When a steroid shot wears off and surgery feels premature, your patients are left in a familiar gap. Platelet-rich plasma (PRP) therapy can help fill it, but only when the right patient meets the right formulation at the right time. The evidence has matured quickly, and this guide gives you the clarity to identify strong candidates, recognize contraindications and refer with confidence to Novant Health Orthopedics & Sports Medicine.
Why PRP deserves a fresh look
PRP therapy concentrates a small sample of your patient's own blood in a centrifuge to isolate platelets rich in growth factors, then injects them into the affected joint, tendon or ligament. Earlier skepticism was reasonable, given inconsistent formulations and underpowered studies. That picture has changed. A 2025 systematic review and meta-analysis in the European Journal of Medical Research pooled 28 randomized controlled trials covering 3,246 patients with knee osteoarthritis. PRP injections improved function more than both hyaluronic acid and physical therapy, with the strongest gains in early-stage disease. This is now an evidence-supported option that belongs in the conversation before a patient progresses toward surgery.
Who's the right candidate
Patient selection drives outcomes more than any other variable. The strongest evidence supports referral for:
- Mild to moderate knee osteoarthritis. Best results occur in Kellgren-Lawrence grades 1 through 3, where cartilage remains. Earlier disease means better response.
- Chronic tendinopathies. Tennis elbow and other persistent tendon conditions show meaningful improvement over placebo, particularly long term.
- Plantar fasciitis. A viable option when conservative measures stall.
- Surgical adjunct. PRP can shorten wound healing time, reduce pain and improve function following rotator cuff repair.
PRP therapy isn't a first-line approach. It's most appropriate when pain has persisted for several months and your patient wants an alternative to a repeat cortisone shot or an option before surgery. Set expectations early: corticosteroids still outperform PRP for short-term pain, but PRP's advantage is mid- and long-term function, lasting up to a year and sometimes longer.
"PRP is not a miracle cure. Instead, think of it as a safe alternative to steroid injections or when you are looking for other options before considering surgery."
When PRP is the wrong call
Recognizing when PRP isn't appropriate protects your patients and prevents disappointment. Avoid or use caution in patients with:
- Clear contraindications. Active infection, blood cancers, low platelet counts, platelet function or clotting disorders or severe anemia.
- Conditions warranting careful evaluation. A history of certain cancers, autoimmune disease, poorly controlled diabetes and use of blood thinners or aspirin.
- Advanced grade 4 osteoarthritis. Bone-on-bone disease yields far less predictable results.
- Surgery on the near horizon. Hold off, since the PRP timeline can complicate surgical planning.
What separates a good outcome from a poor one
Not all PRP is the same. Three factors consistently influence results:
- Formulation quality. For joints, leukocyte-poor and red blood cell-poor PRP reduces inflammation and oxidative stress. Red blood cell contamination is linked to cartilage damage.
- Platelet dose. The 2025 meta-analysis identified an optimal range of 600 to 900 × 10⁹/L, typically delivered across 3 to 5 injections spaced 7 to 14 days apart.
- Post-injection management. Avoid NSAIDs for 2 to 4 weeks, since they blunt the platelet-mediated healing process. Acetaminophen is generally fine, and structured rehabilitation improves results.
When you refer to a team that manages formulation, dosing and aftercare with this level of rigor, your patient receives the conditions shown to deliver results, not just an injection.
Orthopedic care your patients deserve.
Refer with confidence
The better your patient's health is going into the procedure, the better the outcome. So encourage good hydration and nutrition, and, where relevant, weight management, before referral. Discuss insurance coverage and cost up front: because the FDA still considers PRP investigational, coverage and out-of-pocket costs vary, and patients should check with their individual insurance plan to understand their benefits.
Our specialists work alongside you to determine candidacy, set realistic goals and deliver evidence-based care close to home.
