Platelet Rich Plasma (PRP) Injection

Platelet-rich plasma (abbreviated PRP) is a treatment used for a variety of common orthopedic conditions. PRP is a concentration of platelet cells taken from your blood, and these platelets have growth factors that may help in the healing process of chronic injuries. Growth factors are chemicals that signal the body to initiate a healing response. By injecting PRP into areas of an injury, the hope is to stimulate and optimize your body's ability to heal the chronic conditions. PRP contains a high concentration of platelets, other blood cells important in healing, and growth factors.

Uses

PRP has been used in operating rooms for several decades to help with wound healing, and to stimulate bone formation in spinal fusion surgery. Recently, PRP has been used in outpatient settings for the treatment of common overuse conditions including:

• Achilles Tendonitis
• Rotator Cuff Tendonitis
• Tennis Elbow
• Patellar Tendonitis

Some doctors seem to use PRP for just about any condition, while others are more selective.

Procedure

PRP injections can be done in a physician's office. The procedure takes about 30 minutes in order to withdraw the blood, spin the blood in the centrifuge, and inject the PRP into the injured area.

Finding a physician who provides PRP injections can be a challenge, but most commonly these are offered by orthopedic physicians who specialize in the care of chronic sports injuries. 

How PRP Is Obtained

PRP is obtained from the patient who is being treated. Blood is withdrawn from a vein in the patient's arm and the blood is placed in a centrifuge, a machine that spins at a high speed to separate the different types of blood cells. The physician extracts the platelet-rich portion of the blood and injects this into the area of injury. There is not just platelets in the concentrated layer of the "spun" blood, but also other important growth factors, plasma, and some red blood cells.

How PRP Is Injected

PRP injections are given as soon as the blood has been spun and the platelets separated. Some physicians may choose to add an "activating agent," usually either thrombin or calcium chloride, while some inject just the platelets. Studies have shown that the tendons being injected can also activate the PRP, so the activating agent may not be necessary.

Are The Injections Painful?

There is some discomfort associated with both requiring the blood to inject, and for the actual injection itself. Both parts of the procedure involve placing a needle through the skin. There are anesthetics that can be given to help alleviate some of the discomfort associated with placing a needle into the skin. The relief found from a PRP injection is not immediate, often like people experience with a cortisone injection.

Effectiveness

We know from laboratory studies that PRP can help increase certain growth factors that are important in the healing process. What we do not know is if this makes any difference in healing when PRP is injected into an injured part of the body.

While there are reports of cases of success, it is not known if these successes are better, or worse than other standard treatments. Currently, investigations are underway to determine if PRP is more helpful than other treatments for chronic tendonitis.

PRP has been shown to have some beneficial effects for tennis elbow, Achilles injuries, and even knee arthritis. Unfortunately, these are relatively small studies that follow the patients for a relatively short duration. Because of this, most doctors, and definitely most insurance companies, consider PRP to be experimental. However, talk to any patient who has found success with PRP, and they will tell you about how successful this treatment can be! It is important to remember, even though there are some success stories and small studies that show benefit, we really don't know if PRP is worth the expense of this treatment.

Side Effects

Side effects are uncommon, but they are possible. Whenever a needle is inserted through the skin, an infection can occur. The other more common side effect of PRP injections is an increase in inflammation and pain after the injection.

PRP injections are not recommended in individuals with bleeding disorders, those taking anti-coagulation medications (e.g. Coumadin), or those who have cancer, active infections, or are pregnant.

Cost

PRP injections are not covered by most insurance plans, so there is usually a fee for providing this service. If your insurance does not cover these injections, you can try to appeal to the insurance provider, but because there is little scientific evidence to support PRP use, the likelihood of coverage may be low.

Fees for PRP injections vary widely, and you may be able to work out a payment with your physician. While there are many different costs to obtain PRP, most physician offices use disposable kits offered by some of the major orthopedic supply companies. These kits cost a few hundred dollars, so there is certainly flexibility in payment.

A Word From Verywell

PRP injections have been a subject of significant interest for orthopedic surgeons and for their patients. Trying to stimulate a healing response within the body can be a challenge, and PRP injections may be an effective way to achieve that goal. While there is some data to support the use of PRP injections in certain clinical situations, there is other data that questions whether this is more beneficial than traditional treatment. There is little harm in PRP injections, and they are certainly a reasonable option, but the cost of these injections is often not covered by insurance plans. I think it is reasonable to consider a PRP injection, however, it certainly should not be viewed as a mandatory treatment, and this should only be considered when other simpler, and more proven treatments are attempted first.