Practice Uncertainties

How effective are platelet rich plasma injections in treating musculoskeletal soft tissue injuries?

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i517 (Published 17 February 2016) Cite this as: BMJ 2016;352:i517
  1. David J Keene, NDORMS research fellow in trauma rehabilitation1,
  2. Joseph Alsousou, NIHR academic clinical fellow in trauma and orthopaedic surgery2,
  3. Keith Willett, professor of orthopaedic trauma surgery1
  1. 1Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
  2. 2Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK
  1. Correspondence to: D J Keene, Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Oxford OX3 9DU david.keene{at}ndorms.ox.ac.uk

What you need to know

  • Autologous platelet-rich plasma (PRP) is increasingly used to treat musculoskeletal soft tissue injuries, either on its own or as an adjunct to surgery

  • Routine use is not recommended as there is insufficient evidence of clinical efficacy; instead, its use should be restricted to research settings

  • Ensure patients receiving PRP are aware of the limited evidence of efficacy, so that they can make an informed decision about their care

  • Clinicians should be aware of the concentration of PRP, and yield of bioactive proteins, produced by their selected preparation device

Platelet-rich plasma (PRP) has become increasingly popular in sports medicine and orthopaedic practice as treatment for muscle, tendon, and ligament injuries, and has received media attention because of its promise as a regenerative therapy.1 2 PRP is an autologous preparation of a patient’s whole blood, which is centrifuged or filtered, allowing separation of a fraction containing a supraphysiological concentration of platelets (fig 1). PRP can be applied on its own, or as an adjunct to surgery, allowing a high “dose” of growth factors and other bioactive proteins such as cytokines and chemokines to be delivered to the target tissue. This has the potential to improve repair and regeneration, although evidence from in vitro and animal studies has been conflicting.3 4 5

Fig 1 Making autologous platelet-rich plasma (PRP): a whole blood sample is taken (a) then a specialised centrifuge (such as the Magellan Autologous Platelet Separator System from Arteriocyte (b)) or filtration system is used to concentrate the platelets, and the resulting PRP is collected in a syringe for injection into the target tissue (c)

As an autologous preparation, PRP has been introduced into clinical practice without being subject to the stringent development required of new drugs. Many commercially available …

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