Our clinic offers platelet rich plasma injections (PRP) performed by specialist practitioners.

What is platelet rich plasma?

Platelet rich plasma is a blood product, drawn from your body, which has a high concentration of platelets that release various growth factors.[1–3]

These growth factors are thought to have a beneficial effect in tissue healing, and more recently the white blood cells have been thought to provide both anti-inflammatory and ant-infective effects.[4-6] Sports Physicians use PRP as an adjunctive tool to rehab.[7]

What is the evidence?

Currently there are only a few studies of adequate quality that show that PRP is effective for early knee osteoarthritis[8-10], however there is more evidence than for arthroscopic surgery of the knee.[11–13] Studies comparing it to other injections for arthritis of the knee have showed it is superior.[13–16] At this stage there are no predictors of who will respond to each of these injections, and the sensible approach seems to be to use them judiciously to facilitate realistic functional goals. Compared to Cortisone injections, PRP injections don’t seem to delay recovery or increase recurrence of tendon disorders including plantar fasciitis, tennis elbow, rotator cuff problems and jumpers knee.[17–27]

Why is it used?

PRP is used to augment the healing process, particularly in areas of the body where there is slow tissue repair and turnover. High white cell counts appear advantageous in soft tissue and tendon disorders,[6,28-30] while multiple injections with low white cell counts are better for joint pain.[4,9]

PRP Injections can be used for joints, ligaments, tendons and muscles.

PRP Injections can be used for joints, ligaments, tendons and muscles.

Will it work for my problem?

PRP has potential benefits for the right problem in the right patient. It is only one part of the whole management regime for any problem. Despite all the research, overall the current evidence-base for PRP is at high risk of bias.[11,31,32] However, it is very safe and a temporary post-injection flare of symptoms is the most likely adverse effect.[4,33]

Other specific problems that PRP appears to be effective for include:

  • Ankle syndesmosis injuries (and similar ligament injuries with poor healing)
  • Slow healing muscle injuries involving the tendon (hamstring, quadriceps)
  • Chronic tendon pain- such as patella, achilles, elbow and gluteal tendons
  • Chronic plantar fasciitis
  • Early osteoarthritis of the hip

How much does it cost?

The out of pocket cost is quite significant because Medicare specifically exclude any rebate when PRP is performed. It ranges from $300-$900 each, and overall costs depend on the type of PRP used and the number of injections recommended. Sports physicians usually provide the service within the context of understanding the overall problem. When combined with optimisation of diet and exercise, patients are much more likely to experience benefit.[34]

What are the risks?

The main risks are considered the same as any other injection. There is an estimated 1 in 20,000 chance of infection or significant bleeding. These risks are minimised through the use of a sterile technique and an ultrasound to guide the safest course for the needle. About 5% of patients experience a flare of the pain can last 24-48 hours but this is very manageable with analgesia and rest.

What should I expect?

The whole process takes between 20-30 minutes. First, about 10-15mL of your blood is drawn from your arm. Then that blood is centrifuged for 10 minutes. The PRP is then extracted, and injected under ultrasound guidance after the area is cleaned. Local anaesthetic is sometimes used but never in the same injection as the PRP as this destroys the platelets. Anti-inflammatory medications (Celebrex, Mobic, Voltaren etc) should be stopped 2 days prior to injection, and for 2 days afterwards, because these impair platelet function.

The process of PRP therapy

You should plan to rest the injected area for 2-3 days following the injection. Depending on the site of the injection, this may involve getting driven to your appointment, wearing a protective sling, boot or other device (especially the foot/ankle or shoulder).

Reference List

1. Perez, A. G. M. et al. Relevant Aspects of Centrifugation Step in the Preparation of Platelet-Rich Plasma. Int. Sch. Res. Not. 2014, e176060 (2014).
2. Amable, P. R. et al. Platelet-rich plasma preparation for regenerative medicine: optimization and quantification of cytokines and growth factors. Stem Cell Res. Ther. 4, 67 (2013).
3. Kushida, S. et al. Platelet and growth factor concentrations in activated platelet-rich plasma: a comparison of seven commercial separation systems. J. Artif. Organs Off. J. Jpn. Soc. Artif. Organs 17, 186–192 (2014).
4. Riboh, J. C., Saltzman, B. M., Yanke, A. B., Fortier, L. & Cole, B. J. Effect of Leukocyte Concentration on the Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis. Am. J. Sports Med. 44, 792–800 (2016).
5. Fitzpatrick, J., Bulsara, M. K., McCrory, P. R., Richardson, M. D. & Zheng, M. H. Analysis of Platelet-Rich Plasma Extraction. Orthop. J. Sports Med. 5, (2017).
6. Fitzpatrick, J., Bulsara, M. & Zheng, M. H. The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy A Meta-analysis of Randomized Controlled Clinical Trials. Am. J. Sports Med. 0363546516643716 (2016) doi:10.1177/0363546516643716.
7. Samra, D. J. & Orchard, J. W. Patterns of platelet-rich plasma use among Australasian sports physicians. BMJ Open Sport Exerc. Med. 1, e000054 (2015).
8. Patel, S., Dhillon, M. S., Aggarwal, S., Marwaha, N. & Jain, A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am. J. Sports Med. 41, 356–364 (2013).
9. Görmeli, G. et al. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg. Sports Traumatol. Arthrosc. Off. J. ESSKA 25, 958–965 (2017).
10. Tietze, D. C., Geissler, K. & Borchers, J. The effects of platelet-rich plasma in the treatment of large-joint osteoarthritis: a systematic review. Phys. Sportsmed. 42, 27–37 (2014).
11. Meheux, C. J., McCulloch, P. C., Lintner, D. M., Varner, K. E. & Harris, J. D. Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review. Arthrosc. J. Arthrosc. Relat. Surg. Off. Publ. Arthrosc. Assoc. N. Am. Int. Arthrosc. Assoc. (2015) doi:10.1016/j.arthro.2015.08.005.
12. Sihvonen, R. et al. Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear. N. Engl. J. Med. 369, 2515–2524 (2013).
13. Buchbinder, R. & Harris, I. A. Arthroscopy to treat osteoarthritis of the knee? Med. J. Aust. 199, 100 (2013).
14. Ayhan, E., Kesmezacar, H. & Akgun, I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J. Orthop. 5, 351–361 (2014).
15. Campbell, K. A. et al. Is Local Viscosupplementation Injection Clinically Superior to Other Therapies in the Treatment of Osteoarthritis of the Knee: A Systematic Review of Overlapping Meta-analyses. Arthrosc. J. Arthrosc. Relat. Surg. Off. Publ. Arthrosc. Assoc. N. Am. Int. Arthrosc. Assoc. (2015) doi:10.1016/j.arthro.2015.03.030.
16. Campbell, K. A. et al. Does Intra-articular Platelet-Rich Plasma Injection Provide Clinically Superior Outcomes Compared With Other Therapies in the Treatment of Knee Osteoarthritis? A Systematic Review of Overlapping Meta-analyses. Arthrosc. J. Arthrosc. Relat. Surg. Off. Publ. Arthrosc. Assoc. N. Am. Int. Arthrosc. Assoc. (2015) doi:10.1016/j.arthro.2015.03.041.
17. Hart, L. Corticosteroid and Other Injections in the Management of Tendinopathies: A Review. Clin. J. Sport Med. 21, 540–541 (2011).

