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2013 ISAKOS Congress Wrap Up

“Platelet rich plasma (PRP) therapies aim to improve the

process of tissue repair through local delivery of autologous
bioactive agents to influence critical mechanisms such as

inflammation, angiogenesis or extracellular matrix synthesis.
PRP has been used for just about any and all conditions in

orthopaedic sports medicine, and some practitioners swear
by it. I must confess that I am still cautious: I am fascinated
by this new technology, and by the opportunity that PRP may

afford to get my athletes back to health and fit to fight faster.
However, I am aware of the fact that there is still relatively little

level I evidence in favour of PRP. Indeed, the well-performed
level-1 studies seem to paint a different view from what has Dr. Allan Mishra then spoke in his usual understated manner,

been outlined in the press. The early studies were impressive, and presented data from a prospective, randomized trial of
and PRP seems to be effective in the management of tennis 230 patients evaluating the efficacy of PRP for chronic tennis

elbow. However, subsequent well performed randomized elbow. That study revealed a significant improvement in
controlled trials in Achilles tendinopathy form Holland and patients treated with needling and PRP compared to needling

our own in rotator cuff tears do not show any advantages. alone in terms of reported pain and elbow tenderness. The
Another randomized controlled trial using PRP in open repair overall success rate of needling with PRP compared to PRP
of Achilles tendon ruptures from Sweden shows that it is at alone was 84% vs 68% at six months. (p = 0.012). This

best of no use, and possibly harmful. I am aware of another study used a formulation of PRP that contained increased
trial in rotator cuff repair, which shows early advantages, and concentrations of platelets and increased white blood cells

of another two that show no advantages. We performed compared to baseline. This formulations was injected in an
systematic reviews with the Dutch group and with the group unactivated fashion. (Type 1A PRP prepared via the Biomet

who introduced the concept of PRP in the management of GPS PRP System, Warsaw, IN USA; see classification system
musculoskeletal injuries, led by Drs Anitua, Sanchez and below) This paper has been accepted for publication to The

Andia, and found that the scientific evidence is just not there. American Journal of Sports Medicine.
The same applies to muscle injuries. Therefore, at present, I
am happy to perform studies on PRP (and we are doing so), Dr. Mishra stated “The data will hopefully help patients and
clinicians as they navigate the decisions they need to make
but I do not use it in clinical practice, at least not yet!”
with regard to treating chronic tennis elbow. Finally, it was
a pleasure to reconnect with friends from India including
These three talks were followed by presentation of clinical
Dr. Mandeep Dhillion, one of the authors of the recent
excellent investigation using PRP for knee osteoarthritis. I look results from various published studies by the ICL Chairman,
Rogerio da Silva; he looked at the pros and cons, and
forward to future meetings and continuing collaborations. subsequently initiated an excellent discussion.
Please consider joining with me on the Biologic Orthopedic

Society on LinkedIn (BiologicOrtho.com) as we work toward As a member of the audience, I was impressed by the number
better solutions for challenging problems”.
of people who attended this ICL as well as the quality of

Mishra PRP Classification System (Mishra et al 2012)
the presentations and the inquisitive questions that were
subsequently asked.

PRP Classiication
I congratulate ISAKOS for picking this topic for the ICL and
Activated?
Dr. da Silva for getting the best minds in this field on to the White Blood Cells
podium together, which in itself is a monumental task
Type 1
Increased over Baseline
No

Type 2
Increased over Baseline
Yes

Type 3
Minimal or No WBCs
No

Type 4
Minimal or No WBCs
Yes

A: > 5x Platelets
B: < 5x Platelets

Dr. Mishra’s classification is presented above

Then came the turn of Nicola Maffulli, Professor of Sports and
Exercise Medicine at London, and a highly published author;

he played the Devil’s advocate and brought into focus the lack
of significant evidence based studies to validate many points.

I asked Nicola to give the gist of his beautifully presented talk,
and his words are paraphrased below.

ISAKOS NEWSLETTER 2013: Volume II 15