PRP safety and suitability. Questions about medical assessment, medicines, bleeding problems, infection risks and reasons to delay or avoid treatment.

Less often than the marketing suggests. A 240-patient UK trial in JAMA found PRP no better than sham forAchilles tendinopathy, a trial in athletes found it no better than saline for jumper’s knee, and 16 trials found it added nothing to ACL reconstruction. It earns its place in tennis elbow, plantar fasciitis and some cuff problems.

For plantar fasciitis that has lasted more than 3 months, PRP gives better pain and function than a steroid injection at 3 and 6 months across 24 randomised trials, with no difference at 1 month or 12 months. Steroid works faster and fades. Neither replaces stretching, load management and footwear, and not all heel pain is plantar fasciitis.

Sometimes, and the two best trials disagree. An 80-patient Australian trial found a single guided PRP injection beat steroid, sustained at 2 years. A 79-patient UK trial in 2025 found PRP no better than saline in refractory cases. Both agree the problem is usually the gluteal tendons rather than the bursa, and that education plus exercise comes first.

For ankle osteoarthritis, the only placebo-controlled trial found PRP no better than saline, and its authors donot support its use. For ankle sprains and ligaments there is no good trial evidence either way. We say thisplainly because most clinics do not. The useful answer for an ankle is usually a diagnosis, a brace, aphysiotherapist or a surgeon.

Leukocyte-poor PRP has the better record in arthritic joints, where the hip trials favoured it and a 2026network meta-analysis of 21 knee trials found it the more prudent choice. Leukocyte-rich PRP is often chosenfor tendons, though the best patellar tendon trial found it did worst. The difference is modest, and most clinicscannot tell you which they used.

Intraosseous PRP injects platelet rich plasma into the bone beneath the cartilage as well as the joint, becausedamaged subchondral bone drives osteoarthritis. A 2025 double-blind trial of 86 patients with severe kneeosteoarthritis found adding bone injections to joint injections gave greater improvement at 3, 6 and 12 months.The evidence is promising, small and partly industry-linked.

For some people, yes, for a period. A 2026 trial of 90 patients on knee replacement waiting lists found 2 PRPinjections beat steroid and anti-inflammatories at 6 months, which the authors called a bridge before surgery.PRP does not rebuild cartilage, and a 2021 JAMA trial found no benefit over placebo, so it is a bridge, not areplacement.

Platelet rich plasma can reduce pain and improve function in knee osteoarthritis. A 2026 randomised trial inlate stage disease found it outperformed corticosteroid at six months, and meta-analyses in milder diseaseagree, though a 2021 trial in JAMA found no benefit over placebo and NICE calls the evidence limited. Tenniselbow evidence is strongest, hip and Achilles more mixed.

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