From the Guidelines
For tendinosis, Platelet-Rich Fibrin (PRF) is likely a better option than Platelet-Rich Plasma (PRP) due to its slower and more sustained release of growth factors, which better supports the natural healing process of tendon tissue. When considering the treatment of tendinosis, it's essential to prioritize methods that enhance the body's natural repair mechanisms while minimizing potential drawbacks. The use of PRP has been studied in various contexts, including rotator cuff injuries, where limited evidence does not support its routine use for tendinopathy or partial tears 1.
Key Considerations for PRF and PRP
- Extended Release Profile: PRF offers a slower, more sustained release of growth factors over 7-14 days, which aligns more closely with the natural healing timeline of tendons.
- Structural Support: The fibrin matrix in PRF provides additional structural support to the healing tendon, potentially enhancing the overall environment for repair.
- Treatment Procedure: Both PRF and PRP involve drawing blood, processing it, and injecting the concentrate into the affected tendon, with patients typically requiring 1-3 injections spaced 4-6 weeks apart.
- Post-Injection Care: Relative rest for 48-72 hours is recommended after injection, followed by gradual return to activity and rehabilitation exercises to support the healing process.
Given the current understanding and the limited support for PRP in treating tendinopathy 1, PRF emerges as a preferable treatment option for tendinosis due to its potential for more effective and sustained growth factor release and its provision of a supportive fibrin matrix. However, the choice between PRF and PRP should be tailored to the individual patient, considering the specific tendon involved, the severity of the tendinosis, and other patient-specific factors.
From the Research
Comparison of PRP and PRF for Tendinosis
- There is limited research directly comparing PRP and PRF for the treatment of tendinosis, with most studies focusing on the efficacy of PRP alone 2, 3, 4, 5, 6.
- A study published in 2021 found that percutaneous needle tenotomy (PNT) alone was more effective than PNT plus leukocyte-rich platelet-rich plasma (LR-PRP) in reducing pain at 6 weeks, but there were no significant differences between groups at 52 or 104 weeks 2.
- Another study published in 2020 found that post-PRP protocols varied widely, with some studies restricting weight-bearing and others allowing full activity within a few weeks 3.
- A review of current clinical recommendations for the use of PRP found that there is abundant high-quality evidence supporting the use of LR-PRP for lateral epicondylitis and LP-PRP for osteoarthritis of the knee, but insufficient evidence to recommend PRP for rotator cuff tendinopathy or Achilles tendinopathy 4.
- Basic science studies have shown that PRP has anabolic and anti-inflammatory effects on tendons, but the efficacy of PRP treatment for tendinopathy is still controversial 5, 6.
Key Findings
- PRP may be effective in reducing pain and improving function in patients with tendinosis, but the evidence is not consistent across all studies 2, 3, 4, 5, 6.
- The optimal post-PRP protocol is not well established, with varying restrictions on weight-bearing and activity 3.
- More research is needed to fully understand the efficacy of PRP and PRF for the treatment of tendinosis and to establish standardized treatment protocols 2, 3, 4, 5, 6.