Thursday, October 2, 2014
Platelet Rich Plasma (PRP) has its advocates as a viable treatment option, but it lacks evidence shown in clinical studies substantiating these claims. There is very little difference between placebo and treatment groups. The PRP disposable kit costs approximately 250 dollars per kit. Skeletal muscle has a greater regenerative capacity than tendon and ligament. There is also the cost of the centrifuge (approximately 10,000 dollars) needed to spin the blood down. One small level 3 evidence study showed comparable results to cortisone injections for plantar fasciitis after three months using VAS scores. As with lasers, PRP has not yet established strong efficacy for musculoskeletal use. One disadvantage of PRP is that the potency of the cells is dependent on the age of the patient. Stem cell harvesting from adipose tissue and bone marrow may be the next progression in regenerative technologies but there are no large trials to support the theory at this time. Finally, amniotic tissue is being investigated and used for musculoskeletal injuries. Amniotic tissue has the advantage of possessing very young cells, which are pluripotent (able to differentiate into all three germ layers). The price of ¼ cc of tissue ranges from $500-$750. One plantar fascial injection uses ¼ cc. One small study, that had Charles Zelen, DPM as the lead investigator, showed some promise versus control for an eight week follow-up for plantar fasciitis.