PRP for Scapholunate Ligament Tears: Not Recommended
There is no evidence supporting the use of PRP for scapholunate ligament tears, and this treatment should not be offered for this specific indication.
Why PRP Is Not Appropriate Here
The available evidence addresses PRP use in other ligamentous injuries (rotator cuff, ulnar collateral ligament) but provides no data on intrinsic wrist ligaments like the scapholunate ligament. The scapholunate ligament is a small, poorly vascularized intrinsic carpal ligament with fundamentally different biomechanics and healing potential compared to larger ligaments where PRP has been studied 1.
Evidence from Other Ligament Injuries
While some research exists on PRP for other ligamentous structures, the results are mixed and cannot be extrapolated to scapholunate tears:
Rotator cuff pathology: Strong evidence does not support routine PRP use for rotator cuff tendinopathy or partial tears, with only limited evidence suggesting it may decrease retear rates after surgical repair 1.
Ulnar collateral ligament (UCL): Some case series show 86-96% return to play rates for partial UCL tears treated with PRP 2, 3, 4, but these are lower-quality studies without control groups and involve a completely different anatomic structure with different healing characteristics.
General musculoskeletal soft tissue: A comprehensive Cochrane review found insufficient evidence to support PRP for musculoskeletal soft tissue injuries overall, with very low-quality evidence showing no functional benefit at short, medium, or long-term follow-up 5.
Critical Limitations of PRP Evidence
The field suffers from fundamental methodological problems that make even the existing evidence unreliable 1:
- Lack of standardization: PRP preparation methods vary wildly in platelet concentration, leukocyte content, activation methods, and volume injected 1.
- Poor study quality: Most trials are underpowered, lack proper controls, and use inconsistent outcome measures 5.
- Unclear mechanism: The role of platelets versus other cells (leukocytes, red blood cells) remains poorly understood 1.
Appropriate Management of Scapholunate Tears
For acute scapholunate ligament injuries with clinical suspicion:
- Imaging: MRI without contrast can detect scapholunate ligament tears and is superior to CT for soft tissue evaluation 1.
- Definitive diagnosis: CT arthrography has the highest sensitivity, specificity, and accuracy for detecting carpal ligament tears when conventional radiographs are equivocal 1.
- Treatment: Surgical repair or reconstruction remains the standard for complete tears requiring intervention, while partial tears may be managed conservatively with immobilization 1.
Bottom Line
Do not offer PRP for scapholunate ligament tears. There is zero evidence supporting this application, and the injury involves a small intrinsic ligament with poor healing potential that differs fundamentally from the larger ligaments where PRP has been studied (with mostly negative results). Stick to evidence-based treatments: immobilization for partial tears and surgical intervention for complete tears requiring treatment.