Aloha … from BetheGifford introduces new treatment
for tendon, ligament injuries
RANDOLPH, March 26, 2009 – Hanover resident Josh Kahan was competing in an Ironman triathlon in Louisville last fall when he ruptured two tendons in one of his ankles.
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| Hanover’s Josh Kahan competes in the Ironman World Championships in 2007 in Hawaii. |
It was about 95 degrees in the Kentucky sun. Kahan had already swam 2.4 miles, biked 112 miles and was 23 miles into the marathon run – and about 10 hours into his race – when he stepped down and immediately knew something had gone drastically wrong.
“I heard a noise,” said the 44-year-old computer company owner, “ and immediately I almost fell down.”
He walked the remaining three miles of the marathon to the finish line and, upon returning to New England, called his sports medicine provider – the Sharon Health Center off Route 14 in Vermont.
An MRI confirmed the injury and Sharon Health Center podiatrist Dr. Rob Rinaldi explained to Kahan his options. Normally, surgery would be the solution, but “‘we’re getting into this new thing called PRP,’” Kahan recalls the doctor saying.
“I was all game for anything that involved non-surgery,” said Kahan, who was the health center’s first patient to receive PRP, or platelet-rich plasma, therapy and is already among its success stories.
PRP therapy uses the body’s own healing process to regenerate damaged tendons or ligaments without surgery.
It is really little more than injections of a patient’s own blood – specifically blood plasma that has been concentrated to contain platelets rich in connective tissue “growth factors,” or bioactive proteins, that initiate healing.
While the name is big; the process is simple, explain officials at Gifford Medical Center, of which the Sharon Health Center is a part.
About a quarter- to a half-cup of blood is drawn from the patient’s arm into a sterile syringe or two, said Carol Stephenson, Gifford’s laboratory manager.
The syringes are then placed in a high-speed centrifuge machine – in Gifford’s case a Magellan autologous platelet separator purchased just for PRP. The machine spins down the red blood cells, which are discarded, and draws the platelet concentrate off the top, Stephenson said.
This concentrate, or PRP, is then injected – much like receiving a shot – into the injured tendon or ligament by Dr. Rinaldi or fellow sports medicine physician Dr. Peter Loescher, often with the aid of ultrasound.
The technique is not new to the field of medicine.
It’s been used in the operating room for 20 years to promote healing following surgeries, such as total knee replacements, said Dr. Rinaldi. And for the last decade, the equine community has been using it – with good results – on racehorses.
For athletes of the human variety, the outpatient procedure is far newer, but rapidly growing in popularity.
Pittsburgh Steelers wide receiver Hines Ward was reported to have had a version of PRP before playing to victory in Super Bowl XLIII. Fellow Steeler Troy Polamalu, a major league pitcher and professional soccer players have also, according to The New York Times, undergone the procedure along with many amateur athletes.
“We think it is really the most exciting new treatment option for chronic tendon and ligament injuries,” said Dr. Loescher.
In Vermont, Gifford is among only one other health care provider in the state known to be providing PRP. Officials at Gifford and its small, rural Sharon sports medicine practice that remarkably attracts patients from around the region, nation and even other countries for athletic care, say they’ve added the service because companies like Magellan have developed closed-system machines for in-office use, and because of patients like Kahan.
Kahan had his first PRP injection on Dec. 8. He went away with a walking cast to prevent him from overusing the injured joint and directions to return in three weeks for a second MRI. 
On Dec. 30, Kahan had that second MRI. He remembers Dr. Rinaldi’s reaction to the new electronic image of his ankle. “He said, ‘It’s a miracle. It actually healed itself.’”
“That sold me on PRP. From my point of view, that’s nothing short of miraculous,” said Dr. Rinaldi, who has practiced sports medicine for decades, performed countless tendon-repair surgeries and been an athlete – a marathon runner – himself.
Now other Sharon sports medicine patients are hoping for similar results.
Dr. Loescher had a patient drive 250 miles for a PRP injection after the college athlete scheduled for surgery elsewhere heard Gifford was offering the far less-invasive therapy.
Retiree and Lake Sunapee Protective Association President Deborah Benjamin of Newbury, N.H., visited Dr. Rinaldi last month in hopes PRP would work for her. She tore a tendon in her foot – an injury she was hoping PRP would fix so that she could go on and have a needed knee replacement surgery, and “so I can get back on the tennis court and back on the ski slopes,” she said.
“This is going to work,” said Benjamin amid her hour-long appointment that involved the blood draw and two shots – one of anesthesia to numb her foot and one of her concentrated platelet-rich blood plasma.
David Budbill of Wolcott was less sure.
The famed Vermont poet and playwright has struggled for years with chronic plantar fasciitis – a painful inflammation of the connective tissue that supports the arch of the foot.
“My feet are always painful. I want to get my pins (feet) back,” he says. “My goal is to cure these feet without surgery.”
Budbill’s tried about everything else, including cortisone shots, anti-inflammatories, different shoe inserts, acupuncture and yoga.
“I’m hoping to be flabbergasted,” he said of PRP, but wasn’t banking on success.
According to sports medicine providers like Rinaldi and Loescher, PRP has about an 85 percent success rate (compare that to 95 percent for surgery), but they’re not making patients – especially those like Budbill with decades of significant, chronic pain – any guarantees.
PRP is also not currently covered by insurances, so it’s an out-of-pocket expense. And it hurts a bit during the procedure and sometimes after.
“It’s basically one more arrow in our quiver of treatment options,” Dr. Loescher says of the new treatment. “There’s no guarantee for this.”
But there certainly are pluses for the treatment option.
For one, the process has limited risks.
“We’re taking patient’s own blood, which is good because it’s autologous. It’s your correct blood type. You don’t have to worry about infectious diseases. It’s your own, and reactions to yourself can’t happen,” Stephenson said.
And when successful, it can prevent the need for surgery and give athletes a much faster recovery time. The latter, said Dr. Rinaldi, is what all athletes are ultimately searching for. 
“What the athlete always wants to do is get back to their activity with the least discomfort,” he said.
For Kahan, that was certainly the goal.
He had a second PRP injection in February and while he still feels some pain, he’s back to several hours of exercise each day, including biking and cross-country skiing this winter.
“I’m ecstatic,” said Kahan of his PRP results. “To me, it’s been an incredibly positive experience.”
He estimates he saved eight weeks of missed training by avoiding surgery and hopes to start running soon.
“My first race is in June. I’m really hopeful that I have not missed my racing season,” the Ironman said.
To learn more about PRP or schedule an appointment, call the Sharon Health Center at 763-8000.