Stanford pioneers new tendons treatment

August 5, 2008 7:26:43 PM PDT
Researchers at Stanford are working on a new treatment for damaged tendons to help them heal without surgery. And the key agent comes from the patient's own body.

Watching James McGillicuddy fly through drills with the Stanford football team, it's hard to imagine him on the verge of never playing again. The tendon in his right knee was literally torn from the bone.

"I couldn't run, I was limping when I was walking. It would cramp up, felt like someone was stabbing me with a knife, it was terrible," said McGillicuddy.

In James' second surgery in as many years, doctors reattached the tendon. But eight months later, after countless hours of rehab, they confirmed the bad news, the tendon wasn't healing.

That's when James turned to a Stanford researcher, who's experimenting with a treatment to help heal human tissue, not by using drugs, but the patient's own blood.

Dr. Allan Mishra of Stanford's Menlo Clinic is helping to pioneer the use of platelet rich plasma, or "PRP" to coax the body into healing.

"The easiest way to think of how PRP works is to think of cutting yourself. The platelets stop the bleeding, but then they release the growth factors that start the healing response," said Dr. Mishra.

After drawing the patient's own blood, Dr. Mishra places it in a centrifuge which divides the sample into three layers, leaving the platelet rich plasma in the middle, ready to be injected back into the patient's knee or elbow at the point of the tear.

The injections raise the concentration of platelets to about five times normal.

"That's when we put the injections, right underneath where the tendon beneath where the tendon attaches, because that's typically where they get the problem," said Dr. Mishra.

He says evidence suggests the platelets carry growth factor proteins, which in turn stimulate cell regeneration.

Some researchers also believe the platelets may recruit other types of cells, which can help repair the damaged tissue.

"There's a study in Japan that shows when you inject the tendon with PRP, it helps bring circulating or bone marrow derivative cells to that area, and it's like a signal fire to bring in reparative cells," said Dr. Mishra.

Back on the practice field, McGillicuddy says his knee showed dramatic improvement after the PRP injections.

"I was on crutches about six weeks. Five to six days started to feel better. I was running two months later, which is pretty phenomenal," said McGillicuddy.

So is his ability to squat close to 500 pounds. It's evidence he believes, that his days stuck on the sidelines could soon be coming to an end.

"I can squat, power clean, run. I've played spring football. I'm basically 100 percent," said McGillicuddy.

Dr. Mishra is now working with other Stanford researchers to develop clinical trials. He believes the platelet rich plasma therapy may ultimately be combined with surgery to produce the best results.


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