Platelet Rich Plasma (PRP) for the Treatment of Tendinopathy and Osteoarthritis

Platelet-rich plasma (PRP) is a volume of plasma with a supra-physiological (higher than normal) concentration or number of platelets in it. It is produced typically by centrifugation of a patient’s blood on the day of procedure. It is used in sports medicine in the treatment of tendinopathy and osteoarthritis.

PRP can only be used in the clinic setting by registered medical and dental practitioners.

There are broadly speaking two types of PRP, leukocyte-rich platelet-rich plasma (LR-PRP) and leukocyte-poor platelet-rich plasma (LP-PRP). LR-PRP has a supra-physiological or increased concentration of white blood cells (WBC). LP-PRP has an infra-physiological or normal or reduced concentration of WBC.

Tendinopathy can affect the plantar fascia (plantar fasciitis) or tendons such as, but not limited to, the common extensor origin (tennis elbow) or common flexor origin (golfer's elbow) of the elbow, patellar tendon (jumper's knee), rotator cuff of the shoulder, gluteal tendons of the hip, or Achilles tendon. High-grade tendinopathy is tendon degeneration associated with intra-substance tears visualised on ultrasound (US) or MRI scanning. PRP is a second line treatment when rehabilitation, in the form of a well-structured and progressive eccentric strengthening program, has failed in the management of high-grade tendinopathy. LR-PRP should be used, as it has been shown to be more effective, and injected intra-tendinously, into the tear within the tendon, necessitating ultrasound guidance. Multiple injections of PRP should not be used, they have not been shown to be more effective than a single injection of LR-PRP. At SportsMed Sunshine Coast the Zimmer Biomet GPS III system, the most effective system available, is used to produce LR-PRP. Patients can expect a significant flare post-injection lasting 48 hours followed by an ache lasting 2 weeks. Patients then need to resume their rehabilitation program after the post-injection flare in pain has settled to less than 3/10 severity. The healing response induced by the PRP injection will take 12 weeks to take effect with stimulation of collagen production and healing of the intra-substance tear. Low-grade tendinopathy is tendon degeneration with the absence of an intra-substance tear on ultrasound or MRI scanning. Instead of PRP, Focused extra-corporeal shockwave therapy (F-ESWT) is indicated as a second line treatment for the treatment of low-grade tendinopathy.

In the treatment of Kellgren-Lawrence Grade I-III (mild-moderate) osteoarthritis PRP can be used to improve pain and function. LP-PRP should be used as it has been shown to be more effective. At SportsMed Sunshine Coast we use a double-centrifugation protocol and a large volume of blood (up to 100 mL) in order to obtain a maximal ‘dose’ of platelets in order to maximise the effectiveness of any LP-PRP injection. A single injection can improve pain and function by approximately 50% at 6 months post-injection. These improvements, albeit diminishing, can be experienced up to 12-18 months post-injection. A second injection 3-4 weeks after the first injection has not been shown to be any more beneficial. LP-PRP is not chondro-protective (stop cartilage ‘wear’) or chrondro-regnerative (cause cartilage regrowth). Post-injection patients can expect a flare in their pain lasting 48 hours. It typically takes 3 weeks for the PRP to have an effect. 

At SportsMed Sunshine Coast both types of PRP can be safely produced in our purpose-built laboratory under sterile conditions using a type-II biological safety cabinet. We also have the facilities to perform PRP injections under ultrasound guidance both inta-articularly, into the joint, and intra-tendinously, into the tendon, to ensure correct placement.

PRP injections do not attract Medicare rebates and as such patients are out of pocket the full cost of the procedure.