Platelet-rich plasma for muscle injuries: game over or time out?

  • Michael J. Mosca
  • Scott A. RodeoEmail author
Muscle Injuries (SJ McNeill Ingham, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Muscle Injuries


Muscle injuries are common and may be associated with impaired functional capacity, especially among athletes. The results of healing with conventional therapy including rest, ice, compression, and elevation (RICE) are often inadequate, generating substantial interest in the potential for emerging technologies such as platelet-rich plasma (PRP) to enhance the process of soft-tissue healing and to decrease time to recovery. In vitro studies and animal research have suggested that PRP may have benefits associated with the increased release of cytokines and growth factors resulting from supraphysiological concentrations of platelets that facilitate muscle repair, regeneration, and remodeling. Despite the promise of basic science, there is a paucity of clinical data to support the theoretical benefits of PRP. The only double-blind controlled clinical trial was recently reported and showed no benefit of PRP in the time to resume sports activity among athletes with hamstring muscle injury. This review examines the current evidence and the theoretical framework for PRP and muscle healing. Scientific gaps and technological barriers are discussed that must be addressed if the potential promise of PRP as a therapeutic modality for muscle injury is to be realized.


PRP Biologics Muscle injury Muscle regeneration Sports medicine 


Compliance with Ethics Guidelines

Conflict of Interest

Michael J. Mosca was supported by a Harvard College Research Program fellowship award.

