Platelet rich plasma in tendinopathies

  • Agrawal A.C. Professor & HOD Orthopaedics AIIMS, Raipur, CG, India
  • Kalia R.B. Associate Professor, Orthopaedics AIIMS, Raipur, CG, India
Keywords: tendinopathies, platelet-enriched plasma (PeRP), plateletrich concentrate (PRC)


Tendinopathy is a broad term encompassing painful conditions occurring in and around tendons in response to overuse. There is currently no consensus on its optimal treatment. Conservative management is the first line treatment in most patients by activity restriction, non-steroid antiinflammatory drugs, physiotherapy and judicious use of orthoses. However, these traditional treatments fail in some patients. These subsets of patients are treated with steroid injections or surgical interventions but there is no assurance of relief. In such cases a novel emerging technique involving injection of platelet rich plasma isolated from the patient's own blood, at the site of injury, is proving to be more effective. Although there is still insufficient evidence to support the use of PRP for treating musculoskeletal injuries, due to the ease of its preparation and minimal side effects on application, PRP has received much attention as a promising treatment option and the clinical use of PRP is increasing. Platelet-rich plasma (PRP), also known as platelet-enriched plasma (PeRP), plateletrich concentrate (PRC), autogenous platelet gel, or platelet releasate, may be defined as the volume of the plasma fraction of autologous blood having a platelet concentration above baseline.1 Normal platelet counts in blood range between 150,000/ml and 350,000/ml and average about 200,000/ml.2


Download data is not yet available.


1. Marx RE, Carlson ER, Eichstaedt RM, et al. Platelet rich plasma: growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:638-46.

2. Civinini R, Macera A, Nistri L, Redl B, Innocenti M. The use of autologous blood-derived growth factors in bone regeneration. Clin Cases Miner Bone Metab. 2011 Jan;8(1):25-31.

3. Harrison P, Cramer EM. Platelet alpha-granules. Blood Rev 1993; 7:52-62

4. Bucholz RW, Einhorn TA, Marsh JL. Bone and joint healing. In: Bucholz RW, Heckman JD, Court-Brown C, eds. Rockwood & Green's fractures in adults. Sixth ed. Lippincott Williams & Wilkins, 2006:300-11

5. Ahuja KD, Thomas GA, Adams MJ, Ball MJ. Postprandial platelet aggregation: effects of different meals and glycemic index. Eur J Clin Nutr. 2012;66(6):722-726.

6. Geerts SO, Nys M, De MP, Charpentier J, Albert A, Legrand V, et al. Systemic release of endotoxins induced by gentle mastication: association with periodontitis severity. J Periodontol. 2002;73(1):73-78.

7. Sanchez AR, Sheridan PJ, Kupp LI. Is platelet-rich plasma the perfect enhancement factor?: A current review. Int J Oral Maxillofac Implants 2003; 18:93-103

8. Sanchez AR, Sheridan PJ, Kupp LI. Is platelet-rich plasma the perfect enhancement factor? A current review. Int J Oral Maxillofac Implants. 2003;18:93-103

9. Lei H, Gui L, Xiao R. The effect of anticoagulants on the quality and biological efficacy of platelet-rich plasma. Clin Biochem. 2009 Sep;42(13-14):1452-60.

10. Fukaya M, Ito A. A New Economic Method for Preparing Platelet-rich Plasma. Plast Reconstr Surg Glob Open. 2014 Jul 9;2(6):e162.

11. Alsousou J, Thompson M, Hulley P, Noble A, Willett K. The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: a review of the literature. J Bone Joint Surg Br. 2009 Aug;91(8):987-96.

12. Kevy SV, Jacobson MS. Comparison of methods for point of care preparation of autologous platelet gel. J Extra Corp Technol 2004;36:28-35

13. Landesberg R, Roy M, Glickman RS. Quantification of growth factors levels using a simplified method of platelet rich plasma gel preparation. J Oral Maxillofac
Surg 2000;58:297-300.

14. Schoendorfer DW, Williamson LH, Sheckler VL, Fitzgerald BP. Platelet collection with the autopheresis-C apheresis system. Vix Sang 1990;58:100-5.

15. Moog R, Zeiler T, Heuft HG, Stephan B, Fischer EG, Kretschmer V, et al. Collection of WBC-reduced single-donor PLT concentrates with a new blood cell separator: results of a multicenter study. Transfusion. 2003; 43(8):1107-1114.

16. Kaux JF, Croisier JL, Bruyere O, et al. One injection of platelet-rich plasma associated to a submaximal eccentric protocol to treat chronic jumper's knee. J Sports Med Phys Fitness. 2014

17. Laffan M, Manning R. Investigation of haemostasis. In: Lewis SM, Brain BJ, Bates I, editors. Practical haematology. 10th ed. London: Churchill Livingstone; 2006. pp. 380-440.

18. Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med. 2009;37(11):2259-2272.

