foot Book: A Comprehensive Guide to Taking Care of your Feet