Mending tendons without surgery

James McGillicuddy was not getting good news. Three years after arriving at Stanford as one of the nation's top high school football recruits, he'd been stuck on the sidelines the entire time by a torn tendon that, even with two surgeries, just wouldn't stay fixed. More surgery would not help, his doctors told him, but they did have one last option to offer him.

Six months later, the Stanford football coach is calling McGillicuddy the comeback kid. The 6 feet 3 inch, 300-pound offensive lineman has participated in spring practice "full out hitting people," he said, for the first time in his collegiate career. "The tendon,'' he added, "feels great."

McGillicuddy's passport back to the playing field was a procedure developed by Dr. Allan Mishra of Stanford Hospital's Menlo Clinic. His research, published in 2006 in the American Journal of Sports Medicine, has made him an active figure in the study and use of PRP - platelet-rich plasma. Mishra's research focused on PRP as an aid to heal - without surgery - debilitatingly painful tendons around the elbow known to millions as tennis elbow.

But PRP can be used on other tendons, too. In McGillicuddy's case, it was his patellar tendon - the one at his kneecap - that had so deteriorated he couldn't even sit without discomfort. His coaches didn't give him much chance of ever again playing football. They didn't think his surgically-repaired tendon would hold up, despite the year's rest he'd given it after the second surgery. McGillicuddy talked to his father, a neurosurgeon. "At this point," McGillicuddy said, "my dad was like, 'You have nothing else. See if it works."

Mishra drew two tablespoons of McGillicuddy's blood, whirled it in a tabletop centrifuge at 3200 rmps to separate out a half teaspoon of plasma and then injected that into the young man's tendon. The process raises the level of platelets by more than 500 percent compared to whole blood. Those platelets carry growth factor proteins that stimulate cell regeneration and recruit other cells to repair the ailing area.

What excites Mishra is the potential for PRP to help young athletes like McGillicuddy, stressing his body to its limits, as well as older adults whose joints protest the wear and tear of decades. PRP, Mishra said, "is part of the revolution in orthopedics. We're moving away from plates and screws and learning to use the body's own ability to heal."

Not only does a PRP treatment cost a fraction of surgery, it also speeds up recovery time. Its built-in biocompatibility means the possibility of side effects is much lower than with a manufactured pharmaceutical. "This is all from your own body - it's not something we had to cook in a lab," Mishra said.

Those characteristics are rapidly building PRP a successful scientific track record. Its potential, say proponents, could range from applications in the repair of bones, ligaments, cartilage and nerves, either on its own or as an adjunct in a wide variety of surgeries.

"PRP shows great promise both for treatment of chronic musculoskeletal conditions as well as an adjunct to accelerate healing in acute injuries," said Dr. William J. Maloney, Chairman of the Orthopedic Surgery Department at Stanford Hospital & Clinics and the Elsbach-Richards Professor of Surgery.

However, added Maloney, who also chairs the National Hip and Knee Registry Work Group of the American Academy of Orthopedic Surgeons, "well designed prospective clinical trials are necessary to better determine the indications for use. Dr Mishra along with Dr Jason Dragoo of the sports medicine service at Stanford are currently developing those trials."

Mickey Napp was very leery of any surgery at all when she went to Mishra to see about an elbow so painful she couldn't lift a tea cup. Again, the doctors she saw recommended surgery. But one of them told her about Mishra's work.

"I thought, 'I'm going to give this a try.' It doesn't preclude doing surgery if it doesn't work. It's just your own blood, so no odd ingredients are going into your body."

The overall cost of the procedure is far less than a surgery and the recovery time much shorter.

Now 60, and still physically very active, Napp jokes that her PRP-treated arm is actually stronger than the one without injuries. "I teased Allan and told him I need a two-for-one, because my other elbow is starting to go."