19. Harrison P, Mackie I, Mumford A, Briggs C, Liesner R, Winter M, et al. Guidelines for the laboratory investigation of heritable disorders of platelet function. Br J Haematol. 2011;155(1):30-44.

20. Malgoyre A, Bigard X, Alonso A, Sanchez MFK. Variabilité des compositions cellulaire et moléculaire des extraits de concentrés plaquettaires (platelet-rich plasma, PRP) Journal de Traumatologie du Sport. 2012;29:236-240.

21. Kaux JF, Le Goff C, Seidel L, Peters P, Gothot A, Albert A, et al. Comparative study of five techniques of preparation of platelet-rich plasma. Pathol Biol (Paris) 2011;59(3):157-160.

22. Kaux JF, Le Goff C, Renouf J, Peters P, Lutteri L, Gothot A, et al. Comparison of the platelet concentrations obtained in platelet-rich plasma (PRP) between the GPS II and GPS III systems. Pathol Biol (Paris) 2011;59(5):275-277

23. Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent. 2001:10:225-8

24. Mazzucco L, Balbo V, Cattana E, Guaschino R,Borzini P. Not every PRP-gel is born equal. Evaluation of growth factor availability for tissues through four PRP-gel preparations: Fibrinet, RegenPRP-Kit, Plateltex and one manual procedure. Vox Sang. 2009;97:110-8

25. Jungbluth P. Wild M. Grassmann JP, et al. Platelet-rich plasma on calcium phosphate granules promotes metaphyseal bone healing in mini-pigs. J Orthop Res. 2010;28:1448-1455.

26. Giusti I, D'Ascenzo S, Mancò A, Di Stefano G, Di Francesco M, Rughetti A, Dal Mas A, Properzi G, Calvisi V, Dolo V. Platelet concentration in plateletrich plasma affects tenocyte behavior in vitro. Biomed Res Int. 2014;2014:630870.

27. Weibrich G, Kleis WK, Hitzler WE, Hafner G. Comparison of the platelet concentrate collection system with the plasma-rich-in-growth-factors kit to produce platelet-rich plasma: a technical report. Int J Oral Maxillofac Implants. 2005;20(1):118-123.

28. Anitua E. What is PRGF? In: Anitua E, editor. A biological approach to implantology. Vittoria; 2009. pp. 55-66.

29. Lopez-Vidriero E, Goulding KA, Simon DA, Sanchez M, Johnson DH. The use of platelet-rich plasma in arthroscopy and sports medicine: optimizing the healing environment. Arthroscopy. 2010;26(2):269-278.

30. Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Agrawal A.C. et alOrthopaedic Journal of M. P. Chapter, Volume 21, No. 2, 2015 19 Classification of platelet oncentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol. 2009 Mar;27(3):158-67.

31. Sundman EA, Cole BJ, Fortier LA. Growth factor and catabolic cytokine concentrations are influenced by the cellular composition of platelet-rich plasma. Am J
Sports Med. 2011 Oct;39(10):2135-40.

32. Mazzocca AD, McCarthy MB, Chowaniec DM, Dugdale EM, Hansen D, Cote MP, Bradley JP, Romeo AA, Arciero RA, Beitzel K. The positive effects of different platelet-rich plasma methods on human muscle, bone, and tendon cells. Am J Sports Med.2012 Aug; 40(8):1742-9.

33. Levin E, Culibrk B, Gyöngyössy-Issa MI, Weiss S, Scammell K, LeFresne W, Jenkins C, Devine DV. Implementation of buffy coat platelet component production: comparison to platelet-rich plasma platelet production. Transfusion. 2008 Nov;48(11):2331-7.

34. Intravia J, Allen DA, Durant TJ, McCarthy MB, Russell R, Beitzel K, et al. In vitro evaluation of the anti-bacterial effect of two preparations of platelet rich plasma compared with cefazolin and whole blood. Muscles, Ligaments and Tendons Journal. 2014;4(1):79-84.

35. Born GV, Cross MJ. The Aggregation of Blood Platelets. J Physiol. 1963;168:178-195.

36. Greinacher A. Platelet activation by heparin. Blood. 2011; 117(18):4686-4687.

37. Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent 2001; 10:225-8

38. Marx RE. Platelet-rich plasma: evidence to support itsuse. J Oral Maxillofac Surg 2004;62:498-93

39. Ferrero G, Fabbro E, Orlandi D, Martini C, Lacelli F, Serafini G, Silvestri E, Sconfienza LM. Ultrasoundguided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy. J Ultrasound. 2012 Oct 8;15(4):260-6
40. de Mos M, van der Windt AE, Jahr H, et al. Can platelet-rich plasma enhance tendon repair?: a cell culture study. Am J Sports Med 2008; 36:1171-8

41. Aspenberg P, Virchenko O. Platelet concentrate injection improves Achilles tendon repair in rats. Acta Orthop Scand 2004; 75:93-9

