Platelet-Rich Plasma Injection Procedure

PRP injections are performed as an outpatient procedure. Because the patient’s blood must be drawn and prepared for injection, a typical procedure may take anywhere from 45 to 90 minutes.

Platelet-Rich Plasma Injections Require Precision

An experienced physician should perform the injections. The use of imaging technology, such as ultrasound, may be used to ensure a safe and precise placement of the injection into the damaged tendon.

Pre-Injection Precautions

The American Academy of Orthopaedic Surgeons recommends patients avoid or discontinue certain medications prior to injection:

• Avoid corticosteroid medications for 2 to 3 weeks prior to the procedure
• Stop taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin (low dose, 81mg, aspirin may be permissible), or arthritis medications such as Celebrex, a week prior to the procedure
• Do not take anticoagulation medication for 5 days before the procedure (done only under doctor supervision)

In addition, patients are advised to drink plenty of fluids the day before the procedure. Some patients may require anti-anxiety medication immediately before the procedure.

The American Academy of Orthopaedic Surgeons does not advocate for or against platelet-rich plasma treatment. ¹ Santo F. Martinez, M.D. Practical Guidelines for Using PRP in the Orthopaedic Office. American Academy of Orthopaedic Surgeons. http://www.aaos.org/news/aaosnow/sep10/clinical3.asp Published September 10, 2010. Accessed November 15, 2012.

Platelet-Rich Plasma Injections, Step-by-Step

This is an in-office procedure that involves a blood draw, preparation of the PRP, and the injection:

• Blood is drawn from a vein in the patient’s arm into a syringe (15 to 60mL, or 0.5 to 2 ounces, or more may be needed).
• The blood is processed using a centrifuge machine.
• A doctor or technician prepares the centrifuged platelet-rich plasma for injection.
• The affected joint area is cleansed with disinfectant such as alcohol or iodine.
• A lidocaine injection and/or another local anesthetic may be used to numb the injection site. However, some experts believe that anesthetics decrease the effectiveness of PRP. ² Kaux J-F, Bouvard M, Lecut C, et al. Reflections about the optimisation of the treatment of tendinopathies with PRP. Muscles, Ligaments and Tendons Journal. 2015;5(1):1-4.
• If ultrasound is being used, a special gel will be applied to an area of skin near the injection site. An ultrasound probe will be pressed against the gel-covered skin. A live image of the tendon will be projected onscreen for the doctor to see.
• The patient is asked to relax; this will facilitate the injection and also can make the injection less painful.
• Using a syringe and needle, the doctor injects a small amount (often just 3 to 6 mL ³ Halpern B, Chaudhury S, Rodeo SA, Hayter C, Bogner E, Potter HG, Nguyen J. Clinical and MRI Outcomes After Platelet-Rich Plasma Treatment for Knee Osteoarthritis. Clin J Sport Med. 2012 Dec 12. ) of platelet-rich plasma into the affected tendon.
• The injection area is cleansed and bandaged.

The platelet-rich plasma typically stimulates a series of biological responses, including inflammation, so the injection site may be swollen and painful for about 3 to 5 days.

After the PRP Injection: Immediate Follow-up Care

Platelet rich plasma injections may cause temporary inflammation, pain, and swelling. Patients are often advised to take it easy for a few days and avoid putting strain on the affected joint.

A doctor may recommend that a patient:

• Avoid anti-inflammatory pain medication; the doctor may prescribe or recommend another pain medication.
• Use crutches, wear a brace, and/or wear or sling to protect and immobilize the affected joint.
• Apply a cold compress a few times a day for 10 to 20 minutes at a time to help decrease post-injection pain and swelling. (Some doctors may recommend a warm compress instead.)

If the patient does not have a physically demanding job, he or she can usually go back to work the next day. Patients can usually resume normal activities a few days after the injections, when swelling and pain decrease. Patients should not begin taking anti-inflammatory medications until approved by the doctor.

Physical therapy

The patient will likely be prescribed post-injection physical therapy. A licensed physical therapist can teach the patient exercises that build and maintain joint strength and flexibility.