PRP: PLATELET-RICH PLASMA

General Orthopedic Surgeons located in Benbrook, Ft Worth, TX

What it is, where it is used, and why the quality of the PRP product matters

WHAT PRP IS

Platelet-rich plasma (PRP) is an autologous blood product prepared from a patient’s own blood. Centrifugation separates and concentrates platelets into a smaller volume of plasma. Platelets release signaling proteins and growth factors that participate in inflammation control, cell recruitment, angiogenesis, matrix remodeling, and tissue repair.

WHAT PRP CAN BE USED FOR

• Intra-articular osteoarthritis and selected joint pain, most commonly the knee.

• Chronic tendinopathies and enthesis disorders such as lateral elbow tendinopathy, patellar tendinopathy, gluteal tendinopathy, proximal hamstring tendinopathy, selected rotator cuff disease, and some Achilles presentations. • Selected ligament, muscle, and postsurgical applications based on diagnosis and clinician judgment. • Perineural applications and hydrodissection in selected entrapment neuropathies, especially carpal tunnel, where clinical studies have evaluated PRP.

INTRA-ARTICULAR PRP FOR OSTEOARTHRITIS

PRP is commonly used inside an arthritic joint to reduce pain and improve function. The strongest evidence is in mild-to-moderate knee osteoarthritis. Clinical response is typically gradual rather than immediate because PRP is intended to influence the joint environment rather than act as a short-lived numbing or anti-inflammatory drug.

LEUKOCYTE-POOR PRP (LP-PRP)

LP-PRP contains a high platelet concentration while intentionally reducing white blood cells, especially neutrophils, and usually minimizing red blood cells. It is widely used for intra-articular osteoarthritis because it delivers platelet signalingwith less cellular inflammatory load. Recent randomized and meta-analytic data support LP-PRP as an effective option for knee OA, including comparisons with hyaluronic acid.

BMAC FOR TENDINOPATHY AND SOFT-TISSUE INJURY

LEUKOCYTE-RICH PRP (LR-PRP)

LR-PRP retains more white blood cells along with the platelets. Leukocytes release their own cytokines, enzymes, and antimicrobial factors, changing the biologic character of the product. LR-PRP is often discussed in tendon applications, where a stronger inflammatory/remodeling stimulus may be acceptable or desired. For knee osteoarthritis, both LR-PRP and LP-PRP have demonstrated benefit, and high-quality head-to-head trials have not established a universal winner for every patient.

PRP FOR TENDINOPATHY

Tendinopathy is not just “inflammation”; it involves disorganized collagen, altered tendon cells, abnormal vascularity, and impaired load tolerance. PRP is used to deliver a concentrated biologic signal into the abnormal tendon or enthesis while a progressive loading program rebuilds capacity. Evidence varies by tendon: lateral elbow tendinopathy has supportive literature, while Achilles results are more mixed. This is why diagnosis, ultrasound findings, product selection,and rehabilitation matter.

WHY PRP QUALITY MATTERS SO MUCH

• Platelet dose: the total number of platelets delivered matters more than simply saying the blood was “spun.” A clinic should know the system it uses and what concentration it generally produces.

• Leukocytes and neutrophils: these alter the inflammatory character of the injectate and should be intentionally selected for the indication. • Red blood cells: RBC contamination is generally undesirable in orthobiologic PRP because hemolysis and red-cell breakdown products can increase local irritation. • Volume: a knee joint, a small tendon lesion, and a perineural plane require different treatment volumes and delivery strategies. • Activation and handling: anticoagulant choice, delays in processing, agitation, activation strategy, and storage can change platelet behavior. • Sterility: PRP preparation is a same-day biologic procedure and requires disciplined sterile technique from venipuncture through injection. • Accurate placement: Ultrasound guidance is valuable for tendons, deep structures, and perineural targets; image guidance also improves confidence that the intended structure was actually treated.

WHAT A TRUSTWORTHY PRP CLINIC SHOULD BE ABLE TO EXPLAIN

WHAT TO EXPECT

Blood is drawn, processed immediately, and the PRP is injected into the target. A post-injection flare or soreness for several days is common, particularly with tendon treatments and some LR-PRP preparations. Improvement may develop over weeks to months. Some treatment plans use one injection; others use a series depending on the condition, product, and clinician protocol.

RISKS AND LIMITATIONS

• Temporary pain, swelling, bruising, stiffness, and flare.

• Bleeding, infection, vasovagal reaction, or injury to adjacent structures are uncommon but possible. • PRP is not a substitute for correcting instability, severe malalignment, full-thickness tendon rupture requiring surgery, or another incorrect diagnosis. • Response varies between patients and between PRP preparations; standardization remains one of the biggest issues in PRP research and clinical care.

SELECTED REFERENCES

These references are provided for clinical transparency and further reading. Individual treatment decisions require an in-person evaluation.

[1] Laver L, Filardo G, Sanchez M, et al. The use of injectable orthobiologics for knee osteoarthritis: A European ESSKA-ORBIT consensus. Part 1 - Blood-derived products (platelet-rich plasma). Knee Surg Sports Traumatol Arthrosc. 2024;32(4):783-797. doi:10.1002/ksa.12077. [2] Kon E, de Girolamo L, Laver L, et al. Platelet-rich plasma injections for the management of knee osteoarthritis: The ESSKA-ICRS consensus. Knee Surg Sports Traumatol Arthrosc. 2024;32(11):2938-2949. doi:10.1002/ksa.12320. [3] Peng YN, Peng YH, Chen JL, Chen CPC. Intraarticular leukocyte-poor platelet-rich plasma injection is more effective than intraarticular hyaluronic acid injection in knee osteoarthritis: systematic review and meta-analysis. Knee Surg Relat Res. 2025;37(1):15. doi:10.1186/s43019-025-00266-5. [4] Leukocytes Do Not Influence the Safety and Efficacy of Platelet-Rich Plasma Injections for the Treatment of Knee Osteoarthritis: A Double-Blind Randomized Controlled Trial. PubMed PMID: 39394763. 2024. [5] Hurley ET, Sherman SL, Stokes DJ, et al. Experts Achieve Consensus on a Majority of Statements Regarding Platelet-Rich Plasma Treatments for Musculoskeletal Pathology. Arthroscopy. 2024;40(2):470-477.e1. doi:10.1016/j.arthro.2023.08.020. [6] A systematic review on the efficacy of different types of platelet-rich plasma in the management of lateral epicondylitis. PubMed PMID: 35337955. 2022. [7] Ling SKK, Mak CTK, Lo JPY, Yung PSH. Effect of Platelet-Rich Plasma Injection on the Treatment of Achilles Tendinopathy: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2024;12(11):23259671241296508. doi:10.1177/23259671241296508. [8] Dubin J, Leucht P, Murray M, Pezold R. AAOS Technology Overview Summary: Platelet-Rich Plasma for Knee Osteoarthritis. J Am Acad Orthop Surg. 2024;32(7):296-301. doi:10.5435/JAAOS-D-23-00957.

Southwest Orthopedic Associates

✆ Phone (appointments): 817-731-9400

Fax: 817-731-4282

Address: 6311 Southwest Blvd., Ft Worth, TX 76132

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