No magical therapeutic benefit of PRP in Achilles tendinopathy — JAMA paper follow-up and BJSM podcast

My sense is that the popularity of platelet-rich plasma (PRP) is increasing independent of research in this field. BJSM has covered this with front cover attention:

Of most interest to blog readers will be the Podcast on PRP with Robert Jan de Vos and Adam Weir. These authors have arguably the highest quality study testing PRP to date. We congratulate the Dutch researchers on their quality study design and comprehensive investigations.

Conclusions?

– No clinical benefit in 6 months:

–  No ultrasound evidence of benefit:

– and now no benefit at 12 months:

No benefit at 12 months is not a surprise given previous findings. The proposed mechanism for PRP therapy is accelerated early healing. Nevertheless, these data are important as some evangelical PRP providers may be tempted to discount the 6-month results and argue for a ‘delayed benefit’. This is not the last word on PRP and BJSM Associate Editor Kim Harmon (see: Musculoskeletal ultrasound: taking sports medicine to the next level) has pointed out reasons for this series of Dutch studies having ‘no effect’. BJSM is one of the leading venues for rational debate on PRP and we look forward to adding to your knowledge about the clinical utility of this ‘hot’ therapy that is gaining clinical popularity. Time for a quality randomized trial of PRP versus the Alfredson program for Achilles tendinopathy?

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  • Editor's commentary –

    I encourage debate here – what is your clinical experience? Are these researchers misguided? Is there a particular PRP potion that works better than those used in the studies? Is there a mechanistic rationale for PRP to provide a comprehensive cure or is it an oversimplification of a complex biological cascade?

    By analogy, are we asking for a massive dose of one ingredient of a magnificent cake recipe to provide us with the complete delicacy? Are we expecting that we can replace the sound of an orchestra (a complex collection of processes) by having many violinists come in an play very loudly on the G-string?

    Why is this more popular than, for example, GTN patches which have some RCT evidence to support them in 3 different tendinopathies and a logical mechanism of action. I appreciate that there have been negative trials in GTN as well. A hot topic – and tendinopathies remain challenging. Let us know your thoughts?

  • Leoncreaney

    Not surprising given the 6 months results. As previously mentioned in a letter to JAMA, the weakness of this study is that it can be difficult to demonstrate the efficacy of a weak treatment when it is swallowed up within the effect of a more powerful one i.e. eccentric loading.

    Others have argued it would be unethical to perform an RCT with a non-eccentric loading arm, since this is such a well established treatment.

    As mentioned in BJSM editorial, PRP is probably only the beginning of a new era of biological therapies, but the technology is not good enough yet.

    Nevertheless there are many quacks/profiteers who are happy to sell the therapy despite the lack of evidence. Ahead of the curve or bad scientists????