Indications for Platelet-Rich Plasma (PRP) Therapy
Established Indication
PRP is appropriate for general wound healing, representing the only clinical application with sufficient expert consensus for recommendation. 1
The International Society on Thrombosis and Haemostasis (ISTH) achieved consensus (median expert score 7/9) supporting PRP use for general wound healing based on its mechanism of delivering growth factors and cytokines from platelet α-granules that promote angiogenesis, cell migration, proliferation, and differentiation. 1, 2
Applications with Insufficient Evidence
The following conditions have uncertain evidence and cannot be recommended for or against:
Musculoskeletal Conditions
Osteoarthritis (hip and knee): The 2020 VA/DoD Clinical Practice Guideline explicitly states they were "unable to recommend for or against the use of PRP for hip or knee OA" due to inconsistent study results showing mixed benefits with no serious adverse effects. 1 The ISTH consensus rated osteoarthritis as uncertain (median score 6.5/9). 1
Tendon injuries: Uncertain indication with ISTH median score of 5.5/9. 1
Acute muscle injuries: Uncertain indication with ISTH median score of 5/9. 1
Sports injuries: Uncertain indication with ISTH median score of 5.5/9. 1
Bone healing: Uncertain indication with ISTH median score of 6/9. 1
Other Conditions
Burn injuries: Uncertain indication with ISTH median score of 6.5/9. 1
Maxillofacial injuries: Uncertain indication with ISTH median score of 5.5/9. 1
Skin aging/beauty therapy: Inappropriate indication with ISTH median score of only 4/9. 1
Critical Limitations Affecting All Applications
The field suffers from severe lack of standardization that fundamentally undermines clinical decision-making. 1
PRP preparation methods vary widely in terminology, purity, platelet concentration, leukocyte content, red blood cell contamination, and activation procedures. 1
Different preparation techniques result in products with vastly different biological properties and clinical efficacy. 1
Clinical trials have been conducted without clear definition or quantification of PRP biological properties, leading to unreliable conclusions. 1
Multiple commercial preparation devices exist, each producing different product content and quality. 1
Safety Profile
PRP is considered minimally invasive and safe due to its autologous nature, with minimal immunogenicity risk and no serious adverse effects reported in studies. 1, 2
Clinical Caveat
Given the lack of standardization and inconsistent evidence, PRP should only be used for general wound healing in clinical practice. For all other conditions, including osteoarthritis and tendinopathies, the evidence remains insufficient to support routine use despite widespread clinical adoption. 1