Plasma Progress

Jeff Butterfield has been rock climbing for 35 years. At 52, the owner of Acadia Climbing School admits it’s not as easy as it used to be. “Rock climbing has taken a toll on my body,” Butterfield says. “The warranty has run out on my knees—especially the right one.”

Butterfield has a horizontal tear in his meniscus. It’s a tricky injury that is hard to fix with surgery. If Butterfield did go under the knife it’s a good possibility that his meniscus would have to be removed, ending his rock climbing career.

Unwilling to give up on his active lifestyle, Butterfield turned to Dr. Mark Kandutsch at MDI Hospital’s Cadillac Family Practice in Bar Harbor to undergo a groundbreaking new procedure called platelet-rich plasma therapy, or PRP.

PRP is an outpatient procedure that many patients suffering from chronic musculoskeletal injuries are turning to as an alternative to surgery. From tennis elbow and plantar fasciitis to joint pain caused by osteoarthritis, and rotator cuff and meniscus damage, PRP is a minimally invasive way to get relief.

Last year, Eastern Maine Medical Center performed 129 arthroscopies for meniscus tears. The likelihood of a chronic or degenerative tear increases with age, Kandutsch says and adds that these types of tears are estimated to occur in 60% of people over the age of 65. Avoiding these costly and painful surgeries is Kandutsch’s goal with PRP therapy.

The process involves placing a small amount of a patient’s blood on a centrifuge that spins at a high speed, separating red blood cells from the blood platelets. The platelets, containing tissue growth factors that promote healing, are then injected into the injured area. The high concentration of platelets—from three to 10 times that of normal blood—frequently prompts the growth of new soft tissue or bone cells. Because most chronic injuries occur where the blood circulation is poor, the injection of the platelets into this area has been found to be very successful.

“It’s unique because PRP uses the body’s own resources to heal,” Butterfield says. “I think all the runners and athletes in the area are lining up at the door to try it for themselves.”

Kandutsch is one of only a few doctors in the state to do PRP therapy. A member of the American Association of Orthopedic Medicine (AAOM), he first heard about the procedure two years ago at the AAOM annual meeting. Since Kandutsch has been successfully administering a similar type of procedure called prolotherapy for the past 19 years, he was excited to bring PRP therapy to his practice. Prolotherapy, like PRP, works to heal chronic musculoskeletal pain via injection therapy. The difference is that prolotherapy uses nonsteroid materials like glucose for the injection instead of the patient’s own platelets.

“It’s a big deal that MDI Hospital has given official clinical privileges to alternative treatments like prolotherapy and PRP,” Kandutsch says.
Besides being minimally invasive and a relatively quick procedure, Kandutsch’s patients also benefit from the portable ultrasound machine he shares with Jackson Lab. Kandutsch uses ultrasonic guidance to inject the platelets into the exact area of the injury.

“I’ve found this has been a huge help. Your accuracy is better when you can see where you’re placing the needle,” Kandutsch says. “Also, you’re injecting a small amount of platelets—you don’t want to put it in the wrong place and waste it.”

Kandutsch also finds that the ultrasound is helpful when showing patients what their injuries look like. Sharyn Kingma, a marathon runner and trainer at the YMCA, likes the visual she gets on the ultrasound of the sore tendon around her ankle. At almost 60, Kingma’s osteoarthritis in her knees and the painful tendon have sidelined her running. A 20-marathon veteran, she’s just looking forward to getting back on her feet. “I told Mark if I could get two to three miles in a day I’d be happy,” she says. “Mark does everything he can to get an athlete back on their feet.”

Recovery time for PRP therapy is anywhere from one to three weeks. For most athletes it’s hard for them to take it easy. “I have to be patient and wait to jump into activity,” Butterfield says. “It’s hard!” The injured area is quite swollen after the injection, but it’s nothing like the months of recovery time they would have to endure from surgery.

Currently PRP therapy isn’t covered by most health insurance companies, but Kandutsch thinks this will change once the procedure catches on. He hosted a PRP training session with a California-based ultrasound and injection procedure trainer at Jackson Lab for Maine physicians in December 2008 and February 2009 that was well attended. Kandutsch is fired up about PRP and isn’t hesitant to applaud its successes.

He’s treated over 10 patients so far this year. “The lack of good published clinical trials is one of the main reasons there is a lack of insurance coverage,” Kandutsch says. But for people who are looking for a way to avoid the long recovery time of surgery, the $800 fee for the procedure is well worth it.

“I am absolutely without a doubt trying to avoid having surgery,” Kingma says. “If PRP buys me some time, then I’m excited.”