James McGillicuddy was not getting good news. Three years after
arriving at Stanford as one of the nation's top high school football
recruits, he'd been stuck on the sidelines the entire time by a torn
tendon that, even with two surgeries, just wouldn't stay fixed. More
surgery would not help, his doctors told him, but they did have one
last option to offer him.
Six months later, the Stanford
football coach is calling McGillicuddy the comeback kid. The 6 feet 3
inch, 300-pound offensive lineman has participated in spring practice
"full out hitting people," he said, for the first time in
his collegiate career. "The tendon,'' he added, "feels
McGillicuddy's passport back to the playing
field was a procedure developed by Dr. Allan Mishra of Stanford
Hospital's Menlo Clinic. His research, published in 2006 in the
American Journal of Sports Medicine, has made him an active figure in
the study and use of PRP – platelet-rich plasma. Mishra's research
focused on PRP as an aid to heal – without surgery – debilitatingly
painful tendons around the elbow known to millions as tennis
But PRP can be used on other tendons, too. In
McGillicuddy's case, it was his patellar tendon –he one at his kneecap
– that had so deteriorated he couldn't even sit without discomfort.
His coaches didn't give him much chance of ever again playing
football. They didn't think his surgically-repaired tendon would hold
up, despite the year's rest he'd given it after the second surgery.
McGillicuddy talked to his father, a neurosurgeon. "At this
point," McGillicuddy said, "my dad was like, 'You have
nothing else. See if it works.'"
Mishra drew two
tablespoons of McGillicuddy's blood, whirled it in a tabletop
centrifuge at 3200 rmps to separate out a half teaspoon of plasma and
then injected that into the young man's tendon. The process raises
the level of platelets by more than 500 percent compared to whole
blood. Those platelets carry growth factor proteins that stimulate
cell regeneration and recruit other cells to repair the ailing
What excites Mishra is the potential for PRP to
help young athletes like McGillicuddy, stressing his body to its
limits, as well as older adults whose joints protest the wear and tear
of decades. PRP, Mishra said, "is part of the revolution in
orthopedics. We're moving away from plates and screws and learning to
use the body's own ability to heal."
Not only does a
PRP treatment cost a fraction of surgery, it also speeds up recovery
time. Its built-in biocompatibility means the possibility of side
effects is much lower than with a manufactured pharmaceutical.
"This is all from your own body – it's not something we had to
cook in a lab," Mishra said.
are rapidly building PRP a successful scientific track record. Its
potential, say proponents, could range from applications in the repair
of bones, ligaments, cartilage and nerves, either on its own or as an
adjunct in a wide variety of surgeries.
great promise both for treatment of chronic musculoskeletal conditions
as well as an adjunct to accelerate healing in acute injuries,"
said Dr. William J. Maloney, Chairman of the Orthopedic Surgery
Department at Stanford Hospital & Clinics and the Elsbach-Richards
Professor of Surgery.
However, added Maloney, who also
chairs the National Hip and Knee Registry Work Group of the American
Academy of Orthopedic Surgeons, "well designed prospective
clinical trials are necessary to better determine the indications for
use. Dr Mishra along with Dr Jason Dragoo of the sports medicine
service at Stanford are currently developing those trials."
Mickey Napp was very leery of any surgery at all when she went
to Mishra to see about an elbow so painful she couldn't lift a tea
cup. Again, the doctors she saw recommended surgery. But one of them
told her about Mishra's work.
"I thought, 'I'm
going to give this a try.' It doesn't preclude doing surgery if it
doesn't work. It's just your own blood, so no odd ingredients are
going into your body."
The overall cost of the
procedure is far less than a surgery and the recovery time much shorter.
Now 60, and still physically very active, Napp jokes that her
PRP-treated arm is actually stronger than the one without injuries.
"I teased Allan and told him I need a two-for-one, because my
other elbow is starting to go."