18. Bisset, L. et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ 333, 939 (2006).
19. Nichols, A. W. Complications associated with the use of corticosteroids in the treatment of athletic injuries. Clin. J. Sport Med. Off. J. Can. Acad. Sport Med. 15, 370–375 (2005).
20. David, J. A., Sankarapandian, V., Christopher, P. R., Chatterjee, A. & Macaden, A. S. Injected corticosteroids for treating plantar heel pain in adults. Cochrane Database Syst. Rev. 6, CD009348 (2017).
21. Jain, K., Murphy, P. N. & Clough, T. M. Platelet rich plasma versus corticosteroid injection for plantar fasciitis: A comparative study. Foot Edinb. Scotl. 25, 235–237 (2015).
22. Mishra, A. K. et al. Efficacy of Platelet-Rich Plasma for Chronic Tennis Elbow A Double-Blind, Prospective, Multicenter, Randomized Controlled Trial of 230 Patients. Am. J. Sports Med. 42, 463–471 (2014).
23. Filardo, G. et al. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach. Knee Surg. Sports Traumatol. Arthrosc. Off. J. ESSKA 20, 2082–2091 (2012).
24. Behera, P., Dhillon, M., Aggarwal, S., Marwaha, N. & Prakash, M. Leukocyte-poor platelet-rich plasma versus bupivacaine for recalcitrant lateral epicondylar tendinopathy. J. Orthop. Surg. Hong Kong 23, 6–10 (2015).
25. Almeida, A. M. de et al. Patellar Tendon Healing With Platelet-Rich Plasma A Prospective Randomized Controlled Trial. Am. J. Sports Med. 40, 1282–1288 (2012).
26. Dragoo, J. L., Wasterlain, A. S., Braun, H. J. & Nead, K. T. Platelet-rich plasma as a treatment for patellar tendinopathy: a double-blind, randomized controlled trial. Am. J. Sports Med. 42, 610–618 (2014).
27. Wang, A. et al. Do Postoperative Platelet-Rich Plasma Injections Accelerate Early Tendon Healing and Functional Recovery After Arthroscopic Supraspinatus Repair? A Randomized Controlled Trial. Am. J. Sports Med. 43, 1430–1437 (2015).
28. Samra, D. J. et al. Effectiveness of a single platelet-rich plasma injection to promote recovery in rugby players with ankle syndesmosis injury. BMJ Open Sport Exerc. Med. 1, e000033 (2015).
29. Laver, L. et al. Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial. Knee Surg. Sports Traumatol. Arthrosc. Off. J. ESSKA 23, 3383–3392 (2015).
30. Podesta, L., Crow, S. A., Volkmer, D., Bert, T. & Yocum, L. A. Treatment of Partial Ulnar Collateral Ligament Tears in the Elbow With Platelet-Rich Plasma. Am. J. Sports Med. 41, 1689–1694 (2013).
31. Miller, L. E., Parrish, W. R., Roides, B. & Bhattacharyya, S. Efficacy of platelet-rich plasma injections for symptomatic tendinopathy: systematic review and meta-analysis of randomised injection-controlled trials. BMJ Open Sport Exerc. Med. 3, e000237 (2017).
32. Laudy, A. B. M., Bakker, E. W. P., Rekers, M. & Moen, M. H. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br. J. Sports Med. 49, 657–672 (2015).
33. Nguyen, C. & Rannou, F. The safety of intra-articular injections for the treatment of knee osteoarthritis: a critical narrative review. Expert Opin. Drug Saf. 16, 897–902 (2017).
34. Zhang, W. et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr. Cartil. OARS Osteoarthr. Res. Soc. 16, 137–162 (2008).

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St George Private Hospital
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131 Princes Highway
Kogarah NSW 2217

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