Services

Platelet Rich Plasma (PRP) Injections and Viscosupplementation/ Hyaluronic Acid

Platelet-Rich Plasma (PRP) and Viscosupplementation

Understanding Platelet-Rich Plasma Therapy

What Is Platelet-Rich Plasma?

Platelet-rich plasma is an autologous blood product containing a concentration of platelets significantly higher than that found in whole blood.^{1 2} While normal blood typically contains approximately 200,000 platelets per microliter, PRP preparations can achieve concentrations ranging from 2-fold to 7-fold higher, with therapeutic doses often exceeding 1 million platelets per microliter.^{3 4} This concentrated preparation is obtained by drawing a sample of the patient’s own blood and processing it through centrifugation, which separates blood components based on density.¹

The therapeutic potential of PRP lies not just in the platelets themselves, but in the bioactive molecules they contain. Platelets store hundreds of growth factors within their alpha granules, including vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF-β), platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), epidermal growth factor (EGF), and insulin-like growth factor (IGF).^{5 3 6} When activated, a large percentage of these growth factors are released early, with the remainder released gradually over the following days.²

How Does PRP Work?

PRP promotes tissue healing through multiple biological mechanisms.^{1 7} The concentrated growth factors can stimulate cellular proliferation, support angiogenesis, and enhance collagen synthesis, all of which are important components of tissue healing and regeneration.^{8 9} PRP may also help modulate inflammation and create a more favorable healing environment in injured or degenerative tissues.^{1 10}

The fibrinogen within PRP forms a fibrin network that can serve as a scaffold for cellular implantation and multiplication.⁴ This scaffold, combined with the sustained release of growth factors, helps support the body’s natural healing response.^{11 7} The growth factors also recruit cells involved in tissue repair and regeneration.⁹

Preparation Methods

PRP is prepared by drawing blood from the patient and processing it through centrifugation.^{1 4} The most common technique involves a double centrifugation process: the first spin separates red blood cells from the plasma and buffy coat, and the second spin further concentrates the platelets.³ Different centrifugation protocols can significantly affect the final platelet concentration and cellular composition.¹²

Two main types of PRP exist based on white blood cell content: leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP).^{1 2} LR-PRP contains white blood cell counts greater than baseline whole blood levels, while LP-PRP contains reduced white blood cell counts.³ This distinction can influence treatment outcomes, with LP-PRP generally preferred for intra-articular applications such as knee osteoarthritis.¹³

After preparation, PRP can be activated to trigger growth factor release, and the final product is then injected directly into the injured tissue or joint.^{3 4}

Clinical Applications and Effectiveness

Knee Osteoarthritis

PRP has shown promising effectiveness for mild to moderate knee osteoarthritis.^{1 13 15} Meta-analyses have shown clinically meaningful improvements in pain and function compared with placebo or other injectable options in many studies, with benefits that may last up to 12 months and, in some reports, longer.¹⁵ The effectiveness appears to be influenced by platelet concentration, with higher-platelet preparations providing more durable pain relief.¹⁵ LP-PRP may be more effective than LR-PRP for reducing pain in knee osteoarthritis.¹³

The AAOS states that PRP may reduce pain and improve function in patients with symptomatic osteoarthritis of the knee, although the recommendation is limited because of variability among studies.¹⁷

Lateral Epicondylitis (Tennis Elbow)

PRP has also been studied extensively for lateral epicondylitis. Multiple studies and meta-analyses suggest that PRP can provide meaningful long-term pain relief and functional improvement, particularly when compared with corticosteroid injections over longer follow-up periods.^{19 20} Platelet concentration appears to matter, with higher-dose PRP associated with better outcomes.²²

Rotator Cuff Conditions

For rotator cuff tendinopathy and partial-thickness tears, PRP injections have shown improvement in pain and function, especially at longer-term follow-up.^{23 24} PRP has also been used as an adjunct during arthroscopic rotator cuff repair, where studies suggest reduced short-term retear rates and improved early functional outcomes in selected cases.^{25 26}

Acute Muscle Injuries

The evidence for PRP in acute muscle strains, particularly hamstring injuries, remains mixed, but some studies suggest PRP may reduce return-to-play time in selected athletes.^{28 29 30}

Safety Profile

PRP maintains a strong safety profile across many orthopedic applications.^{10 13} Because PRP is autologous, meaning it is derived from the patient’s own blood, the risk of disease transmission or immunologic reaction is negligible.^{7 9} The most common side effects are temporary soreness, swelling, or bruising at the injection site. Serious complications are uncommon.³¹

Treatment Expectations and Protocols

PRP therapy typically involves 1 to 3 injections, often performed several weeks apart depending on the condition being treated.^{17 20} Unlike corticosteroids, which may provide rapid but temporary relief, PRP tends to work more gradually. Patients often experience initial soreness for several days to 1 to 2 weeks, with improvement commonly beginning around 4 to 6 weeks and continuing over several months.^{19 32}

