The exaggeration of the effects of PRP (Platelet-Rich Plasma)

Currently, in modern life, health and quality of life are receiving increasing attention. Among conservative treatment measures, platelet-rich plasma (PRP) injection is widely researched and utilized, particularly for traumatic injuries, osteoarthritis, and ligament injuries, with the expectation of achieving complete recovery without surgery.

Theoretically, platelet-rich plasma (PRP) is a biological product extracted from the patient's own blood. Following centrifugation, the resulting plasma fraction contains a higher-than-normal concentration of platelets and growth factors.

Platelets play a crucial role in tissue repair and regeneration. The growth factors in PRP can support:

• Stimulating the healing process of injured tissue
• Promoting collagen production
• Assisting in reducing inflammatory responses within the joint
• Improving the biological environment within the knee joint

However, whether PRP is genuinely as effective in practice as it is in theory remains a matter of global debate, with insufficient strong evidence to settle the issue once and for all.

Is PRP being used quite “liberally” in clinical practice?

Allow me to provide 3 examples:

Regarding knee osteoarthritis, PRP is indicated for cases of mild to moderate knee joint damage after physical therapy, weight loss, lifestyle modifications, or pharmacotherapy have failed to yield results, or when used in combination with the aforementioned methods. Adhering to a multimodal treatment philosophy, PRP injections are rarely used as a standalone measure.

In clinical practice, many patients come to me with severe knee osteoarthritis, even presenting with restricted range of motion, limb malalignment, and radiographic findings of “bone to bone,” yet they have still been prescribed PRP injections, often multiple times. As a result, they experience no pain relief or only negligible pain relief.

Regarding avascular necrosis of the femoral head, it is much the same. Many patients undergo PRP injections with the expectation of curing avascular necrosis of the femoral head? Synthesized studies show that PRP does not have the capacity to reverse the necrotic lesions of the femoral head; it is only effective when used as an adjunct therapy combined with core decompression or stem cells in the early stages, and even then, there is insufficient robust evidence to prove this. Therefore, it can be tentatively concluded that administering pure PRP intra-articularly into the hip joint to treat avascular necrosis of the femoral head is ineffective. 

Rotator cuff tears are no exception. There are several studies highlighting the efficacy of PRP in rotator cuff healing. However, these typically involve cohorts with partial-thickness or small full-thickness tears, evaluated via ultrasound, which lacks high evidentiary value. For large or massive tears with tendon retraction, it is hard to believe that PRP is effective or to understand how it could form a “bridge” between the torn tendon and bone. Yet, patients still receive these injections and only seek out shoulder-specialized orthopedic surgeons for surgical intervention when no relief is obtained.

A recently emerging research direction involves postoperative PRP injections; this is currently being implemented, but more time is required to draw definitive conclusions.

And there are numerous other joint and ligament injuries for which it is currently being prescribed...

An “harmless yet ineffective” treatment that comes at no small cost

Because PRP is extracted from your own body, it naturally rarely causes side effects or adverse bodily reactions. However, the indiscriminate and inappropriate use of PRP not only wastes the patient's time but is also quite costly. An average injection costs several million VND, and a course of treatment may span 2 to 3 injections depending on the type. This is certainly a price point that requires careful consideration relative to the average income in Vietnam.

So, does the doctor administer PRP injections to patients?

The answer is YES. However, two points must be clarified:

• First, one must strive to strictly adhere to the proper indications for each stage of the disease.
• Second, it is essential to thoroughly explain and discuss the options with the patient so they understand and can make an informed choice. Based on my clinical practice experience, even when indicated at the correct stage, patients do not always exhibit the same pain-relieving response. In fact, a small minority of cases experience no effect whatsoever.

In conclusion, platelet-rich plasma (PRP) has many beneficial effects in the treatment of osteoarthritis, ligament pathologies, and sports injuries; however, it must be administered according to proper indications based on thorough consultation and explanation to ensure patient comprehension, informed choice, and consent.

Dr. Do Vu Anh

References

1. Shahid A, Malik A, Bukhari A, Shaikh A, Rutherford J, Barkatali B. Do Platelet-Rich Plasma Injections for Knee Osteoarthritis Work? Cureus. 2023 Feb 2;15(2):e34533. doi: 10.7759/cureus.34533. PMID: 36751575; PMCID: PMC9897683
2. Iqbal MA, Mannan M, Khalil S, Hameed MH, Karim F, Ahmad Z, Carter D, Shrivastava N. Efficacy of Platelet-Rich Plasma (PRP) in the Management of Rotator Cuff Tears: A Case Series From a Tertiary Care Center. Cureus. 2025 Jul 29;17(7):e88965. doi: 10.7759/cureus.88965. PMID: 40896049; PMCID: PMC12392367.
3. Han J, Gao F, Li Y, Ma J, Sun W, Shi L, Wu X, Li T. The Use of Platelet-Rich Plasma for the Treatment of Osteonecrosis of the Femoral Head: A Systematic Review. Biomed Res Int. 2020 Mar 7;2020:2642439. doi: 10.1155/2020/2642439. PMID: 32219128; PMCID: PMC7081027.
4. Clevio Desouza, Vijay Shetty, Effectiveness of platelet-rich plasma in partial-thickness rotator cuff tears: a systematic review, Journal of ISAKOS, Volume 9, Issue 4, 2024, Pages 699-708, ISSN 2059-7754. https://doi.org/10.1016/j.jisako.2024.04.010.
5. Zhu B, Li J, Li X, Feng S, Li B. Core decompression combined with platelet-rich plasma-augmented bone grafting for femur head necrosis: a systematic review and meta-analysis. Int J Surg. 2024 Mar 1;110(3):1687-1698. doi: 10.1097/JS9.0000000000001028. PMID: 38181110; PMCID: PMC10942211.