Hi, I�m Dr. J. Michael Bennett. Today we�re going to talk about alternative methods of
treatment. The first topic today will be platelet-rich plasma and stem cell therapies.
This is a very exciting time in orthopedic surgery because there are a lot of alternatives
to surgical intervention that are out on the horizon that are being extensively studied
at this point. So to be up front, straight out, platelet-rich plasma and stem cell therapies
are not covered by insurance. Now stem cell therapies can be covered in certain instances
regarding bone grafting � trying to incorporate healing when it comes to bones � but as
far as tendon regeneration or tendon healing they have not been approved.
Now there are some studies that are very promising regarding platelet-rich plasma. One particular
study looked at the elbow. Tennis elbow is a big problem, particularly in overhand players
like tennis players. Tennis elbow is a degeneration of the tendon, the common extensor tendon
� the extensor carpi radialis longus � which is part of the common extensor tendons that
insert at the outside of the elbow. This basically helps give you strength with wrist extension.
So anybody that does a lot of wrist extension, or any forced wrist extension, is likely to
develop tennis elbow. It�s a dull, aching pain that gets particularly worse whenever
you extend your elbow, extend your fingers, or try to lift objects with your palm facing
downward. Standard treatment for lateral epicondylitis
involves a heavy physical therapy program, counterforce bracing � which is a forearm
brace that helps unload this tendon � as well as sometimes a steroid injection. Most
of the time � about 90/95 percent of the time � that will take care of itself. And
a lot of the time the lateral epicondylitis will burn out by a six month period of time,
sometimes up to a year. Occasionally we have patients that do not
respond to the steroid injection, the therapy, the counterforce bracing, and just have never
healed over time. They remain symptomatic from six months to a year; they�re still
having problems. The concern with getting recurrent steroid injections is that it can
cause discoloration of the skin, something that�s called fat atrophy � you can actually
get some thinning in the skin area � and it�s basically just not that good for the
tendon itself. It helps with the pain but it does not cure you or help heal the tendon.
For the first time, with platelet-rich plasma, we are able to take your own blood and use
it to help heal it. What the process involves is an aspiration of the peripheral blood,
and it�s taken in a special machine called a centrifuge, and the blood is spun down,
and the centrifuge is used to separate the blood from the plasma. The end result is a
platelet-rich plasma concentration. You want to think of the platelets as a very immature
type of cells. These immature cells have not grown up, or matured, yet. So the idea is
to inject these immature cells into an area that�s degenerative � where the tendon
is bad � and hopefully convert those degenerative tendon cells into healthy, new tendon cells.
There is some Level 1 evidence � which means there are some very good studies that are
out there � that show that injections for tennis elbow can be beneficial. It usually
can require one to three injections, one injection every one to two weeks as needed. They take
the blood, spin the blood, and inject it at that site. And so far preliminary results
are encouraging and patients have noticed a significant decrease in their pain and a
return in their strength. However, long term studies are not available,
particularly long term in the sense of 10 years. This is a very new technology and so
we have to take that into consideration. Because it�s new, insurance companies will not pay
for it. So you have to work with your physician and figure out how you will cover the actual
injection cost. There are a number of institutions incorporating platelet-rich plasma and stem
cell therapies in a majority of studies at this point so we can anticipate that in the
future we will have much more proof and many more studies that will actually show the benefits
of platelet-rich plasma and stem cell therapies. So if you have any questions regarding platelet-rich
plasma or you would like a consultation regarding whether or not you would be a candidate for
platelet-rich plasma, please feel free to contact my office. I�m Dr. J. Michael Bennett.
Thank you.