Not all PRP is the same. Outcomes can depend on platelet concentration, leukocyte content, preparation method, injection timing, and the specific condition being treated.^{10 15 22 33}

Insurance and Cost Considerations

Many insurance plans do not cover PRP therapy, including Medicare, PPO and HMO insurances. ¹⁷

---

Viscosupplementation

Viscosupplementation is a separate injection treatment used most commonly for knee osteoarthritis. In this procedure, a gel-like substance called hyaluronic acid is injected into the knee joint. Hyaluronic acid is a naturally occurring substance found in joint fluid and acts as both a lubricant and a shock absorber inside the knee.³⁴

In patients with osteoarthritis, the concentration and quality of hyaluronic acid in the knee joint may be reduced. The theory behind viscosupplementation is that restoring some of this cushioning and lubrication may help improve joint movement and reduce pain.³⁴

Viscosupplementation may be considered in selected patients with symptomatic knee arthritis who are looking for a non-surgical treatment option. Depending on the specific product, treatment may involve one injection or a series of injections.³⁴ Although results can vary from patient to patient, some patients do report meaningful symptom relief. The AAOS notes, however, that hyaluronic acid injections are not recommended for routine use in symptomatic knee osteoarthritis because the evidence overall is mixed.^{34 35}

Conclusion

PRP represents a promising biologic therapy that harnesses the body’s natural healing mechanisms. The strongest evidence supports its use in conditions such as knee osteoarthritis, lateral epicondylitis, and selected rotator cuff conditions.^{15 19 24} Because PRP is made from the patient’s own blood and contains concentrated platelets and growth factors, it offers a treatment approach focused on supporting the body’s natural repair response.^{1 5}

Viscosupplementation is a different non-surgical option focused primarily on improving lubrication and cushioning within the arthritic knee joint.³⁴ A thoughtful evaluation can help determine whether PRP, viscosupplementation, or another treatment is the best fit for your condition, symptoms, and goals.

