Dr. Wolin: I would say that with the standard procedure as currently being accepted, it is really a relatively small amount. We only put about 4 cc. If you take a regular syringe you are only looking at about that much and most of the time it is one injection. I think it is very unlikely that you are going to be harmed. Multiple injections, while they may not harm you, may not help you either.
What is the future for PRP?
Dr. Wolin: I think the future is first of all getting to understand it better in terms of identifying the correct PRP to place. I think we have to better define what we call the clinical problems, the areas where it works the best and where it unfortunately sometimes does not work so well. I think we have to know a little bit more about the rehabilitation. Can we push the envelope? Can we shorten that period of time when the athlete can return or do we have to lengthen it? Is there something different about, say for example, an 18 or 19-year-old pitcher as compared to a 35-year-old pitcher? It is all about getting to learn more about what is an extremely promising technology.
Do you see it as becoming more prevalent for the amateur and college athletes, or do you think it will be spreading to more of the weekend warriors, or are you seeing that trend already?
Dr. Wolin: I think that trend is already with us.
Are there different PRP treatments for the different injuries, or they are just different companies using different solutions for the same injury?
Dr. Wolin: I think as we look in the future, we need to look at whether or not one company has a better product or whether or not they all work equally well.
I was looking at the specialities from the American Orthopedics Society for Sports Medicine saying it just was deemed to be safe for cartilage as well as the ligaments, tendons, and muscles as well, Is that correct?
Dr. Wolin: Yes. That is another issue, and that has to do more with the aging athlete where cartilage starts to breakdown in the knee. What we are finding now is that this same technology that has been used for muscles and tendons and ligaments can also help in regard to cartilage.
Have you performed that?
Dr. Wolin: I have.
What were the results like?
Dr. Wolin: I would say it is early, but so far I think the results are quite encouraging. We are going to need to define PRP’s role in treating these problems. I think we have to be realistic with our own results and we have to be realistic with our patients. We cannot tell a patient that is a panacea for all of the problems that she or he may have, but what we can do is say on the basis of what we know so far whether or not PRP is a reasonable alternative.
Can you explain how it works?
Dr. Wolin: There is the femur, or the thigh bone. There is the tibia, the shin bone. Between the two bones of the knee are two washers, each of those is called a meniscus. Between the bones connecting them are structures and those are the ligaments. In the middle of the knee there are two of them that make a cross. One crosses from the back to the front and that is called the anterior cruciate ligament, and the other one stays in the back and that is called the posterior cruciate ligament. Now, on the ends of all of these bones, on the femur, on the tibia, on the kneecap, is a whitish material and that is called articular cartilage. It is the same material that you will see on the end of a chicken bone. It is normally white, it is normally smooth, and it is normally glistening. All of these things have to work together to produce a normal knee.
What happens when there is a subchondral defect then?
Dr. Wolin: When there is a subchondral defect there is force that is applied to the bone below the surface, and subchondral means below the chondral surface or below the level of the articular cartilage. Commonly, it occurs either in the femur or it occurs in the tibia and almost always it is a result of an injury taking place to either the meniscus, where you lose the weight bearing portion of the meniscus, or you have an injury to the articular cartilage, the cartilage on the end of the bone, and the bone below it sees more stress.
What kind of injury would cause that?
Dr. Wolin: Any that results in injury to the meniscus, to the anterior cruciate ligament, and to the articular cartilage.
How long would it take until you really started feeling that you needed to have a procedure?
Dr. Wolin: Most injuries will get better after a while. That is what we call the honeymoon period, when you have not tried it out and you may not try to run, you may not try to cut. If you do develop one of these subchondral injuries you are probably going to notice it in say weeks and definitely over months. As time goes by you are going to notice it more and more.
Is it just sore or is it a sharp pain? What do the patients feel?
Dr. Wolin: I have had patients tell me that it is like a toothache every time they try to walk on it. Certainly if they try to run or they jump on it, then it will get worse after and with repetitive activity.
When they come in and you find out that is the problem, what was the standard treatment for that?
Dr. Wolin: Most of the time if we eventually end up seeing that, doctors will say rest. Give it time. It is a “bruise” in the bone and it will heal.