Patterns of platelet-rich plasma use among Australasian sports physicians.

BACKGROUND: We hypothesised that the application, production and administration of platelet-rich plasma (PRP) varies widely among sports physicians, bringing into question the validity and consistency of PRP described in research and clinical use. We also assessed congruence between the reported clinical indications for PRP, and the available research evidence for these indications. METHODS: We conducted an anonymous 23 question online survey of 153 current Fellows of the Australasian College of Sports Physicians (ACSP), using an emailed link. It was opened from April 2014 until August 2014. RESULTS: The survey confirmed that there is wide variation in the application, production and administration of PRP. Over one-third (38%) of sports physicians performed PRP injections themselves. Almost half of clinicians (49%) did not provide the service themselves, and only referred for PRP injections. The remaining clinicians did not inject PRP or refer for PRP injections at all. Clinicians who provided PRP injections varied from an average of 0-500 injections per month, with a median of 12 times per month. Australian sports physicians were far more likely to use PRP than their New Zealand counterparts. For sports physicians who provided or referred for PRP injections, tendinopathy was overwhelmingly cited (n=63) as the condition for which clinicians thought PRP was most effective. 30 respondents cited effectiveness for osteoarthritis. CONCLUSIONS: This study confirms that there is no clear consensus among sports physicians on the preparation, administration or best clinical indications for PRP.

Effectiveness of a single platelet-rich plasma injection to promote recovery in rugby players with ankle syndesmosis injury.

AIMS: To determine whether a single ultrasound-guided platelet-rich plasma (PRP) injection into the anterior inferior tibiofibular ligament (AITFL) reduces the time for rugby athletes to return to function and match play following MRI confirmed ankle syndesmosis injury. METHODS: Cohort controlled pilot study. 10 Rugby Union players were recruited during the 2014 season, and consented to receive a single autologous PRP injection into the AITFL within 14 days of MRI confirmed ankle syndesmosis injury. A historical control group included 11 comparable Rugby Union players between 2011 and 2013 who were treated conservatively with the same inclusion criteria and rehabilitation protocol as the intervention group. Participants followed a standardised rehabilitation protocol involving simple milestones for progression. Early functional tests were performed 2 weeks after the removal of the CAM (controlled ankle motion) boot. Time to return to play was recorded. Repeat functional testing occurred within 1 week of return to play. RESULTS: Groups were comparable in anthropometrics, playing position and MRI injury severity. Time to return to play was significantly less in the intervention group (p=0.048). Following return to play, athletes in the intervention group showed higher agility (p=0.002) and vertical jump (p=0.001). There was a lower level of fear avoidance associated with rugby in the intervention group (p=0.014). CONCLUSIONS: This pilot study shows that, following ankle syndesmosis injury, a single autologous PRP injection may accelerate safe and successful return to Rugby Union, with improved functional capacity and reduced fear avoidance. It demonstrates the feasibility of a randomised controlled trial to further assess this therapy. TRIAL REGISTRATION NUMBER: ANZCTRN12614000055606.