References

1. Sheean AJ, Anz AW, Bradley JP. Platelet-Rich Plasma: Fundamentals and Clinical Applications. Arthroscopy. 2021;37(9):2732-2734.
   View source | Back to top ↑
2. Finnoff JT, Awan TM, Borg-Stein J, et al. American Medical Society for Sports Medicine Position Statement: Principles for the Responsible Use of Regenerative Medicine in Sports Medicine. Clin J Sport Med. 2021;31(6):530-541.
   View source | Back to top ↑
3. Vaidakis D, Papapanou M, Siristatidis CS. Autologous Platelet-Rich Plasma for Assisted Reproduction. Cochrane Database Syst Rev. 2024;4:CD013875.
   View source | Back to top ↑
4. Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, et al. Autologous Platelet-Rich Plasma for Treating Chronic Wounds. Cochrane Database Syst Rev. 2016;(5):CD006899.
   View source | Back to top ↑
5. Cecerska-Heryć E, Goszka M, Serwin N, et al. Applications of the Regenerative Capacity of Platelets in Modern Medicine. Cytokine Growth Factor Rev. 2022;64:84-94.
   View source | Back to top ↑
6. Huang S, Li Q, Li X, et al. Recent Research Progress of Wound Healing Biomaterials Containing Platelet-Rich Plasma. Int J Nanomedicine. 2025;20:3961-3976.
   View source | Back to top ↑
7. Fang J, Wang X, Jiang W, et al. Platelet-Rich Plasma Therapy in the Treatment of Diseases Associated With Orthopedic Injuries. Tissue Eng Part B Rev. 2020;26(6):571-585.
   View source | Back to top ↑
8. Karjalainen TV, Silagy M, O'Bryan E, et al. Autologous Blood and Platelet-Rich Plasma Injection Therapy for Lateral Elbow Pain. Cochrane Database Syst Rev. 2021;9:CD010951.
   View source | Back to top ↑
9. Etulain J. Platelets in Wound Healing and Regenerative Medicine. Platelets. 2018;29(6):556-568.
   View source | Back to top ↑
10. Hunter CW, Deer TR, Jones MR, et al. Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) From the American Society of Pain and Neuroscience. J Pain Res. 2022;15:2683-2745.
    View source | Back to top ↑
11. Boivin J, Tolsma R, Awad P, Kenter K, Li Y. The Biological Use of Platelet-Rich Plasma in Skeletal Muscle Injury and Repair. Am J Sports Med. 2023;51(5):1347-1355.
    View source | Back to top ↑
12. de Melo BAG, Martins Shimojo AA, Marcelino Perez AG, Duarte Lana JFS, Andrade Santana MH. Distribution, Recovery and Concentration of Platelets and Leukocytes in L-PRP Prepared by Centrifugation. Colloids Surf B Biointerfaces. 2018;161:288-295.
    View source | Back to top ↑
13. Xiong Y, Gong C, Peng X, et al. Efficacy and Safety of Platelet-Rich Plasma Injections for the Treatment of Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Med. 2023;10:1204144.
    View source | Back to top ↑
14. Bensa A, Previtali D, Sangiorgio A, et al. PRP Injections for the Treatment of Knee Osteoarthritis: The Improvement Is Clinically Significant and Influenced by Platelet Concentration: A Meta-Analysis of Randomized Controlled Trials. Am J Sports Med. 2025;53(3):745-754.
    View source | Back to top ↑
15. American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Knee (Non-Arthroplasty): Evidence-Based Clinical Practice Guideline. 2021.
    View source | Back to top ↑
16. Xu Y, Li T, Wang L, et al. Platelet-Rich Plasma Has Better Results for Long-Term Functional Improvement and Pain Relief for Lateral Epicondylitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Sports Med. 2024;52(10):2646-2656.
    View source | Back to top ↑
17. Li S, Yang G, Zhang H, Li X, Lu Y. A Systematic Review on the Efficacy of Different Types of Platelet-Rich Plasma in the Management of Lateral Epicondylitis. J Shoulder Elbow Surg. 2022;31(7):1533-1544.
    View source | Back to top ↑
18. Oeding JF, Varady NH, Messer CJ, et al. Platelet Concentration Explains Variability in Outcomes of Platelet-Rich Plasma for Lateral Epicondylitis: A High Dose Is Critical for a Positive Response. Am J Sports Med. 2025.
    View source | Back to top ↑
19. Chen X, Jones IA, Park C, Vangsness CT. The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-Analysis With Bias Assessment. Am J Sports Med. 2018;46(8):2020-2032.
    View source | Back to top ↑
20. Hamid MS, Sazlina SG. Platelet-Rich Plasma for Rotator Cuff Tendinopathy: A Systematic Review and Meta-Analysis. PLoS One. 2021;16(5):e0251111.
    View source | Back to top ↑
21. Yang FA, Liao CD, Wu CW, et al. Effects of Applying Platelet-Rich Plasma During Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Sci Rep. 2020;10(1):17171.
    View source | Back to top ↑
22. Wang C, Xu M, Guo W, et al. Clinical Efficacy and Safety of Platelet-Rich Plasma in Arthroscopic Full-Thickness Rotator Cuff Repair: A Meta-Analysis. PLoS One. 2019;14(7):e0220392.
    View source | Back to top ↑
23. Nakagawa H, Krochmal P, Thomas I, et al. Effects of Percutaneous Platelet-Rich Plasma Injection on Return-to-Play After Acute Hamstring Muscle Injury: A Systematic Review and Meta-Analysis. Br J Sports Med. 2026;60(5):370-378.
    View source | Back to top ↑
24. Grassi A, Napoli F, Romandini I, et al. Is Platelet-Rich Plasma (PRP) Effective in the Treatment of Acute Muscle Injuries? Sports Med. 2018;48(4):971-989.
    View source | Back to top ↑
25. Sheth U, Dwyer T, Smith I, et al. Does Platelet-Rich Plasma Lead to Earlier Return to Sport When Compared With Conservative Treatment in Acute Muscle Injuries? Arthroscopy. 2018;34(1):281-288.e1.
    View source | Back to top ↑
26. Costa LAV, Lenza M, Irrgang JJ, Fu FH, Ferretti M. How Does Platelet-Rich Plasma Compare Clinically to Other Therapies in the Treatment of Knee Osteoarthritis? Am J Sports Med. 2023;51(4):1074-1086.
    View source | Back to top ↑
27. Chen XT, Fang W, Jones IA, et al. The Efficacy of Platelet-Rich Plasma for Improving Pain and Function in Lateral Epicondylitis: A Systematic Review and Meta-Analysis With Risk-of-Bias Assessment. Arthroscopy. 2021;37(9):2937-2952.
    View source | Back to top ↑
28. Corsini A, Perticarini L, Palermi S, Bettinsoli P, Marchini A. Re-Evaluating Platelet-Rich Plasma Dosing Strategies in Sports Medicine: The Role of the "10 Billion Platelet Dose" in Optimizing Therapeutic Outcomes. J Clin Med. 2025;14(8):2714.
    View source | Back to top ↑
29. American Academy of Orthopaedic Surgeons. Viscosupplementation Treatment for Knee Arthritis.
    View source | Back to top ↑
30. American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Knee (Non-Arthroplasty): Evidence-Based Clinical Practice Guideline. 2021.
    View source | Back to top ↑