Which patients might benefit from platelet-rich plasma?
PRP has become a popular form of regenerative medicine. This review looks at the evidence for its use in various musculoskeletal conditions.
PRACTICE RECOMMENDATIONS
› Consider plateletrich plasma (PRP) for conservative management of knee osteoarthritis and lateral epicondylitis. B
› Consider giving multiple injections of PRP for longterm pain relief and expedited return to sport in patellar tendinopathy. B
› Do not use PRP for Achilles tendinopathy due to a lack of clinical evidence. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Concerning the effectiveness of PRP, it is important to consider early publication bias. Although recent studies have shown its benefits,6,14,15,37 additional studies comparing PRP to placebo will help demonstrate its efficacy. Interestingly, a literature search by Bar-Or et al38 found intra-articular saline may have a therapeutic effect on knee OA and confound findings when used as a placebo.
Recognizing the presence or lack of clinically significant improvement in the literature is important. For example, while some recent studies have shown PRP exceeds the minimal clinically significant difference for knee OA and lateral epicondylitis, others have not.32,37 A 2021 systematic review of 11 clinical practice guidelines for the use of PRP in knee OA found that 9 were “uncertain or unable to make a recommendation” and 2 recommended against it.39
In its 2021 position statement for the responsible use of regenerative medicine, the American Medical Society for Sports Medicine includes guidance on integrating orthobiologics into clinical practice. The guideline emphasizes informed consent and provides an evidence-based rationale for using PRP in certain patient populations (lateral epicondylitis and younger patients with mild-to-moderate knee OA), recommending its use only after exhausting other conservative options.40 Patients should be referred to physicians with experience using PRP and image-guided procedures.
CORRESPONDENCE
Gregory D. Bentz Jr, MD, 3640 High Street Suite 3B, Portsmouth, VA 23707; bentzgd@evms.edu