Scott A. Rodeo is a consultant for Cytori Therapeutics; Rotation Medical; and Flexion Therapeutics.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.••
    Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev. 2014;4, CD010071. Most current systematic review and critical analysis of 19 randomized clinical studies of PRP for soft tissue injuries.PubMedGoogle Scholar
  2. 2.
    Engebresten L, Steffen K, Alsousou J, Anitua E, Bachl N, Devilee, et al. IOC consensus paper on the use of platelet-rich plasma in sports medicine. Br J Sports Med. 2010;44:1072–81.CrossRefGoogle Scholar
  3. 3.•
    Reurink G, Goudswaard GJ, Moen MH, Weir A, Verhaar JA, Bierma-Zeinstra SM, et al. Platelet rich plasma injections in muscle injury. N Engl J Med. 2014;370(26):2546–7. First published randomized controlled trial of PRP in athletes with acute hamstring injuries showed no effect on resumption of sports activity at 6 months.CrossRefPubMedGoogle Scholar
  4. 4.
    Demange MK, Marques de Almeida A, Rodeo SA. Updates in biological therapies for knee injuries: tendons. Curr Rev Musculoskelet Med 2014 June 24. [Epub ahead of print].Google Scholar
  5. 5.•
    Castillo TN, Pouliot MA, Kim JH, Dragoo JL. Comparison of growth factor and platelet concentration from commercial platelet-rich plasma separation systems. Am J Sports Med. 2011;39(2):266–71. Laboratory study with human subjects documented significant differences in concentrations of growth factors and other blood constituents with commercially available PRP separation systems - may have important implications for clinical practice and research designs.CrossRefPubMedGoogle Scholar
  6. 6.
    Mazzocca AD et al. Platelet-rich plasma differs according to preparation method and human variability. J Bone Joint Surg. 2012;94:308–16.CrossRefPubMedGoogle Scholar
  7. 7.
    Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg. 2004;114:1502–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Weibrich G, Kleis WK, Hafner G, Hitzler WE, Wagner W. Comparison of platelet, leukocyte, and growth factor levels in point-of-care platelet-enriched plasma, prepared using a modified curasan kit, with preparations received from a local blood bank. Clin Oral Implants Res. 2003;14:357–62.CrossRefPubMedGoogle Scholar
  9. 9.
    Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med. 2009;37:2259–72.CrossRefPubMedGoogle Scholar
  10. 10.
    Hall MP, Brand PA, Meislin RJ, Jazrawi LM, Cardone DA. Platelet-rich plasma: current concepts and applications in sports medicine. J Am Acad Orthop Surg. 2009;17:602–8.PubMedGoogle Scholar
  11. 11.
    Harmon GK. Muscle injuries and PRP: what does science say? Br J Sports Med. 2010;44:616–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Menetrey J, Kasemkijwattana C, Day CS, Bosch P, Vogt M, Fu FH, et al. Growth factors improve muscle healing in vivo. J Bone Joint Surg (Br). 2000;82-b:131–7.CrossRefGoogle Scholar
  13. 13.
    Nurden AT. Platelets, inflammation and tissue regeneration. Thromb Haemost. 2011;Suppl 1:S13–33.CrossRefGoogle Scholar
  14. 14.
    Pizza FX, Peterson JM, Baas JH, Koh TJ. Neutrophils contribute to muscle injury and impair its resolution after lengthening contractions in mice. J Physiol. 2005;562(3):899–913.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    McCarrel TM, Minas T, Fortier LA. Optimization of leukocyte concentration in platelet-rich plasma for the treatment of tendinopathy. J Bone Joint Surg Am. 2012;94:141–8.CrossRefGoogle Scholar
  16. 16.
    Halpern BC, Chaudhury S, Rodeo SA. The role of platelet-rich plasma in inducing musculoskeletal tissue healing. HSS J. 2012;8(2):137–45.CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Sanchez M, Antiua E, Orive G, Mujika I, Andia I. Platelet-rich therapies in the treatment of orthopedic sports injuries. Sports Med. 2009;39(5):345–54.CrossRefPubMedGoogle Scholar
  18. 18.
    Boswell SG, Schnabel LV, Mohammed HO, Sundman EA, Minas T, Fortier LA. Increasing platelet concentrations in leukocyte-reduced platelet-rich plasma decrease collagen gene synthesis in tendons. Am J Sports Med. 2014;42:42–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Wagers AJ, Conboy IM. Cellular and molecular signatures of muscle regeneration: current concepts and controversies in adult myogenesis. Cell. 2005;122:659–67.CrossRefPubMedGoogle Scholar
  20. 20.
    Lovering RM, Roche JA, Bloch RJ, Deyne PG. Recovery of function in skeletal muscle following 2 different contraction-induced injuries. Arch Phys Med Rehabil. 2007;88:617–25.CrossRefPubMedGoogle Scholar
  21. 21.
    Lefaucheur JP, Sebille A. Muscle regeneration following injury can be modified in vivo by immune neutralization of basic fibroblast growth factor, transforming growth factor beta 1 or insulin-like growth factor 1. J Neuroimmunol. 1995;57:85–91.CrossRefPubMedGoogle Scholar
  22. 22.
    Wright-Carpenter T, Opolon P, Appell HJ, Meijer H, Wehling P, Mir LM. Treatment of muscle injuries by local administration of autologous conditioned serum: animal experiments using a muscle contusion model. Int J Sports Med. 2004;25:582–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Hammond JW, Hinton RY, Ann Curl L, Muriel JM, Lovering RM. Use of autologous platelet-rich plasma to treat muscle strain injuries. Ann Acad Med Singap. 2009;38(8):733–4.Google Scholar
  24. 24.
    Gigante A, Torto DM, Cianforlini M, Busilacchi A, Davidson PA, Greco F, et al. Platelet rich fibrin matrix effects on skeletal muscle lesions: an experimental study. J Biol Regul Homeost Agents. 2012;26(3):475–84.PubMedGoogle Scholar
  25. 25.
    Terada S et al. Use of an antifibrotic agent improves the effect of platelet-rich plasma on muscle healing after injury. J Bone Joint Surg. 2013;95:980–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Wright-Carpenter T, Klein P, Schaferhoff P, Appell HJ, Mir LM, Wehling P. Treatment of muscle injuries by local administration of autologous conditioned serum: a pilot study on sportsmen with muscle strains. Int J Sports Med. 2004;25:588–93.CrossRefPubMedGoogle Scholar
  27. 27.
    Loo WL, Lee DY, Soon MY. Plasma rich in growth factors to treat adductor longus tear. Acta Orthop Belg. 2010;76(4):443–8.Google Scholar
  28. 28.
    Hamilton B, Knez W, Erale C, Chalabi H. Platelet enriched plasma for acute muscle injury. Am J Sports Med. 2010;37(9):1135–42.Google Scholar
  29. 29.
    Wetzel RJ, Patel RM, Terry MA. Platelet-rich plasma as an effective treatment for proximal hamstring injuries. Orthopedics. 2013;36(1):e64–70.CrossRefPubMedGoogle Scholar
  30. 30.
    Bubnov R, Yevseenko V, Semeniv I. Ultrasound guided injections of platelets rich in plasma for muscle injury in professional athletes: comparative study. Med Ultrasound. 2013;15(2):101–5.Google Scholar
  31. 31.
    Bernuzzi G et al. Use of platelet-rich plasma in the care of sports injuries: our experience with ultrasound-guided injection. Blood Transfus. 2014;12(1):229–34.Google Scholar
  32. 32.
    Hamid SA, Yusof A, Mohamed Ali MR, Yusof A, George J. Platelet-rich plasma (PRP): an adjuvant to hasten hamstring muscle recovery. A randomized controlled trial protocol (ISCRTN66528592). BMC Musculoskelet Disord. 2012;13:138.CrossRefGoogle Scholar
  33. 33.
    Creaney L, Hamilton B. Growth factor delivery methods in the management of sports injuries: the state of play. Br J Sports Med. 2008;42:314–20.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Harvard CollegeCambridgeUSA
  2. 2.Sports Medicine and Shoulder Service Orthopedic SurgeryNew YorkUSA
  3. 3.The Hospital for Special SurgeryWeill Medical College of CornellNew YorkUSA

Personalised recommendations