Platelet-rich plasma (PRP)
What is platelet-rich plasma (PRP) therapy?
Platelet-rich plasma (PRP) is a type of regenerative therapy used in sports medicine. It has gained popularity in the last ten years as an alternative treatment to manage a number of spine and musculoskeletal (MSK) disorders and injuries. One of the reasons for the increasing interest in PRP has been disappointing long-term results with current treatment options. Targeted steroid injections are the initial option for the spine and joint-related pains, however, these have not been shown to be beneficial in the long-term (1). Further, recent evidence suggests that there is a possible detriment to joints with repeat steroid exposures over time. A large high-quality randomized trial comparing triamcinolone (a steroid compound) to saline (salt water) in knee injections every 12 weeks for 2 years, indicated that triamcinolone resulted in significantly greater cartilage volume loss than did saline without any improvement in pain (2).
Our blood includes a number of different components, including white blood cells (immune cells), red blood cells (delivers oxygen), and platelets (helps with clotting but holds a number of different growth factors). PRP is a preparation of a patient’s own blood to select out the platelets from the other components. The concept and description of PRP started in the field of hematology to describe plasma with a platelet count above peripheral blood (3). The rationale for concentrating platelets is based upon a high concentration of essential growth factors and cytokines inside the platelets (contained in pockets in the platelet known as alpha granules). Also, platelets are suspended in plasma which also holds a full complement of clotting factors, chemokines, growth hormones, and other plasma proteins. There is a number of different hypotheses on how PRP can help with MSK disorders, but in general, it is believed that the growth factors and cytokines, in the plasma and released from the platelets, initiate a process of healing and repair when injected at a site of injury (4, 5).
The earliest reports of PRP in clinical use was in the 1980s in the surgical setting. It was used as an agent to reduce bleeding from surgical incisions. Since then, there has been rapid expansion and application for the use of PRP across different medical specialties. PRP has been shown to be beneficial in a number of clinical studies, and with these early studies, it has been offered widely for a number of different MSK disorders or injuries. Despite the wide application of PRP in clinical practice, the research behind PRP has been trailing behind. Fortunately, there has been a significant increase in the number of randomized clinical trials (study with the highest quality) on PRP since 2000 (Figure 1).
Taken from: Johal, H et al. Impact of Platelet-Rich Plasma Use on Pain in Orthopaedic Surgery: A Systematic Review and Meta-analysis. Sports health 2019.
Without high-quality research in pain and sports medicine, both clinicians and patients will not know which intervention is helpful. Further, research helps identify not only if an intervention will be helpful, but detect inadvertent side-effects or harms associated with therapy that was not previously known. We aim to provide a review of clinical research on PRP to help both clinicians and patients understand the utility and potential benefits and make an informed decision about pursuing this therapy.
Dr. James Khan MD, MSc
Pain Medicine Specialist & Anesthesiologist
Hepper, C.T., Halvorson, J.J., Duncan, S.T., Gregory, A.J., Dunn, W.R. and Spindler, K.P., 2009. The efficacy and duration of intra-articular corticosteroid injection for knee osteoarthritis: a systematic review of level I studies. The Journal of the American Academy of Orthopaedic Surgeons, 17(10), p.638.
McAlindon, T.E., LaValley, M.P., Harvey, W.F., Price, L.L., Driban, J.B., Zhang, M. and Ward, R.J., 2017. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial. Jama, 317(19), pp.1967-1975.
Andia I, Abate M: Platelet-rich plasma: underlying biology and clinical correlates. Regen Med 2013;8:645–658.
Peter, I., Wu, K., Diaz, R. and Borg-Stein, J., 2016. Platelet-rich plasma. Physical Medicine and Rehabilitation Clinics, 27(4), pp.825-853.
Alves, R. and Grimalt, R., 2018. A review of platelet-rich plasma: history, biology, mechanism of action, and classification. Skin appendage disorders, 4(1), pp.18-24.
Johal, H., Khan, M., Yung, S.H.P., Dhillon, M.S., Fu, F.F., Bedi, A., and Bhandari, M., 2019. Impact of Platelet-Rich Plasma Use on Pain in Orthopaedic Surgery: A Systematic Review and Meta-analysis. Sports health, p.1941738119834972.
Disclaimer: Do not treat this as medical advice as it is used for educational purposes only. If you are having pain or health-related complaints, please seek out a licensed healthcare professional. Our medical specialists are health care professionals with in-depth knowledge of the human body with specializations in regenerative medicine and clinical skills to assess, diagnose, and treat illness, injury or disability.
366 Bay Street, 10th Floor, Toronto ON, M5H4B2, (416)7223393, PRP Therapy