An interesting article posted on the Sports Illustrated website June 27, 2013, suggested that one of the mainstays thought to help players avoid Tommy John surgery may be striking out. The gist of the article was that pitchers and other players have turned to platelet-rich plasma (PRP) therapy to treat ulnar collateral ligament (UCL) injuries in an effort to avoid surgical reconstruction using a tendon taken from elsewhere in the body.

Pitchers and other throwing athletes stress the UCL with each throw. Recent research into to biomechanics shows that many of these baseball players are stressing their UCL because they have poor range of motion in their shoulder. Once their UCL is torn, many players would rather avoid invasive surgical reconstruction that will take them out of the game for the rest of the season. PRP injections can help stimulate healing through the release of growth factors, but this promising new therapy is failing for many baseball players.

Doctors in the Regenexx network have had good success using PRP to treat baseball UCL injuries, so why are many treatments at other clinics failing? First, all PRP isn’t created equal. Laboratory tests have shown that low platelet counts paired with the red and white blood-cell contamination present in most PRP mixes can reduce the effectiveness of PRP. Many baseball players who should be injected with the Dom Perignon of PRP are being injected with its Budweiser equivalent. Second, if the UCL tear is more severe, clinical experience indicates that it needs to be treated with the patient’s own stem cells. Because many providers have only PRP at their disposal, everything gets treated with PRP. In addition, the torn UCL may be severe enough that same-day stem-cell procedures need to be replaced with injection of  cultured stem cells. Very few providers offer access to both. Finally, the tear may be so severe that only surgery will help.

There are other issues as well. Few sports orthopedists have access to ultrasound, nor do they understand how to use this technology. On the diagnostic side, ultrasound makes it possible to stress a patient’s elbow and easily observe if the UCL has hidden tears or weak areas. This is not possible with MRI. On the treatment side, ultrasound makes it possible to target and treat specific weak areas of the ligament rather than making blind injections.

It appears that PRP treatments for many baseball players are failing because the PRP mix itself is not optimal, some players need stem-cell injections because of the severity of their tear, and ultrasound diagnosis and precise injection techniques aren’t being used.

“Tommy John Surgery Alternatives” first appeared as a post on the Regenexx blog.

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