Ryan Williams: Excellent Highlights on The Heterogeneity of PRP Preparation
Ryan Williams, Physician Assistant at BHS Orthopedic Associates, shared on LinkedIn about a recent article by Ryan Marra et al, published in Journal of Orthopedic Research and Therapy:
”Here are some thoughts on a review article from Ryan Marra et al.
The article, ‘Is platelet rich plasma (PRP) superior to autologous whole blood injection (ABI) and improving clinical outcomes for musculoskeletal and tendinopathic conditions?’ reviewed PRP vs. ABI in lateral epicondylitis, plantar fasciitis, and hamstring tendinopathy.
The authors did an excellent job highlighting the heterogeneity of PRP preparation (note: all studies used <40mL of whole blood for PRP preparation or did not report), lack of standardized reporting of biological components of the PRP, and the effect of needling (fenestration and/or tenotomy) as limitations and confounding variables in their review.
In addition, most of the lateral epicondyle studies did not specify or did not use US guidance.
They concluded that given these issues, in addition to increased cost with PRP, that ABI is a reasonable alternative option.
The following common themes in MSK PRP literature:
- What are the constituents of PRP?
- What is the dose delivered?
- What mechanisms are actually driving the outcome? have been highlighted in several articles such as Everts et al, z023, Burford and Sherman, 2024, and Nakagawa et al, 2025.
Hopefully, as more articles draw attention to inconsistent reporting and methodology of orthobiologic studies, the studies will improve.
Practically, this emphasizes the need to consider cost-effective treatments for tendinopathy-type conditions that fail to improve with standard conservative treatment and what options in the armamentarium should be utilized and in what order.
For needle, biologic or procedure based interventions, typically I will offer the following in escalating order of cost and invasiveness:
- Dextrose Prolotherapy
- Needle Tenotomy/Fenestration (use of hypodermic needle, not device based)
- PRP
- PRP with Needle Tenotomy/Fenestration
- Device based tenotomy referral (with or without PRP depending on the physician)
- Surgical referral
With the exception of surgery, all of these are performed under US-guidance.
Anecdotally, the added benefit of ABI when proceeding with needle tenotomy/fenestration is not significant.
In conclusion, this review also highlights what is likely unequivocally agreed upon by experts in PRP, ‘low-dose’ PRP is not superior to other treatments for tendinopathy.”
Title: Is Platelet-Rich Plasma (PRP) Superior to Autologous Whole Blood Injection (ABI) in Improving Clinical Outcomes for Musculoskeletal and Tendinopathic Conditions?
Authors: Ryan Marra, Liam Wright, Charles Crawford, Andrew Seyler, Matthew Marling, Domenic Pearson, Tejas Patel, David Handron
Read the Full Article on Journal of Orthopedic Research and Therapy
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