42. Kajikawa Y, Morihara T, Sakamoto H, et al. Plateletrich plasma enhances the initial mobilization of circulation-derived cells for tendon healing. J Cell Physiol 2008;215:837-45

43. Kovacevic D, Rodeo SA. Biological augmentation of rotator cuff tendon repair. Clin Orthop 2008;466:622-33

44. Tayapongsak P, O'Brien DA, Monteiro CB, Arceo-Diaz LY. Autologous fibrin adhesive in mandibular reconstruction with particulate cancellous bone and marrow. J Oral Maxillofac Surg 1994; 52:161-5

45. Mishra A, Pavelko T. Treatment of chronic elbow tendinosus with buffered platelet-rich plasma. Am J Sports Med 2006;34:1774-8

46. Sánchez M, Anitua E, Azofra J, et al. Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices. Am J Sports Med 2007;35:245-51

47. Randelli PS, Arrigoni P, Cabitza P, Volpi P, Maffulli N. Autologous platelet rich plasma for arthroscopic rotator cuff repair: a pilot study. Disabil Rehabil 2008:1-6

48. Pearson J, Rowlands D, Highet R. Autologous blood injection to treat achilles tendinopathy? A randomized controlled trial. J Sport Rehabil. 2012 Aug;21(3):218-24

49. Smith J1, Sellon JL. Comparing PRP injections with ESWT for athletes with chronic patellar tendinopathy. Clin J Sport Med. 2014 Jan;24(1):88-9.

50. Vetrano M1, Castorina A, Vulpiani MC, Baldini R, Pavan A, Ferretti A. Platelet-rich plasma versus focused shock waves in the treatment of jumper's knee in athletes. Am J Sports Med. 2013 Apr;41(4):795-803

51. Dragoo JL, Wasterlain AS, Braun HJ, Nead KT. Platelet-rich plasma as a treatment for patellar tendinopathy: a double-blind, randomized controlled trial. Am J Sports Med. 2014 Mar;42(3):610-8.

52. Zayni R, Thaunat M, Fayard JM, Hager JP, Carrillon Y, Clechet J, Gadea F, Archbold P, Cottet BS. Plateletrich plasma as a treatment for chronic patellar tendinopathy: comparison of a single versus two consecutive injections. Muscles Ligaments Tendons J. 2015 Jul 3;5(2):92-8.

53. Charousset C, Zaoui A, Bellaiche L, Bouyer B.Are multiple platelet-rich plasma injections useful for treatment of chronic patellar tendinopathy in athletes? a prospective study. Am J Sports Med. 2014 Apr;42(4):906-11..

54. Filardo G, Di Matteo B, Di Martino A, Merli ML, Cenacchi A, Fornasari P, Marcacci M, Kon E. PlateletRich Plasma Intra-articular Knee Injections Show No Superiority Versus Viscosupplementation: A Randomized Controlled Trial. Am J Sports Med. 2015 Jul;43(7):1575-82.

55. de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Tol JL. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010 Jan 13;303(2):144-9

56. de Vos RJ, Weir A, Tol JL, Verhaar JA, Weinans H, van Schie HT. No effects of PRP on ultrasonographic tendon structure and neovascularisation in chronic midportion Achilles tendinopathy. Br J Sports Med. 2011 Apr;45(5):387-92.

57. de Jonge S, de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Tol JL.One-year follow-up of platelet-rich plasma treatment in chronic Achilles tendinopathy: a doubleblind randomized placebo-controlled trial. Am J Sports Med. 2011 Aug;39(8):1623-9.

58. Kesikburun S, Tan AK, Yilmaz B, Yasar E, Yazicioglu K. Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up. Am J Sports Med. 2013 Nov;41(11):2609-16

59. Owens RF Jr1, Ginnetti J, Conti SF, Latona C. Clinical and magnetic resonance imaging outcomes following platelet rich plasma injection for chronic midsubstance Achilles tendinopathy. Foot Ankle Int. 2011 Nov;32(11):1032-9.

60. Bell KJ, Fulcher ML, Rowlands DS, Kerse N. Impact of autologous blood injections in treatment of midportion Achilles tendinopathy: double blind randomised controlled trial. BMJ. 2013 Apr 18;346

61. Cmolik BL, Spero JA, Magovern GJ, Clark RE. Redo cardiac surgery: late bleeding complications from topical thrombin induced factor five deficiency. J Thorac
Cardiovasc Surg 1993;105:222-7

62. Mazzocca AD, McCarthy MB, Chowaniec DM, Cote MP, Romeo AA, Bradley JP, Arciero RA, Beitzel K. Platelet-rich plasma differs according to preparation method and human variability. J Bone Joint Surg Am. 2012 Feb 15; 94(4):308-16.)
How to Cite
Agrawal A.C., Kalia R.B. Platelet rich plasma in tendinopathies. ojmpc [Internet]. 2015Dec.31 [cited 2024Jul.18];21(2):11-0. Available from:
Review Article