Take Your Best Shot

Patients turn to platelet-rich plasma injections to avoid surgery.

Ortho injury? PRP injections could offer a surgery alternative. When Will Barnes, 63, tore his meniscus, an orthopedic surgeon told him his only option was knee surgery, an invasive procedure involving several months of pain, rehabilitation, and recovery — if all went smoothly. “I was not excited about that. I just wanted to go running again,” says Barnes, who had been training to run a half marathon with his son. Barnes researched joint repairs and learned about PRP (platelet-rich plasma), an alternative treatment that could help him avoid the longer-term repercussions of surgery. PRP is created by spinning a sample of a patient’s blood at a high speed to separate plasma (liquid) from platelets and then injecting a solution of platelet-rich plasma into the injured area. Platelets, cell fragments found in blood, can trigger cell and tissue growth. “I just really appreciate the approach,” says Barnes, who oversees ecology and conservation work at the New Mexico State Land Office. “You’re using your own body to heal yourself, and you’re healing yourself from the inside rather than taking stuff out of your body. It just makes so much sense.” PRP is also widely used around the world — including at John Hopkins Musculoskeletal Center and the Mayo Clinic — to accelerate post-surgery healing, generate bone in dental care, and treat osteoarthritis as well as tendon, ligament, muscle, and joint injuries. Yet the treatment is not widely known, and insurance coverage is minimal and rare, mostly involving vehicle crashes, worker’s compensation–related injuries, and chronic non-healing wounds. Research into PRP’s efficacy is promising and growing, but skeptics point to low patient numbers in studies as well as variations in clinician protocols. There is no oversight or standard of care, so treatments range considerably in quantity of injections and cost ($500 to $2,500 nationally), a reality that concerns clinicians who train extensively to provide PRP. PRP treatments usually require “plus or minus six sessions” with multiple injections each time, according to Dr. Jonas Skardis, DOM, who has taught clinicians PRP since 2006. “Thousands and thousands of doctors are using PRP, and one negative is they tend to use one injection in one session and then goodbye,” Skardis says. Dr. Mavrick Lobe, DOM, who has provided PRP for 15 years, advises seeking care from an experienced, trusted professional. He has attended trainings led by Skardis and traveled throughout the country taking advanced classes in constituting PRP, injection procedures, and ultrasound imaging of injected tissue. Both Santa Fe doctors have a special injection therapy license. “It’s a continuous study for people who are serious about this,” says Lobe. “You learn from clinical experience when you can help someone and when you can’t. It’s a type of practice where you have to do it to become more proficient at it.” Those who have found relief through PRP are true believers. “To have this solution is not standard,” says Robin Grier, a part-time Santa Fe resident and economics professor at Texas Tech University. “My primary care doctor didn’t know about it. At the same time, it works.” Grier, 52, visited Skardis at New Mexico Pain Management after injuring her back in a vehicle crash. She was initially reluctant about the cost, $975 per treatment for three to six treatments, but says she “would do anything to avoid surgery.” “Not being able to do the activities you like — that’s all costly too, in other ways,” she says. Grier has needed numerous treatments due to a connective tissue disorder. “I love to talk about this therapy because it’s been such a miracle in my life, and I wish more people would do it,” she says. “I wish it was cheaper and more widespread to get more people functional faster and not have surgery. It would improve people’s lives.” Over the course of treatment, Grier has viewed ultrasounds that show the regrowth of her tendons and ligaments. “This is gardening. It’s growing stuff inside a joint,” Skardis says. “I facilitate a garden of new collagen growing inside your knee or shoulder or elbow.” Lobe, a jujitsu martial artist, was sold on PRP after opting to use the treatment to heal a severe neck injury rather than undergoing surgery that would have ended his athletic career. He says people should check into treatment once pain limits their activities or work. In some cases, he can help people who have suffered longer. One was Anthony van der Vossen, a lifelong Española resident. Van der Vossen, of Holmes Wrecker Service, has endured pain throughout his 37-year career as a heavy tow truck operator. A friend recommended he see Lobe after a neurologist advised major surgery for intense pain from his shoulder to his fingers. “You only have one body,” van der Vossen says while waiting to receive treatment on his shoulder and hand at Lobe’s office. “Would you rather suffer and be hurting all the time? It’s worth every nickel. I can’t say enough good things about it.” Once his blood solution was ready, van der Vossen lay on his side as Lobe injected a nerve blocker to ease the discomfort of multiple injections around the injured area. Lobe navigated an ultrasound probe over van der Vossen’s shoulder as the white squiggly lines of tendons appeared on the computer screen. As he watched the screen, Lobe carefully injected a needle, gently nudging it into a tendon, inflating the tendon with van der Vossen’s blood. He reminded van der Vossen to take it easy for the next couple of days, since people can feel sore and stiff for 24 hours after a treatment. For optimum results, Lobe and Skardis recommend that patients take physical therapy in addition to PRP. As the need for orthopedic care rises each year, more people may turn to such options, especially since surgeons will need to double their joint replacement caseloads to meet future demand, according to a recent study reported at this year’s American Academy of Orthopaedic Surgeons meeting. Barnes has run a few times since finishing five sessions of PRP. “I think more people should try this,” he says. “It was such a difference . . . as a health care alternative — to have a two-hour conversation about my situation and have someone look carefully at my knee. I felt really taken care of.” He’s talking with his son about running a half marathon this fall. Deborah Busemeyer is a freelance writer who won several awards while working for newspapers in Colorado, Wyoming, and New Mexico. She led communications for the New Mexico Department of Health for six years and continues to help organizations communicate effectively.