In talking about the trials and its validity in clinical medicine, we are always considering a trial that has a huge sample size, over a very long period of time, and is of double blinded randomized controlled trial.
In general, such type of study is very tedious and extremely costly. Due to this reason, it will take a long while before we have the chance to see any such valid study coming at least for another two decades.
However, the reality is that if the patient has to wait for this trial to be presented, he or she may have no other alternative options left, even though he has been given the best practice of medicine. Given that PRP therapy is of low risk and at time do give good result, it is then the patient’s owns decision to decide if he would like to consider this options if it is safe, not too costly.
There are numerous smaller studies that have proven that the PRP therapy do give a good result. While in others, the result may not be that convincing.
For the past almost ten years, our doctors in the clinic had done countless number of prp therapy procedure. Many of the respondent have benefited greatly from this popular treatment. This is surprising so for even the most recalcitrant and troublesome cases. People as old as 84 year old also improved a great deal. Chronic ligament and tendon tear for some 30 years, as a racket sport player in their teenage year also seen tremendous improvement is a big consolation. Other cases like the aesthetic indication for skin texture and color, knee joint pain, shoulder joint pain, lower back pain, has also seen improvement.
In a 2009 systemic review of few randomized controlled clinical trials, it show it has sufficiently evaluated the safety and efficacy of PRP therapy. The studies concluded that PRP therapy is very promising. However, it has not sufficiently proven the case. It is very promising because it has shown to be an option for the treatment for joint lesion, tendon, and ligament and muscle injury.
There is a Cochrane analysis on PRP therapy in a number of studies. The studies involved dental surgery for dental implant. Before the implant, due to the insufficient height of bone tissue thickness to accommodate the upper jaw implant, a sinus lift need to be done in a prior session before the actual implant placement.
A sufficient thickness of sinus bone can be created by a surgery to push up the sinus membrane and insert bone fragments harvested from elsewhere donor site such as the iliac crest. We may also place a sponge tissue inserter to fill up the space.
The PRP is usually blended with the bone marrow or the tissue inserter so as to jump start ad fasten the 3 stages of wound healing:
In this study the result does not give a clear evidence on the beneficial effect of PRP therapy.
By now the PRP therapy for nerve injury and its application in sport medicine has produced promising result in the early trials. However, larger trials are needed to show a more consistent result.
Many prior studies though in a small scale show promising result in the early trials. A 2013 review showed more study is needed to determine the PRP therapy effectiveness in the hair regrowth. Although early study show very promising result in the treatment of alopecia.
In a 2014 Cochrane analysis, in the application of PRP therapy for skeletal muscular injury. In this study, it found a weaker evidence for decrease of pain for a period of up to three months.
In the 2016 review of meta-analysis of some trials which are randomized controlled clinical trial for PRP therapy used to help augmenting the bone graft. One of the study found a very significant increase and difference in bone augmentation versus other study.
More than 10 years ago, since 2004, the proponent of the PRP treatment claimed that the less than favourable result of the PRP therapy is believed to be due poor quality PRP harvested. This may be due to the system used for harvesting, such as the tubing used or the inadequate spin devises.
This is arguable as the devise or machine only capture a small percentage of the total platelet cell could well give a biased result. Moreover, there is another factor of inter individual variability in the platelet count.
Even for the same individual, there also exist variation during different day of the month or time of the day, depending on the hydration status, type of diet, and physical activity undertaken. It has to be noted that more is not necessarily be better.
The different concentrating technique employed may affect the degranulation of the platelet cell for the release of bio-active proteins.