Monday, July 7, 2014

Injection Treatment No Help for Hamstring Injuries

An expensive and unusual treatment that relies on components from a patient’s own blood doesn’t appear to speed recovery from hamstring muscle injuries, according to new research.

The treatment is favored by top athletes, but the study found no benefit from platelet-rich plasma injections, at lease when administered in a certain way.

A physician who relies on the largely untested therapy says the new research misses the mark. But the study’s lead author stands by the findings, published in the June 26 issues of The New England Journal of Medicine.

“We found no benefit of platelet-rich plasma injections compared to placebo injections” in terms of the time athletes needed to return to playing sports and their risk of getting injured again, said study lead author Dr. Gustaaf Reurink, a sports medicine specialist with the Erasmus Medical Center in Rotterdam, the Netherlands.

Hamstrings are muscles at the back of the thigh and crucial to flexing the hip and knee, said Dr. Lewis Maharam, a sports medicine specialist in New York City.

In the past, pro football players with torn hamstrings might need to be kept off the field for 8-12 weeks to recover through rest and physical therapy, Maharam said, but he said platelet-rich plasma injections have made a big difference.

The goal of the treatment is to attract body-repairing stem cells to the hamstring injury, he said. To do this, a physician sends a patient’s blood to a lab for processing to remove platelets and parts of the immune system known as lymphocytes. These are injected into the patient’s body at the site of injury and, at least, according to theory, send a cry for help to stem cells that arrive to save the day.

“When it’s done correctly, patients heal in 2-3 weeks maximum, and they’re back running,” Maharam said.

In the new study, researchers gave two injections of either platelet-rich plasma or saline (a placebo) to 80 athletes with hamstring injuries. The researchers tracked them for six months. They reported that the treatment appeared to have no effect. The median time to start playing sports again was 42 days for athletes in both groups. About 15% of athletes in both groups re-injured themselves.

Reurink said the treatment might not work because the plasma doesn’t do enough to boost the healing process.

Maharam questioned the study, saying the researchers didn’t flood the injured hamstrings via the injections or adjust the amount of plasma based on the size of the injury. Reurink responded that the researchers carefully pinpointed the injuries and used the treatment amount recommended by the manufacturer of the system that produced the plasma treatment.

Platelet-rich plasma injection is an early stage application arising from stem cell research. It probably has some benefit when done properly. It reminds me of radial keratotomy, the predecessor of laser eye correction. It worked by the results were not great.

The process attempts to attract stem cells to the site of injury. The next evolution in the process is to inject the patient’s own stem cells into the injury site. Stem cell injection has been successfully performed in Europe on heart patients for the past 7 years.

The current hurdle is collecting enough stem cells to make the process work. It is easy in children as they have an abundance of stem cells. However, as we age, stem cell production diminishes.

Current research is focusing on harvesting a few stem cells, then getting them to produce large numbers of stem cells outside the body for future injection.

I predict that within just a few years, stem cell therapy will be common place. We will all be storing stem cells the way we store blood today. It will revolutionize health care making most surgeries obsolete. My greatest fear is that stem cell research has been and will continue to be thwarted at every step by those in our current health care system that benefit most from the broken system entrenched in our society.

Pay close attention to any development in stem cell research but don’t undergo plasma-rich platelet injection. It’s premature. I currently have one patient receiving true stem cell injections. The initial responses have been favorable. I’ll give you an update when there’s more to the story.

Source: National Institutes of Health (NIH) –Wednesday, June 25, 2014