What should you ask before a PRP visit?

Sources

1. The American Academy of Physical Medicine and Rehabilitation convened a technical expert panel that ran a structured literature review (2023, updated through June 2025) and a modified Delphi process, and issued five evidence-based clinical recommendations plus 11 consensus-based best practices for PRP in knee osteoarthritis. The statement is explicit that orthobiologic therapies 'remain an evolving area of practice' and that robust, dose-dependent randomized controlled trials are still needed to establish PRP's clinical effects.

   Borg-Stein J, Jayaram P, Colorado BS, et al. — AAPM&R guidance statement on platelet rich plasma for knee osteoarthritis. PM&R, 2026. DOI: 10.1002/pmrj.70144.

2. The ESSKA-ICRS consensus applied the RAND/UCLA appropriateness method to 216 clinical scenarios for intra-articular PRP in knee OA. Only 84 scenarios (38.9%) were rated appropriate, 9 (4.2%) inappropriate and 123 (56.9%) uncertain. PRP was judged appropriate in patients aged 80 or under with KL grade 0-III osteoarthritis AFTER failed conservative non-injective or injective treatment; it was NOT considered appropriate as a first treatment, nor in KL grade IV (bone-on-bone) osteoarthritis, where 91.7% and 87.5% of scenarios respectively were uncertain.

   Kon E, de Girolamo L, Laver L, et al. — Platelet-rich plasma injections for the management of knee osteoarthritis: The ESSKA-ICRS consensus. Recommendations using the RAND/UCLA appropriateness method for different clinical scenarios. Knee Surgery, Sports Traumatology, Arthroscopy, 2024. DOI: 10.1002/ksa.12320.

3. A Bayesian network meta-analysis restricted to LARGE randomized trials (at least 100 patients per group; 57 trials, 22,795 participants, 18 intra-articular interventions) found treatment effects were larger in the 35 high-risk-of-bias trials than in the 22 low/unclear-risk trials. Excluding high-risk trials, the effects of 16 of the 18 intra-articular interventions in knee or hip OA were smaller than the minimal clinically important difference and most were consistent with placebo effects; triamcinolone had the highest probability of exceeding the MID at weeks 2-6.

   Pereira TV, Saadat P, Bobos P, et al. — Effectiveness and safety of intra-articular interventions for knee and hip osteoarthritis based on large randomized trials: A systematic review and network meta-analysis. Osteoarthritis and Cartilage, 2025. DOI: 10.1016/j.joca.2024.08.014.

4. A systematic review of 29 randomized trials of PRP for knee OA that reported a platelet count, concentration or dose found that the 28 treatment arms with statistically significant positive outcomes at 6 months had a mean platelet dose of 5,500 (+/-474) x 10^6, while the three arms without a positive difference averaged 2,302 (+/-437) x 10^6 (P<.01). The same separation held at 12 months: 5,464 versus 2,253 x 10^6 (P<.05).

   Berrigan WA, Bailowitz Z, Park A, et al. — A Greater Platelet Dose May Yield Better Clinical Outcomes for Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Systematic Review. Arthroscopy, 2025. DOI: 10.1016/j.arthro.2024.03.018.

5. A systematic review and meta-analysis of platelet dosage across musculoskeletal conditions identified a potential dose-response relationship in knee osteoarthritis, with an apparent threshold above 10 billion platelets for favourable clinical outcomes, and the effect more pronounced for function than for pain. For conditions other than knee OA the authors found the literature too unclear to identify an optimal dose.

   Berrigan W, Tao F, Kopcow J, et al. — The Effect of Platelet Dose on Outcomes after Platelet Rich Plasma Injections for Musculoskeletal Conditions: A Systematic Review and Meta-Analysis. Current Reviews in Musculoskeletal Medicine, 2024. DOI: 10.1007/s12178-024-09922-x.

6. A systematic review and meta-analysis of adverse events in randomized trials of intra-articular PRP for knee osteoarthritis found PRP associated with mild, transient adverse events - knee pain and swelling - that typically resolve without intervention, and more frequent with LEUKOCYTE-RICH formulations. Leukocyte-poor PRP had a safety profile similar to hyaluronic acid. Knee stiffness was more frequent with PRP than with normal saline (P=.031). No severe adverse events were reported in any group.

   Nakagawa HF, Kim J, Rabinowitz J, et al. — Assessment of adverse events and safety associated with intra-articular platelet-rich plasma injections compared to other injectates for knee osteoarthritis: A systematic review and meta-analysis. PM&R, 2026. DOI: 10.1002/pmrj.70141.

7. Medicare's national coverage policy covers autologous platelet-rich plasma ONLY for patients with chronic non-healing diabetic, pressure and/or venous wounds, and only within an approved coverage-with-evidence-development clinical study. There is no Medicare national coverage for PRP in osteoarthritis or tendinopathy, which is why these injections are billed to the patient as cash-pay.

   Centers for Medicare & Medicaid Services — Autologous Platelet-rich Plasma (Coverage with Evidence Development). CMS.gov, 2024.

8. The devices used to spin PRP at the point of care are cleared by FDA as clinical centrifuges, product code JQC, a Class I device under 21 CFR 862.2050 - for example the Biomet GPS Platelet Separation Kit (K030555, cleared 2003) and the Harvest SmartPrep2 / SmartPrep Platelet Concentration System (K103340, cleared 2010). That clearance covers the equipment that separates blood. It is not an FDA approval of platelet-rich plasma as a treatment for osteoarthritis, tendinopathy or any other orthopedic condition, and copy must never blur the two.

   U.S. Food and Drug Administration (Center for Devices and Radiological Health) — 510(k) Premarket Notification database and Product Classification: JQC, Centrifuges (Micro, Ultra, Refrigerated) For Clinical Use, 21 CFR 862.2050. FDA accessdata (CDRH device databases), 2003.