Do PRP (Platelet Rich Plasma) injections help for tendon and joint pain?

Platelet Rich Plasma (PRP)- Its use in Musculoskeletal Conditions

The use of PRP in musculoskeletal conditions has increased in popularity in recent years. Endorsed by many world-class athletes including Rafael Nadal, Tiger Woods, and Kobe Byrant, just to name a few, this injection has become a controversial hot topic within the world of medicine.

What is PRP?

PRP is autologous blood with a platelet concentration above baseline. It utilizes the growth factors (GF) in platelets to help with tissue healing. GF expressed by platelets have the ability to directly influence tissue regeneration through angiogeneis, chemotaxis and cell proliferation. Therefore, by injecting growth platelets into the site of injury, the body responds by stimulating it’s healing process- cell migration, proliferation & remodeling (Foster, Puskas, Mandelbaum, Gerhardt, & Rodeo, 2009)

Musculoskeletal Conditions

PRP has been used to treat a range of musculoskeletal conditions. Some patients have reported an improvement in their condition while a vast majority has reported nil changes to their injuries.  So what does the research say about the use of PRP?

Tennis Elbow (Lateral Epicondylalgia)

  • A 2014 systematic review by de Vos, Windt, & Weir, Level 1 Evidence, found only 1 out of the 6 included studies showed the benefit of PRP.
  • Conclusion: PRP injections are not effective for the management of lateral epicondylalgia

Patella Tendinopathy

  • A 2014 systematic review by Liddle & Rodríguez-Merchán found improvement of knee pain and functional outcomes within 6 months to 2 years post injection. Unfortunately these results were reported from non-comparative studies. When looking at higher- level comparative studies, PRP was not superior over other treatment methods.
  • Conclusion: superiority of PRP over control treatments could not be conclusively demonstrated.

 

Plantar Fasciitis

  • Franceschi, Papalia, Franceschetti, Paciotti, Maffulli, & Denaro in 2014 found lower level studies to show an improvement in symptoms at baseline to the follow-up assessment.
  • Additionally, 2 randomized control trials (RTC) found PRP to have greater efficacy over corticosteroid injections both at short term (6 weeks) and long term follow up (24 months).
  • Conclusion: PRP injection therapy may be of benefit over purely conservative treatment and other injection therapy modalities to treat plantar fasciitis.

Knee Osteoarthritis (OA)

•      Out of the 10 studies included in Laudy, Bakker, Rekers, & Moen’s 2015 Systematic review, 5 were randomized controlled trials.

•      They concluded that PRP limits pain more effectively than placebo injections and hyaluronic injections. But this study needs to be interpreted with caution. All studies but 1 produced high risk of bias due to the impossibility to blind participants and/or personnel.  

Take Home Message

Despite its theoretical benefits, PRP has inconclusive evidence to support its use as some low quality studies show benefits, while higher quality studies show little to no effect. Physiotherapy management post PRP injection should follow the healing process and rehabilitation timeframe.

As PRP has been shown to have minimal adverse effects, health care practitioners should consider this an option before surgical management. That is, if the patient is ready to spend $300+ per injection.  There are multiple studies demonstrating the benefit of physiotherapy management (and other conservative treatment) for the above conditions - these should be exhausted before the consideration of PRP injections.

 


Yinka Olorunnife is a Physiotherapist and Pilates Instructor at Lifecare Ashburton Sports Medicine.  Yinka has a specific interest in lower limb injuries and basketball physiotherapy, having grown from her experience as a professional athlete.

Yinka delivers expertise in these areas of physiotherapy to Ashburton and nearby areas such as Camberwell, Glen Iris, Burwood and Oakleigh.  For more on Yinka see our physiotherapists page here


 

References

Anitua, E., Sánchez, M., Nurden, A. T., Zalduendo, M. M., De La Fuente, M., Azofra, J., & Andía, I. (2007). Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients. Rheumatology, 46(12), 1769-1772.

de Vos, R. J., Windt, J., & Weir, A. (2014). Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review. British journal of sports medicine, 48(12), 952-956.

Foster, T. E., Puskas, B. L., Mandelbaum, B. R., Gerhardt, M. B., & Rodeo, S. A. (2009). Platelet-rich plasma from basic science to clinical applications. The American journal of sports medicine, 37(11), 2259-2272.

Franceschi, F., Papalia, R., Franceschetti, E., Paciotti, M., Maffulli, N., & Denaro, V. (2014). Platelet-rich plasma injections for chronic plantar fasciopathy: a systematic review. British medical bulletin, ldu025.

Gobbi, A., Lad, D., & Karnatzikos, G. (2015). The effects of repeated intra-articular PRP injections on clinical outcomes of early osteoarthritis of the knee. Knee Surgery, Sports Traumatology, Arthroscopy, 23(8), 2170-2177.

Kassolis, J. D., Rosen, P. S., & Reynolds, M. A. (2000). Alveolar ridge and sinus augmentation utilizing platelet-rich plasma in combination with freeze-dried bone allograft: case series. Journal of periodontology, 71(10), 1654-1661.

Laudy, A. B., Bakker, E. W., Rekers, M., & Moen, M. H. (2015). Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. British journal of sports medicine, 49(10), 657-672.

Liddle, A. D., & Rodríguez-Merchán, E. C. (2014). Platelet-Rich Plasma in the Treatment of Patellar Tendinopathy A Systematic Review. The American journal of sports medicine, 0363546514560726.

Monto, R. R. (2014). Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot & ankle international, 35(4), 313-318.

Omar, A. S., Ibrahim, M. E., Ahmed, A. S., & Said, M. (2012). Local injection of autologous platelet rich plasma and corticosteroid in treatment of lateral epicondylitis and plantar fasciitis: randomized clinical trial. The Egyptian Rheumatologist, 34(2), 43-49.

Peerbooms, J. C., Sluimer, J., Bruijn, D. J., & Gosens, T. (2010). Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. The American journal of sports medicine, 38(2), 255-262.

Sánchez, M., Fiz, N., Azofra, J., Usabiaga, J., Recalde, E. A., Gutierrez, A. G., ... & Orive, G. (2012). A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Arthroscopy: The Journal of Arthroscopic & Related Surgery,28(8), 1070-1078.

Stafford, H., & Sandbulte, Z. (2011). Platelet-Rich Plasma?. Athletic Training and Sports Health Care, 3(4), 164-166.