March 2010

Out On a Limb: Pro rated

When hearing about how a therapy has helped a professional athlete, it can be difficult to extrapolate those results to your own patient population.

Jordana Bieze Foster, Editor

Tiger Woods may have lost Gatorade, but he’ll always have platelet rich plasma.

Do an online search for the cutting-edge injection therapy, and the embattled golfer’s name comes up as one of its early adopters for sports medicine applications. Woods reportedly received several PRP injections last year to address tendinitis that had developed following a 2008 ACL injury (see “Knee loads during golf: Implications after TKA”).

And Woods wasn’t even the first high-profile athlete to make headlines for using PRP. In January 2009, Pittsburgh Steelers safety Troy Polamalu received an injection to treat a strained calf sustained during a playoff game. He reportedly was so pleased with the results that he recommended the same treatment to teammate Hines Ward, after the receiver sprained his medial collateral ligament the following week. When Ward improbably returned to play in the Super Bowl two weeks later, PRP became big news (see “The promise of platelets”).

The problem with therapies being linked to celebrities is the perception that one has to have celebrity status in order to be a candidate for treatment. And it’s true that some emerging techniques  are so rarely performed or so expensive that they can’t be accessed without an inordinate supply of money, connections, or both.

PRP isn’t one of those treatments. It’s minimally invasive (depending on how your patients feel about needles), uncomplicated, and relatively inexpensive, with some practitioners charging a flat fee of $200 per injection. Factor in that it also could end up obviating the cost of surgery, and the PRP club starts to look less and less exclusive.

Still, when hearing about how a particular therapy has helped a professional athlete, it can be difficult to extrapolate those results to your own patient population, which in most cases involves a much different range of activity levels and priorities. A procedure’s pricetag may not be much of a consideration for a pro athlete, but a delayed recovery from an injury – or, worse, no recovery at all – could end up costing the pro athlete much more than the average patient. An incremental improvement in outcomes associated with one technique versus another might not be clinically significant for most patients, but for a pro athlete that little added edge could mean making the cut, cracking the starting lineup, or earning an incentive bonus.

But that doesn’t mean high-profile patients’ experiences can’t be valuable for the rest of us. In this issue, researchers from Duke report that National Football League skill players saw drops in performance measures in the seasons leading up to an eventual Achilles tendon rupture—suggesting a possible prodromal period in which early intervention (including PRP, perhaps?) could avert a more serious injury (see “Return to football after Achilles tendon rupture”). Even if most of your patients don’t have as much at stake as an NFL player, the potential for early intervention could be similar.

It’s fine to withhold judgement on PRP until more high-level evidence is available. But in the meantime, preliminary results shouldn’t be discounted just because they involve a celebrity. Not even if that celebrity is named Tiger.

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