Rowan Paul: Platelet Dose Determines Success in PRP Therapy

Rowan Paul, Sports Medicine and Interventional Regenerative Orthobiologics Physician at RegenCore, shared on LinkedIn:

”Platelet dose determines success in PRP therapy. 10-12B platelets across treatment courses. [1]

In Knee O/A there is a clear dose-dependent relationship between platelet count and clinical efficacy.

William A. Berrigan, MD, RMSK showed that ≥5B platelets per injection achieve significant improvements in pain and function at 6, 12 months, while< 3.5 billion platelets fail.[2]

Prof. Himanshu Bansal showed that 10B platelets/injection had chondroprotective effects lasting 1yr with improvements in painand functional score vs HA.[3]

For lateral epicondylosis, platelet concentration factor directly predicts treatment success, with meta-regression showing that platelet concentration alone explains 58.5% of outcome variability.[4]

High-dose PRP equals VAS improvement while low-dose formulations ≠ benefit.[4] For medium cuff tears, higher dose equals better painand healing rates.[5]

In the real world, with DB registry data, 3> 2>1 injection which suggests higher platelet dose over time matters.

References
1. Re-Evaluating Platelet-Rich Plasma Dosing Strategies in Sports Medicine: The Role of the “10 Billion Platelet Dose” in Optimizing Therapeutic Outcomes-A Narrative Review. Corsini A, Perticarini L, Palermi S, Bettinsoli P, Marchini A. J Clin Med. 2025 Apr 15;14(8):2714. doi: 10.3390/jcm14082714. PMID: 40283544; PMCID: PMC12027823.
2. A Greater Platelet Dose May Yield Better Clinical Outcomes for Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Systematic Review. Berrigan WA, Bailowitz Z, Park A, Reddy A, Liu R, Lansdown D. Arthroscopy. 2025 Mar;41(3):809-817.e2. doi: 10.1016/j.arthro.2024.03.018. Epub 2024 Mar 19. PMID: 38513880.
3. Platelet-Rich Plasma (PRP) in Osteoarthritis (OA) Knee: Correct Dose Critical for Long Term Clinical Efficacy. Bansal H, Leon J, Pont JL, et al. Scientific Reports. 2021;11(1):3971. doi:10.1038/s41598-021-83025-2.
4. Platelet Concentration Explains Variability in Outcomes of Platelet-Rich Plasma for Lateral Epicondylitis: A High Dose Is Critical for a Positive Response: A Systematic Review and Meta-Analysis With Meta-Regression. Oeding JF, Varady NH, Messer CJ, et al. The American Journal of Sports Medicine. 2025;:3635465241303716. doi:10.1177/03635465241303716.
5. Platelet-Rich Plasma: Fundamentals and Clinical Applications. Sheean AJ, Anz AW, Bradley JP. Arthroscopy : The Journal of Arthroscopic and Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2021;37(9):2732-2734. doi:10.1016/j.arthro.2021.07.003.
6. Platelet-Rich Therapies for Musculoskeletal Soft Tissue Injuries. Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. The Cochrane Database of Systematic Reviews. 2014;(4):CD010071. doi:10.1002/14651858.CD010071.pub3.
7. Molecular and Biologic Effects of Platelet-Rich Plasma (PRP) in Ligament and Tendon Healing and Regeneration: A Systematic Review. Chalidis B, Givissis P, Papadopoulos P, Pitsilos C. International Journal of Molecular Sciences. 2023;24(3):2744. doi:10.3390/ijms24032744.”

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