PRP (Platelet Rich Plasma) Injections

Summary

Platelet rich plasma (PRP) is created by concentrating plasma that has been extracted from a patient’s blood. It can then be injected into an area of tendonitis, muscle injury, or ligament strain to potentially improve symptoms and facilitate healing. The concentrated plasma contains a variety of growth factors including Platelet Derived Growth Factor (PDGF) and Vascular Endothelial Growth Factor (VEGF) that have been shown in laboratory studies to enhance tissue healing and increase microcirculation to the involved area. PRP injections have been proposed as a means of stimulating healing for a variety of foot and ankle conditions including Achilles tendonitis, Achilles tendon ruptures, insertional Achilles tendonitis, peroneal tendonitis, recalcitrant plantar fasciitis, and calf muscle tears. It can also decrease the inflammatory response, and therefore pain in a number of conditions such as osteoarthritis. However, it can NOT undo any structural damage to joints or tendons so these positive effects may not be long lasting.

In theory, PRP treatment makes sense for some conditions. However, to date, clinical studies demonstrating the long-term efficacy of PRP injections compared to more traditional treatments such as corticosteroid injections have been limited. As a result most insurances do not cover the cost of PRP injections. Many physician groups and health systems aggressively promote PRP as a treatment option as billing patients directly can be quite lucrative.

How is PRP harvested?

Platelet Rich Plasma is generated by taking a vial of a patient’s blood and spinning it in a centrifuge. This separates the blood into layers based on the density of elements in the blood. The layers include: the red blood cells (heaviest layer); the “Buffy Coat” containing the platelet rich plasma; and a plasma-poor layer (lightest layer). The plasma rich layer is isolated and then injected into the involved area under sterile conditions. If the injection is performed outside of the operating room it may be aided by ultrasound or fluoroscopic x-rays to ensure that it is injected into the correct area.

Are there any potential complications associated with PRP injections?

Any invasive procedure can be associated with potential complications! However, the complication rate associated with PRP injections appears to be very low. The main potential complication is the chance of an infection at the site of the injection. Reaction to the blood products has not been a problem because the patients own blood products are used so no cross-reaction would be expected. One problem is the cost. This procedure is still considered experimental by most insurance companies so patients often have to pay out of their own pockets. This can be expensive as the equipment needed to prepare the blood can be expensive.

Edited by Stephen Pinney MD April 5th, 2025