Blood Therapy for Joint Injuries -- In-Depth Doctor's Interviews

What is the process of making platelet rich plasma?

Dr. Steven Sampson: Basically, we draw blood from the patient’s arm, we place the blood in a machine called a centrifuge, which spins the blood and eliminates the unwanted properties in blood that don’t play a role in healing. For example, plasma and red blood cells don’t really regenerate tissue and facilitate healing, so we eliminate those. What we’re left with is platelet rich plasma, and platelets, we’ve learned in the last 20 years, release powerful growth factors that stimulate healing and regenerate tissues. We’re left with a small amount packed with rich and powerful platelets that release these growth factors. Then under ultrasound guidance, like looking at the baby, we look into someone’s rotator cuff tendon or their tennis elbow or their knee tendon or their joint to regenerate cartilage, and we’ll inject, under ultrasound guidance, to insure that we’ve placed the platelet graft within a millimeter of their target injury.

How does it actually make the healing work?

Dr. Sampson: We think about the natural human body, and we all have the ability to self-heal. We’ve all fallen, had a bruise, cut ourselves with a scab, and it seems to heal, sometimes even without a scar and you never think about it again. What we’ve learned is that the human body releases platelets that migrate and travel to the area of injury. They look like sea sponges and release growth factors, and then coordinate repair and regeneration. Basically, we’re mimicking the natural ability of the body to heal itself, so we’re taking these platelets and increasing them up to 15-fold and then reintroducing them into the body, almost tricking the body that there’s a new injury to maximize healing.

What kind of a success rate have you had?

Dr. Sampson: There are a lot of studies that we’re doing, and we did a study on knee arthritis that we’re hoping to publish and submit our data. We found that out of 13 patients that were all surgical candidates with knee arthritis, at least 60 percent had life changing functional benefit, and when it comes to tendons, we’ve seen even better results. I’d say anecdotally, up to 80 percent. It’s really important that we select the right candidate so we’re very particular. A lot of writers here in Los Angeles will get elbow and wrist pain, and we do different diagnostic studies like MRI, X-ray, and ultrasound, and we don’t see any abnormalities, and we’ll tell those patients they’re probably not the best candidate. If we find the proper candidate, we’ve found that more or less 80 percent of patients do well. Patients may require between one to three injections, depending on the nature of their injury and various other factors that can be involved.

Does insurance cover the procedure?

Dr. Sampson: The procedure is considered experimental, and we’re involved in an FDA approved study with 10 centers across the country on tennis elbow to determine if it is safe and effective. Hopefully, it will promote increased availability for more patients, but for now, it’s an out-of-pocket expense.

Is it fairly expensive?

Dr. Sampson: If you break down the cost of surgery and complications and associated loss of work time, it’s a fraction of the cost, but it is something that I feel that the more patients that begin to get this and demand it, and the more different insurance companies recognize that this can help avoid surgery, the more common it will become.

What are the advantages to surgery and the other therapies that are out there?

Dr. Sampson: Surgery has a role, and we like to screen patients and determine who proper surgical candidates are, but I find in this active based community of Los Angeles, a lot of people want to avoid surgery and stay active with less downtime. Even in the best surgery cases, there are inherent complications that can occur from infection, nerve injury, scarring, and increased pain.

We try to reduce those risk factors and allow people more of a natural based healing approach, and what we’ve found with tendons is they’re very tough to heal. A tendon connects a muscle to a bone and basically is made of a million little fibers of a rope. What happens is that rope doesn’t fully rip in half – it actually gets thicker with little gaps in the rope of scar tissue or calcium deposits. When we treat that tendon, we want to improve blood flow, improve oxygen, and regenerate, as opposed to reduce inflammation.

For example, cortisone injected into a tendon may give an athlete or a weekend warrior some immediate relief. What we’ve found is the pain returns in six to eight weeks, and we’ve caused further injury to the tendon, which can rupture. A lot of treatments are pretty difficult to address tendons because of their nature that they have poor blood flow and often heal with scarring and don’t heal 100 percent.

Is this a permanent treatment?

Dr. Sampson: Yes, and that’s what’s appealing about this treatment is we’re not just masking the pain and symptoms, much like cortisone or anti-inflammatories, we’re actually treating the root of the problem. We have images that show on ultrasound and MRI where we’ve actually regenerated tendons to their original state. We’re treating the root of the problem, which also means it’s not a quick fix process. Aside from high level athletes that may have an immediate injury, and while there’s a natural healing response already in motion, we’re just layering on top of that and accelerating it with platelet rich plasma. Most people have had injuries for weeks, months, or years, and we’re starting from scratch. It can take several weeks to months before they may have benefit of symptoms.

Who is a good candidate for the treatment?

Dr. Sampson: What’s nice about platelet rich plasma therapy is there’s a very minority of patients that aren’t a good candidate for this treatment. We treat two types of patients – patients that want to get better faster and are very active and athletic and have new injuries to kick start their healing and maybe cut their rehabilitation recovery time in half. We also treat weekend warriors and just regular patients that have pain in their knees with prolonged sitting at the movies and having pain standing up and can’t walk several blocks. We treat patients with tendon injuries throughout the body, as well as cartilage and joint pain with osteoarthritis.

What do you hope to be able to do with this treatment in the future?

Dr. Sampson: I think this is a promising technology in a field we call ”ortho biologics” that includes stem cells. Platelet rich plasma is helping a lot of people, and as far as stem cells go, this is the most accessible treatment at this time. This is available in offices throughout the country, and I think as word gets out more, patients will be demanding this treatment. What we might find is platelet rich plasma may just be opening the door to greater treatments that we’re currently doing research on, including stem cells and obtaining higher concentrations of these growth factors to have even more dramatic and immediate relief.