PRP Injections: Is Non-Evidence-Based Treatment Harmful To Patients And Costing Too Much?

| | Evidence Based Medicine


Platelet rich plasma (PRP) and autologous injections have recently drawn attention from media and workers’ comp system participants. Though these methods have been used in surgery to aid in wound healing for several decades, they have recently been introduced into the outpatient setting to treat musculoskeletal injuries. The jury is still out on the efficacy of both PRP and autologous injections in treating outpatient injuries. PRP injections are costly and with little to no support from evidence-based guidelines, are widely scrutinized in the medical industry.

What is the difference between autologous and PRP injections?

Autologous and PRP injections are similar but have distinct differences in both procedure and cost. Blood consists mainly of a liquid (called plasma) and also contains small solid components comprised of red cells, white cells and platelets. The platelets contain proteins (called growth factors) which play an important role in the healing of injuries.

When performing autologous injections, blood is drawn from the patient and then immediately re-injected into the injury site. The theory is that injecting autologous blood at the injury site may trigger a series of events to stimulate the healing process.

PRP injections differ from autologous injections as the patient’s blood is drawn, but rather than re-injected immediately into the injury site, it is centrifuged to separate the solids from the platelet rich plasma. The layer with a high concentration of platelets (PRP) is then removed and injected into the injury site. The theory behind PRP is that if platelets are concentrated to contain a higher amount of growth factors than normally found in the blood (up to 5-10 times greater), healing can be accelerated.

What injuries can autologous and PRP injections treat?

Medical professionals are trialing PRP and autologous injections to treat rotator cuff tears, chronic plantar fasciitis, anterior cruciate ligament (ACL) injuries, tennis elbow, ankle sprains, tendonitis, and ligament sprains. They are also being explored for treating osteoarthritis of the knee, shoulder, hip and spine.

What is the average cost of treatment?

PRP costs more than autologous treatment because doctors must centrifuge the blood and use a special kit for the injection. The cost of PRP injections can vary widely, but on average the cost is between $500 and $1,500 per injection and can be as high as $2,500 or more per injection; ultrasound guidance increases the cost. In most cases, the patient receives only one injection; however, the doctor sometimes gives a series of PRP injections over a span of several weeks.

Do evidence-based guidelines support PRP and autologous injections?

The efficacy of both PRP and autologous injections in treating outpatient musculoskeletal injuries is still in question. As more research studies are completed, opinions may change. For now, most evidence-based guidelines in the workers’ compensation industry do not support these injections as a first line therapy and, in many cases, they are not recommended at all.

For chronic tendon injuries, The American Academy of Orthopedic Surgeons (AAOS) states “PRP therapy has not yet been demonstrated to be more effective than traditional treatment” and goes on to say that “for acute ligament and muscle injuries, there is not definitive evidence that PRP therapy actually improves the healing process.”

While PRP and autologous injections may have the potential to improve healing in a number of different injury types, medical professionals have not fully determined which injuries benefit most. Until more research becomes available regarding the benefits and side effects of these injections, providers and insurance companies need to be cautious. As with any healthcare service, the priorities are to ensure patients receive the best possible treatment supported by evidence-based guidelines, and that healthcare spending achieves optimum outcomes.

*Copyright permission granted for use of image by Joint Healing Center, NY.

Zenia Cortes, MD, Orthopedic Surgeon

Dr. Zenia Cortes brings her combined expertise in sports and orthopaedic medicine to UniMed Direct, along with insights from her experience in peer and utilization review.

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