How many kids from 12 to 18 are coming in with these kinds of injuries who either want to get Tommy John or are looking into PRP?
Dr. Wolin: Actually, I am seeing an astounding number of young baseball pitchers who have this injury. I would say over the course of the last 5 to 10 years with the exponential growth in youth baseball and travel baseball we are seeing more and more young baseball players unfortunately with these types of injuries. While the volume of Tommy John surgeries has also gone up exponentially, what we really ought to try to do is to try to find an alternative that can give those young athletes a chance to take a step back and heal before returning to play. If we can avoid surgery, I think especially for those young athletes, we have had a major impact on their lives.
How young is too young when it comes to doing this kind of procedure?
Dr. Wolin: Well usually the patients who have these problems with the ligaments are kind of a self-selected group. The injuries occur usually after completion of their growth, so the bottom age for this type of injury is somewhere around 14, maybe 15. The youngest Tommy John operation I have ever done unfortunately was on a 15-year-old. So, anywhere from that age group up we see these patients.
Has it grown much over the last 5 to 10 years?
Dr. Wolin: Yes. The number of patients that I and other sports medicine physicians are seeing with this particular problem has really exploded.
Are you seeing more people coming in and inquiring about PRP because they are hearing about it through the grape vine from either friends or other athletes who have gotten it?
Dr. Wolin: Yes.
What is the rate of you saying having this is what you should do versus Tommy John?
Dr. Wolin: It depends on the type of tear. It also depends on when you get a chance to see them. Many athletes that I see will have had a prior injury that might have been a partial tear, but the athlete will continue to throw and that partial tear becomes a complete tear. So when it becomes a complete tear, the PRP really is not as good of an option. If we can see these patients earlier, I think the chances of having successful results with the PRP will also go up.
How quick is it?
Dr. Wolin: The procedure itself takes about 25 minutes.
What other injuries would you use it for? Where else in the body is it best versus having more invasive surgery?
Dr. Wolin: In terms of soft tissue injury, it seems the platelet rich plasma is going to have its major benefits; the hamstring for example, which is a common injury we see in explosive sports like soccer or football. We also see use for PRP in more overuse type injuries, say runners with Achilles tendon problems; that has been successful. In and around the elbow, problems with the tendons, what is called tennis elbow, but it is not only for tennis. You see golfers who have “tennis elbow” and there is also a problem on the other side of the elbow; if the tennis elbow is on this side of the elbow, the golfer’s elbow is supposed to be on this side of the elbow. Again, you can see tennis players or golfers with either one, but the main point is that those soft tissue injuries are amenable to treatment with PRP.
Is the recovery time about the same for all those different injuries? Do you see the recovery time for ankles, elbows, hamstrings being about 2 months?
Dr. Wolin: Well, it depends on the injury and it depends on the grade of the injury. The one thing that most patients don’t know about before they come in is that after the PRP injections, there has to be a structured therapy program because we have to give the body a chance to heal. For example, in Eddie’s case, a pitcher, we do not even want them throwing for at least a month. Then they will start beginning at very short distances and increasing those distances. When they go through that whole process and they are asymptomatic or do not have pain, that is when we allow them to return to sport. It is a similar process whether it is a hamstring; it is an Achilles tendon; it’s a tennis elbow, etc. So in addition to the physician who does the PRP injection you have to have a skilled physical therapist who understands the protocol.
What are the results? Can someone get back to 100% after PRP?
Dr. Wolin: What we know, for example in the elbow, if you would take an elite group of throwing athletes, pitchers who have partial tears of their ulnar collateral ligament, the chance of them being able to come back to the same level that they were experiencing before they started throwing is roughly 80%. Though the study population that I am quoting is relatively small, it is about 20. There is follow-up now on those athletes who have gone back and thrown, so those results are very encouraging. If we get the right patients, especially if we get them early enough, if they are identified properly, if they have the proper rehabilitation from physical therapists and athletic trainers, cooperation from their organizations whether it be a professional team or collegiate team or a high school team, the chances of them being able to return to their same level of activity before they got hurt is quite good.
What’s new about PRP?
Dr. Wolin: A couple of things. I think especially with regard to the ulnar collateral ligament, the Tommy John injury, we now have some good evidence that it works. The second is an understanding by the rest of the public that this technology is available and that it can be of benefit to them. So definitely it has moved from something where the elite or only the professional athlete will have it to one where the weekend warrior will know about it and they will come into the office asking about it.
Why is it so controversial?
Dr. Wolin: Well I think in general anything new, especially in sports medicine, can generate a lot of interest but it can also generate a lot of controversy. There are also a lot of different types of PRP. There a lot of different companies that have different products, they are not all the same. Some have different concentrations of different types of cells and one of the issues that we are having from a scientific basis is trying to compare the results of different types of platelet rich plasma. Scientifically, there is an ongoing discussion as to which one of those preparations is the best. As far as whether or not it is what we call a performance enhancer, such as in anabolic steroids or in blood doping that you see in cycling, I look at platelet rich plasma as a means of getting the body to heal a problem rather than actually enhancing performance. As far as we know the value of this treatment is in treating an injured part, it is not trying to make an uninjured part perform better.
Are there any dangers to the athlete or the everyday Joe who gets this procedure done?
Dr. Wolin: I think they are relatively small. Any procedure where you have a needle placed can theoretically cause an infection, but it is extremely unlikely. The physician has to be knowledgeable about the anatomy; it is important to get it exactly in the right place. In my office we will always use an ultrasound machine to show us where the needle is going so we know that it goes exactly to the place where it is supposed to go rather than, if you will, kind of touching and guessing as to where it should be. Under those circumstances I think the chance of anything bad happening is extremely small.
Can you overdo it and hurt your own healing system by putting in too many of these cells?