Platelet-rich Plasma (PRP) injections

The bottom line

If you’re a millionaire, PRP is definitely worth trying. That’s why Kobe, Tiger, etc have all done it.

If you’re not, then you have a tough choice to make: are you willing to spend an average of $840 per injection (sometimes more for multiple injections) for a chance at avoiding surgery? It’s typically not covered by insurance, so you’ll have to pay out of pocket. Do you have a injury that just won’t heal, the pain is super annoying, and your injury is one of the ones studied for PRP (see below for which ones those are)? Then consider PRP, but maybe also consider cheaper options first.

What is PRP?

You can take all the supplements you want, but they typically won’t reach the actual joint that’s painful. If you get an injection, it can directly help with pain, but injections are typically of the cortisone variety, which is just a band-aid solution. And worse, cortisone can damage joints over time.

Enter PRP. They draw out a bunch of blood, spin it down, extract out platelets and other stuff that can help with healing, and then inject it back into you (in the place that hurts). Sometimes they add other stuff that can help with tissue healing or growth. Basically, platelets and associated growth factors can increase angiogenesis (growth of new blood vessels) and mitogenesis (creation of new cells), both of which can help with healing.

How effective is PRP for pain?

This is highly joint specific. For example, I got PRP in my wrist many years ago, and not only did it provide no benefit, but it caused the many nerves around the wrist to react like there was a burning fire in there. Gah! I should have listened to the second opinion doctor, who said other joints would be better PRP candidates.

So what are those joints, with good evidence for efficacy?

  • The knee (specifically, knee osteoarthritis)
  • The elbow (specifically, lateral epicondylitis)

Which joints does PRP show either mixed evidence, or evidence of very small benefit?

  • Shoulder (rotator cuff repair)
  • Knee again (ACL repair though)
  • Elbow (this time medial epicondylitis)

What are the different types of PRP?

PRP comes in a few different flavors.

  • Leukocyte-rich PRP can provide an extra boost for soft tissue healing, but can also cause an exaggerated inflammatory response.

  • Leukocyte-poor PRP doesn’t have those leukocytes!

  • Activated PRP is sort of “pre-activated” in the sense that stuff like growth factors are pre-released from the platelets before they’re injected back into you.

  • Non-activated PRP isn’t activated before hand! Activation then happens naturally in your body.

Regarding activation, there doesn’t seem to be much evidence comparing the two methods, when it comes to actual effects on pain and healing, only studies on activated PRP’s possible mechanistic advantage. Similarly, leukocyte rich PRP doesn’t seem to have a strong advantage over leukocyte poor PRP, sometimes peforming worse and sometimes better depending on the joint (for example, leukocyte rich does better in patellar tendinopathy, but neither seems to work well for lateral epicondylitis).

Note that PRP has also shown some promise for scar healing, hair loss and erectile dysfunction. PRP could alsotheoretically raise levels of growth factors that are banned by WADA for athletic competition.

Does PRP have drawbacks?

Other than the relatively high cost, PRP doesn’t have many drawbacks. And if it helps you avoid surgery, that cost can be well worth it.

Some weirdos such as myself have outsized joint reactions to the PRP, which resolve in around a day but feel like hellfire in the meantime.