Caution on PRP injections for musculoskeletal injuries

Tuesday, 23 Feb 2016

Routine use of platelet rich plasma injections cannot be recommended in clinical practice for musculoskeletal soft tissue injuries given the lack of evidence to support its efficacy, experts say.

Writing in a Practice Uncertainties article published in the BMJ the othopaedic and trauma experts from the UK said platelet-rich plasma (PRP) had become increasingly popular in sports medicine and orthopaedic practice as a treatment for muscle, tendon, and ligament injuries.

Because PRP was an autologous preparation it had been introduced into clinical practice without being subject to the stringent development required of new drugs, they noted.

Reviewing the evidence the research team said they had difficulty drawing clear conclusions because of heterogeneous musculoskeletal conditions and outcome measures, underpowered studies, and poor reporting.

Only half of the trials included analyses of PRP content and quality, and these showed marked differences in platelet concentration and white cell content.

This was problematic as different PRP preparations and application techniques could affect effectiveness, they said.

Although evidence showed PRP was generally considered to have a low risk of harm it could introduce infection.

“We argue that patients should only be offered PRP for musculoskeletal soft tissue injuries within the context of well designed clinical trials, with informed consent, high quality verbal explanations, and supporting written information,” they wrote.

Clinicians offering PRP should ask manufacturers for the evidence of the platelet and growth factor concentrations, the constitution, and the viability of their PRP product (platelet activation levels), they added.

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