Celeste Robb-Nicholson

Harvard Health Letters

Q. What's your professional opinion of platelet-rich plasma therapy for soft tissue injuries? Is it safe for older adults?

A. Platelet-rich plasma therapy (PRPT) is an unproven approach to treating chronic pain due to orthopedic injuries. It involves injecting platelets and plasma taken from a person's own blood into injured tissue to stimulate the body's repair mechanisms. It's used for acute injuries in elite athletes, as well as pain in non-athletes that doesn't respond to standard therapies, such as anti-inflammatory drugs, steroid injections, physical therapy, or surgery.

When a tendon, muscle, or ligament is injured, the body starts its healing process with inflammation, followed by the growth of new cells and the creation of a network of collagen fibers and protein molecules that restructures and strengthens the tissue. The process is coordinated by growth factors and other proteins that signal cell repair, many of which are contained in platelets, the blood cells responsible for clotting.

The idea behind PRPT is that platelets accelerate the natural healing process because they contain growth factors in concentrated doses. The exact mechanism is still under investigation.

The technique is relatively simple. A small amount of blood (1.5 to 4 tablespoons) is drawn and spun in a centrifuge to separate the platelets from other blood components. This produces one to two teaspoons of platelet-rich plasma, with platelets at three to 10 times the concentration found in normal blood. Then, under ultrasound guidance, the concentrated substance is injected near the injured tissue.

The procedure takes about 20 minutes. Although the injection site hurts for a few days, the procedure leaves no scar, and recovery is considerably faster than recovery after surgery. Since the patient's own blood is used, there's almost no risk of rejection or an allergic reaction.

PRPT reportedly shortens recovery times and reduces pain in the treatment of elite athletes. Proponents claim it's also effective in treating acute and chronic tendon conditions. Most of the evidence is anecdotal.

In one small study of 20 men and women considering surgery for chronic tennis elbow pain, 15 were treated with PRPT. Two months later, those receiving PRPT had a 60 percent improvement in pain, compared with 16 percent in the control group. The study was reported in the American Journal of Sports Medicine (November 2006). A small, randomized trial of patients with Achilles' tendinitis is in progress, and several large randomized trials have begun for acute tendon and muscle injuries.

Although PRPT shows promise, it's too early to know how effective it is or for whom. We also don't know its long-term effects, how often it can be performed, or whether age makes a difference.


Celeste Robb-Nicholson, M.D., Editor in Chief, Harvard Women's Health Watch


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