PRP Injections (Platelet-Rich Plasma)

A PRP injection contains your own plasma with a concentrated dose of your own platelets — nothing from a donor. The platelets carry growth factors that are thought to support healing^[23]. Some preparations remove most white blood cells (leukocyte-poor) and others keep them (leukocyte-rich); your physician chooses based on whether a joint or a tendon is being treated^[11][13].

Good candidates usually have mild to moderate knee arthritis or a chronic tendon problem — such as tennis elbow, gluteal tendinopathy or plantar fasciitis — that has not improved after several months of physical therapy and other conservative care. People with blood or platelet disorders, active infection or active cancer in the area should not have it. We confirm the diagnosis first, often with ultrasound or MRI.

Yes — age alone does not rule out PRP, and much of the knee research has been in people over 50. The placebo-controlled RESTORE trial, which enrolled people aged 50 and older, found PRP no better than saline at 12 months^[9], while other trials have been more positive^[10]. What matters more than age is how advanced the arthritis or tendon damage is.

PRP is sometimes used for ankle arthritis and for foot problems such as plantar fasciitis, but the evidence is mixed. For plantar fasciitis, PRP relieved pain better than cortisone at three to six months but not at one year^[19]; for chronic Achilles tendinopathy, a randomized trial found PRP no better than saline^[18]. Research on arthritis in the small joints of the foot is very limited.

Avoid anti-inflammatory medicines (NSAIDs) such as ibuprofen and naproxen for about two weeks before your injection, because they impair platelet function^[1]. Acetaminophen is usually fine. Do not stop a prescribed blood thinner or heart-protective aspirin on your own — we will coordinate with the doctor who prescribed it^[8]. Eat normally and drink plenty of water beforehand.

After a PRP knee injection, expect soreness and swelling for a day or two^[23]. Use ice, keep your leg elevated when resting and take acetaminophen if needed, but ask before using anti-inflammatory medicines. Walking is fine, but avoid running, jumping and heavy exercise for the first several days. Most people then resume a graded exercise or physical therapy program. Call us if you develop fever, increasing redness or severe pain.

PRP works gradually: it can take a few weeks to notice improvement and several months for the full effect, and when it helps, relief may last six months to a year or longer^[23]. Results vary by condition — in one tendon trial the benefit of PRP was still present at two years^[17] — but PRP does not help everyone.

It depends on what is being treated. Tendon problems are often treated with a single injection^[13]. For knee arthritis, one review found three injections about a week apart outperformed a single injection at 12 months^[12]. If PRP helps, some people repeat it when symptoms return; if it does not help after an adequate trial, we discuss other options rather than repeating it.

Not always — they trade speed for duration. Cortisone usually relieves pain within days but often wears off sooner, while PRP starts more slowly and has lasted longer in several trials, including knee arthritis at three to nine months^[12] and gluteal tendinopathy, where cortisone’s benefit faded by 24 weeks^[17]. Cortisone is usually covered by insurance; PRP usually is not.

The main downsides are cost, uncertain results and a short flare of pain. PRP is usually self-pay, it helps some people and not others^[23], and it causes more temporary swelling and pain than hyaluronic acid injections^[11]. Serious complications such as infection are rare, and disc injections carry extra risks, including disc infection.

Usually not. Medicare’s national coverage decision for blood-derived products (NCD 270.3) addresses PRP only for chronic non-healing wounds — covering diabetic wounds nationally and leaving other chronic wounds to local contractors^[2] — and Wellpoint Federal (formerly National Government Services), the Medicare contractor for New York, does not cover PRP for musculoskeletal or joint conditions; several large commercial insurers also consider it investigational^[1]. New York workers’ compensation guidelines recommend PRP only in specific cases, such as chronic tennis elbow^[3], and not for knee problems^[4].

We do not post prices because the cost depends on what is being treated, how many injections are planned and the imaging guidance needed. PRP is relatively expensive because it is prepared individually from your own blood^[23], and it is usually self-pay. Before treatment, our staff will give you a written estimate, check whether any part of your visit is covered and explain what you will owe.

Alternatives depend on the problem. For knee arthritis, options include exercise therapy, a cortisone or hyaluronic acid injection, genicular nerve ablation and, eventually, joint replacement. For a stubborn tendon, percutaneous tenotomy or shockwave therapy may help. For disc pain, a careful diagnosis guides choices such as basivertebral nerve ablation.