Director of Orthobiologics, Ohio State Sports Medicine Head Team Physician, Ohio State Wrestling Associate Professor, Department of Physical Medicine and Rehabilitation
Dosing in #PRP is a hot topic. We should strive to stay current, but remember foundational principles so we do not go too far with current trends. Heavy emphasis on hot topics has a history of swinging the pendulum too far in the field of #orthobiologics Here is a brief list of #orthobiologics trends that were at one time associated with strong (nearly dogmatic) beliefs, but now those views have softened as we have learned. 1) Activation- some believed PRP needed activation with calcium chloride or thrombin. Interestingly, without any gold-standard study to reference, this topic seems to have all but disappeared from present discussions. 2) Leukocytes- there was a belief that leukocytes must be avoided in the joint. But when BMAC or APS were brought forward, leukocytes were again absent from the conversation. Now, we've come back to admitting maybe some WBCs are helpful. There are at least 2 comparative studies demonstrating that there is no difference between LP- vs LR-PRP for knee OA (both by Filardo et al). 3) Mesenchymal stem cells- early adopters of BMAC touted the MSC content. Then came the realization that BMAC has almost no MSCs in it and that any therapeutic benefit came from sources like IRAP (which comes from the leukocytes!) Present day, there is a strong emphasis on "PRP dosing". Those advocating "high dose" only are not addressing a very large body of literature including the only positive FDA study for knee OA that used a series of lower concentration PRP injections (https://lnkd.in/egkKTqVw) Not only are there multiple RCTs showing that a series of low concentration PRP injections improves outcomes for knee OA (see previous posts for references), but there's more to PRP than the platelet count. I'll cover these other important variables in future posts. Have a great week and keep learning! *PRP for OA is off-label. These posts are intended for education only and do not constitute medical advice*
Clinical Sports Pharmacist, Ethnopharmacist, Innovative Creator, Journeyer, Thought Leader
8moGreat topic to keep learning!