My Thoughts on PRP Injections

Platelet-rich plasma (PRP) injections have become more and more prevalent in the past few years (even though it’s been around for over 25 years), both in use and in the mainstream media. Subsequently, patients often inquire about what PRP injections are and if they should get one. I would like to share my thoughts on the subject and would appreciate to hear what other clinicians think about them. I’ll keep my thoughts brief and to the point, although this topic could be (and usually is) discussed in mind-numbing detail/length.

There has been increasing PRP research coming out over the years and after going through a bunch of articles (not nearly all of them), hearing a few lectures on PRP, and talking with physicians, these are my current feelings on PRP:

The efficacy of PRP is questionable

It seemed like for every 1 article that reported some positive effect of PRP injections, there were 3 or 4 that reported no difference (again, this is the trend I noticed, not hard/objective data) – that’s quite an uneven distribution. Some of these studies were reasonably well-designed (some of the early ones were not), so you can’t disregard the results.

The “gold-standard” study

Quite simply, it doesn’t exist (yet). I know there are physicians out there who say they’re just waiting for that gold-standard randomized, double-blind study to show how great PRP is…..but, that study doesn’t exist and we’re all still waiting. I would have thought by now that a study of this magnitude would have come out already. And I’m beginning to think that physicians don’t want this study to come out, because it might not show what they wanted it to.

No set protocols

It seems that PRP is being tried on just about anything – with use on tendons seemingly the favorite – and with differing procedures/protocols. How much blood to use, how long to spin it, what to include in the injection, how to deliver the injection, do you affix it to the tissue or just spray it around, etc. are all varied among the studies. If we can’t agree on where/when to use it and how to use it, you really start to question it.

It’s expensive

These injections cost on average around $1500 and insurances typically don’t cover the cost of PRP injections - which I honestly don’t blame them for doing considering the lack of good-outcome research. That’s a lot of money to ask someone to shell out for something with mixed results. Being expensive does have its “benefit” though in that if a patient shells out $1500 for a treatment, they want it to work and there will probably be somewhat of a placebo/perceived value effect.

Concluding thoughts

In theory (based on biologic healing processes), I see how PRP could potentially help and I truly am hopeful that it can become an effective intervention. But the more and more you go over the research, I wonder if this is just going to be another one of those passing medical fads that seemed like a good idea on paper, but never actually panned out.

So, when patients ask me if they should get a PRP injection, at this time I cannot in good faith say go for it. I explain to them that the results of the studies are mixed and that it’s an expensive, out-of-pocket cost, and let them come to their own conclusion.

Please share your thoughts on the topic and let me know what you tell patients.

header image credit

via Dennis Truebig, Modern Sports PT

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