Tendonitis affects just about everyone sometime in their life. Whether it's the rotator cuff, patellar tendon, or tennis elbow, it is usually the result of overuse of the affected tendon. Usually the condition is temporary and can be easily relieved with rest, ice, and the use of inflammatory medicines (eg. Ibuprofen). Sometimes physical therapy and/or cortisone injections are necessary. The majority of these afflictions resolve without incident, but there are times when the pain and limitations persist.
"This happens as the acute phase of tendonitis, where there is active inflammation, progresses to the chronic phase of tendonopathy, where the tendon and/or sheath are replaced with scar tissue. This can cause recalcitrant pain and decreased function," explains Dr. Brian Halpern, a sports medicine specialist at the Hospital for Special Surgery in New York. "It can seem crippling to the sufferer and when the pain and dysfunction reach that point, a high tech answer is available in suitable patients," said Dr. Halpern.
An example of these high-tech treatments is the "Cascade Autologous Platelet System" method (Harvest Technologies is another). It is one of a few techniques that use platelet rich plasma (PRP) to help the body regenerate and heal. Tissue healing relies on adequate blood supply and cellular migration." Platelet derived growth factors are critically involved in this process. Many methods have been employed to harness these growth factors.
The theory behind using Buffered PRP was to concentrate blood platelets and their growth factors for incorporation back into a patients' own tissue to facilitate repair. Essentially, a small amount of blood is withdrawn from the patient's arm and spun down in the medical office with a centrifuge for a few minutes. This isolates the PRP with activated growth factors. The PRP isolate is then injected back into the area of tendonitis of the patient who had just contributed their own blood. The goal is to enhance the healing environment to cure the chronically affected tissue by concentrating the essential components of repair from the patient's own blood, thus limiting side effects and facilitating healing.
Several in vitro and in vivo studies have elucidated potential benefits in using PRP to treat tennis elbow. Other studies have demonstrated the value of PRP for treating both plantar fascilitis and Achilles tendonitis. At Halpern's institution, there are ongoing studies researching Cascade in rotator cuff repair and for in-office treatment for many tendon problems.
It is quite possible that in the near future, PRP injections become part of the gold standard for tendonitis treatment. "In patients who fail to respond to anti-inflammatory medications and physical therapy, an injection of PRP may save patients a trip to the operating room," adds Dr. Halpern. There are already anecdotal reports from Europe of PRP being used in professional soccer and hockey players to help them recover more quickly from common injuries such as ankle sprains and pulled groins.
"The future looks very promising as we attempt to concentrate these biologically active growth factors at the bedside to help patients in pain. Allowing the body to heal itself is not just logical...it is very effective," notes Dr. Halpern. Finally, a severe and painful affliction is getting the attention it richly deserves with the additional and important benefit of a non-surgical solution.
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For more information about sports medicine, visit the Joe DiMaggio Sports Medicine Center.
Mission statement: Manhattan's Joe DiMaggio Sports Medicine Center is devoted to rendering the very best non-surgical foot and ankle care, specializing in effective, non-intrusive methods as a primary objective. At the same time, the Center is affiliated with the world renowned Hospital for Special Surgery (HSS), affording traditional surgical and other options. The HSS, located in New York, has been recently rated the Number One hospital in the country for orthopedics by the US News and World Report. The Center also offers the expertise of orthopedic surgical and non-surgical clinicians in all areas of care.
The Center is named after American sports icon Joe DiMaggio, whose heel spur disability remains one of the most well-known sports injuries in history.