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2013 ISAKOS Congress Wrap Up

Controversies in PRP Use: In the words of Rogerio Teixeira da Silva, Past President–

The Instructional Course at Brazilian Orthopedic Sports Medicine Society..

ISAKOS 2013
“The main objective of the PRP ICL at ISAKOS, in Toronto,
was to perform a broad discussion in this very controversial

topic. We had a good audience for an ICL early in the morning,
showing that the topic continues to have the attention of the

Prof. Mandeep S. Dhillon
orthopedic surgeons, mainly the ones who deal with sports
injuries. From the basics (with Steve Arnoczky’s lecture) to
President Indian Arthroplasty
Association
the always welcome counterpoint view showed by Nicola
President Indian Foot & Ankle Society Maffulli, we had the opportunity to see high level scientific

Vice President Indian Association of presentations. Also we had an outstanding contribution from
Sports Medicine
Alan Mishra, showing his 8 year experience with the study of
PRP treatment in tendinopathy. I focused my presentation on
Chandigarh, INDIA
the more recently published papers where PRP was employed
in different clinical situations, and opened the opportunity for

Platelet Rich Plasma seems to have taken the Orthopaedic, the audience to think about new treatment strategies and
research projects on this topic. It was a great pleasure to chair
Sports Medicine, and Plastic and Reconstructive surgery
communities by storm. The enthusiasm and interest generated this very interesting ICL in ISAKOS Toronto 2013.”

in recent years seems to far outstrip the medical research,
which is still an ongoing process, and many things are yet not Steven P. Arnoczky, gave a comprehensive talk on the basic
adequately defined in relation to efficacy, quantification, usage aspects of PRP, the gist of which is paraphrased below

and regulatory aspects.
Platelet Rich Plasma (PRP) is defined as an increase in the
I googled the words platelet rich plasma one day prior to concentration of platelets above that found in the same volume

the ICL at the ISAKOS meeting, and was amazed at the of whole blood. Platelets (and the liquid plasma component of
number of hits; I got 5.5 million hits on this subject alone! blood they are suspended in) contain over 1100 bioactive
factors involved in the healing and regeneration of connective
The interest in this is definitely immense, but in the words of
Allan Mishra, “the most read article is probably the one in the tissues. PRP has a long history of safety and efficacy in
dental and maxillofacial surgery as well as cosmetic surgery.
New York Times” Famous sportsmen using this treatment
for early return to sports have ranged from top Golfers (Tiger In considering the basic science of PRP, it is important to
Woods) to famous American footballers like Hines Ward and recognize that all PRP products are not the same and they

Troy Polamalu of the Pittsburg Steelers, and the pressure on can vary in 1) the concentration of platelets (as a function of
doctors to use this methodology has been immense.
whole blood drawn), 2) the inclusion/exclusion of white blood

cells, 3) the use of an exogenous platelet activation agent, and
To put this subject in a scientific perspective and look at 4) the level of fibrin production. These variables may have an
the most recent research through the opinions of world
effect on the indications and outcomes of PRP use in sports
leaders, Dr. Rogerio Teixeira da Silva from Sao Paulo Brazil, related injuries and may explain the variable results presented
coordinated this ICL at ISAKOS 2013 Toronto, and invited in the literature regarding the efficacy of PRP. Therefore, the

the top minds in PRP focused research, namely Steven P. classification system proposed by Dr. Allan Mishra (which
Arnoczky from Michigan USA, (who has been at the forefront categorizes the 4 variables noted above) should be employed
of numerous path-breaking research projects), Allan Mishra
when publishing outcome studies using PRP so as to more
from Stanford, (who initiated the interest in this topic by his clearly define the efficacy of specific PRP product in a specific
pioneering work on Tennis Elbow many years ago), and
clinical application. It is also important to remember that most
Nicola Mafulli from London (who is a World leader in tendon growth factors do not have a linear dose-response curve so
related research).
having a higher concentration of platelets does not always
guarantee a more robust biologic response. The precise
concentration of platelets in PRP (as well as the frequency

and mode of application) that can effectively (and consistently)
augment healing in the many applications that have been

advocated for PRP have yet to be determine. Therefore, more
well-designed and appropriately analyzed level 1 studies are

still needed to identify the role of PRP in the treatment of
sports injuries.

14 ISAKOS NEWSLETTER 2013: Volume II