PRP Preparation Guidelines for Gluteal Tendinopathy
For chronic hip trochanteric bursitis and gluteal tendinopathy, prepare leukocyte-rich PRP using a double-spin centrifugation method with specific attention to anticoagulant selection, timing, and processing temperature to optimize platelet concentration and clinical outcomes. 1
Blood Collection Protocol
Draw blood directly into plastic tubes (never glass) using trisodium citrate, ACD, or CPD as anticoagulant—avoid EDTA as it causes premature platelet activation 1
Collect 4-8 tubes of 9-10 mL blood using a 21G butterfly needle, rotating tubes immediately after draw to increase contact between inner tube surface and blood 2
Use a gentle tourniquet only for vein location, maintaining minimal pressure during collection to prevent blood cell activation and hemolysis 2
Discard the first milliliter(s) of blood to avoid tissue factor contamination, ensuring blood flows without intermediate stopping 2
Process blood at room temperature as soon as possible, preferably within 1 hour of collection 2, 1
Centrifugation Method
Double-spin technique is recommended for gluteal tendinopathy as it achieves higher platelet concentrations and better clinical outcomes compared to single-spin methods 1:
First Spin (Platelet Separation)
- Centrifuge at low G force (approximately 150-200g) for 10-15 minutes to separate platelet-rich plasma from red blood cells 2, 1
- This produces the platelet-rich plasma layer above the white blood cell layer 2
Second Spin (Platelet Concentration)
- Transfer the PRP to a new tube and centrifuge at higher G force (approximately 2500g) for 10 minutes 2
- Remove most of the platelet-poor plasma, leaving concentrated platelets in residual plasma 2
Note: Single-spin methods retain more white blood cells (10^8 to 10^9 WBCs per unit), which may provide additional immune and antibacterial properties relevant for tendinopathy treatment 2, 1
Processing Specifications
Maintain room temperature throughout processing to avoid cold activation and protein precipitation 2, 1
Complete centrifugation on a stable surface to prevent vibration that could affect platelet quality 2
For patients on anticoagulant medication, extend centrifugation time to 18-20 minutes 2
Preparation for Injection
Use freshly prepared PRP within 4 hours for optimal results 1
Activate PRP with calcium chloride, autologous thrombin, or collagen type I depending on clinical application 1
Perform ultrasound-guided injection intratendinously into the gluteus medius/minimus tendon and trochanteric bursa 3, 4
Critical Pitfalls to Avoid
Never store PRP at 4°C as cold activation may occur prematurely 1
Never use EDTA anticoagulant as it causes premature platelet activation 1
Do not delay processing beyond 1 hour as this compromises platelet viability 2, 1
Avoid glass tubes which cause contact activation 2
Clinical Context for Gluteal Tendinopathy
Leukocyte-rich PRP is specifically recommended for gluteal tendinopathy based on superior outcomes compared to corticosteroid injection, with benefits continuing to improve through 2 years 5, 3. The preparation method described above produces the leukocyte-rich formulation that demonstrated 64.1% of patients achieving modified Harris Hip Score ≥74 versus 45.9% with corticosteroid at 12 weeks 5, 4.
Document the specific preparation method used as this significantly impacts reproducibility and clinical outcomes 1. The double-spin leukocyte-rich protocol has the strongest evidence for gluteal tendinopathy with symptoms >4 months and confirmed intratendinous pathology on ultrasound or MRI 5, 3.