Mythbusting

Platelet Rich Plasma… in the ED? For an ankle???

This was a prospective, randomized, double-blinded, placebo-controlled trial – THAT INVOLVED INJECTIONS INTO AN ANKLE FOR AN ANKLE SPRAIN.  The kind me and you do, oh, I dont know, at least 2-3 times a year.  And manage to do just fine.  But this was not just any injection, but platelet rich plasma.  Which just does not sound cheap, and sounds like terrible indication creep if I’ve ever heard it.

After 37 patients were randomized to placebo or platelet rich plasma intra-articular injections, both groups had were evaluated for their visual analog scale (VAS) pain scores and Lower Extremity Functional Scale (LEFS) on days 0, 3, and 8. LEFS and a numeric pain score were obtained via phone call on day 30. All participants were splinted, given crutches, and instructed to not bear weight for 3 days; at which time patients were reevaluated.

This seems like a colossal waste of time, money, and resources.  Perhaps they were really testing to see if they could find 37 patients silly enough to accept an intra-articular injection for a low risk injury, then have a splint placed (I wont get into my thoughts on placing a splint for injuries like this, instead I’ll refer you to here and here).  Then again, if we continue to provide patients with other sham procedures despite evidence that demonstrates their are useless, then perhaps ED platelet rich injections are merely the next evolutionary step after back surgery and knee arthroscopies.

Standard

2 thoughts on “Platelet Rich Plasma… in the ED? For an ankle???

  1. Clint Kalan says:

    PRP is becoming a huge craze in the ortho world. It’s theory is that the extra inflammatory response will accelerate healing in otherwise poorly vascular ligaments/tendons. It’s being sold to middle aged athletes with tendonopathies that do not heal like they are 20 anymore (so probably not an intra-articular injection). While there are some small trials that do show benefit, I’m sure it’s in very select patient populations. I’m also sure that the drop outs were because of the fact that this is injected with repeated 18 ga needle pops through the affected tendon, and tends to be very painful.

    I can’t also see why adding more inflammation in an already inflamed area from an acutely injured ligament would help. This was designed for chronic tendonopathies. Oh, and it sometimes costs thousands of dollars and often is done in proprietary processes….

    • Thanks for the response!

      A review from arthroscopy (http://www.ncbi.nlm.nih.gov/pubmed/25595696):

      “Concerning ACL graft maturation, there is promising evidence that the addition of PRP could be a synergic factor in acquiring maturity more quickly than grafts with no PRP, with the clinical implication of this remaining unclear. Regarding tunnel healing, it appears that there is not an improvement with the addition of PRP. There is no proof that clinical outcomes of ACL surgery are enhanced by the use of PRP”

      Using it routinely and outside of clinical trials is frankly, dishonest.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s