Platelet rich plasma for sports injuries

Written by: Mr Georgios Arealis
Edited by: Lisa Heffernan

The production of plasma rich in platelets and growth factors began back in the early 70s. In 2009, two Pittsburgh Steelers received PRP injections for ankle injuries before they won their game at the Super Bowl. Orthopaedic surgeon Mr Georgios Arealis tells us more about how PRP can be used to treat sports injuries.

Snowboarder going down a slope. Snowboarders can be prone to certain injuries, which may benefit from PRP treatment.

Firstly, platelet rich plasma (PRP) can be defined as a fraction of autologous blood (obtained from the same person) with a large concentration of platelets. A typical blood specimen comprises of 93% red blood cells, 6% platelets and 1% white blood cells. PRP has almost no red blood cells, 90% is platelets and there can be a varying number of white blood cells. Once activated, platelets release growth factors and proteins, which can be used to heal and repair wounds and damaged tissues. This is the role of platelet rich plasma, which is prepared in a laboratory setting.


Uses of PRP

Platelet rich plasma injections can be used to treat a variety of sports conditions, including the following:

  • Elbow epicondylitis: tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis). PRP injections have a 90% success rate in treating tennis elbow.

PRP injections significantly reduce post-operative pain. In one study, 93.6% of patients who received PRP stopped taking painkillers or took them occasionally (paracetamol) three weeks after the injection. However, 57% of patients who didn’t receive PRP were still on painkillers after three weeks.

  • Shoulder sub-acromial impingement: patients who are not suitable to be operated on due to co-morbidities, for example, can be treated with PRP therapy.
  • Rotator cuff tears and repairs.
  • Shoulder osteoarthritis and osteochondral lesions; in six studies by Meheux et al with 739 patients, PRP injections significantly improved symptomatic osteoarthritis in patients 12 months after the injections.
  • Reconstruction of ligaments: AC joint reconstruction and sternoclavicular joint reconstruction.
  • Patellar tendinopathy; all studies using PRP to treat this condition show improvements after nine months, following one to three injections.
  • Muscle injuries; a randomised study of 30 male Ukrainian athletes compared PRP treatment with conventional conservative therapy for acute muscle injuries. The PRP group experienced faster pain relief, improved muscle function and better range in motion after treatment. They also returned to sports ten days after PRP treatment, in comparison to 22 days for those in the control group.


Who is not suitable for PRP?

Anyone with any of the following is not suited to PRP treatment:


Treatment can also be withheld if the patient:

  • Has been using NSAIDs within 48 hours of the PRP procedure
  • Has cancer of the bone
  • Uses tobacco extensively
  • Has had a recent illness or fever
  • Has used corticosteroids within the last two weeks


Risks of PRP treatment

As with any treatment, there are always some risks involved. Patients may experience infection, some bleeding, nerve damage and pain.

According to NICE, using an autologous blood injection for tendinopathy raises no major safety concerns. However, as there is still little evidence about the efficacy of this treatment, it should only be carried out under special conditions.

The World Anti-Doping Code (WADA) publishes a list of prohibited substances every year. The prohibition for intramuscular injections of PRP was removed from the list in 2011, so it is now acceptable to administer PRP injections into muscles.

It’s still advised to proceed with caution in the use of PRP in athletic sporting injuries, as it is a relatively new treatment, but if carried out under the supervision of an orthopaedic specialist, there is little risk involved.


If you’d like to speak about how platelet rich plasma can help you and your sporting injuries, you can get in touch with Mr Georgios Arealis for more information.

By Mr Georgios Arealis
Orthopaedic surgery

Mr Georgios Arealis is a leading consultant trauma and orthopaedic surgeon in Kent and London specialising in shoulder, elbow and upper limb surgery. Currently he practices privately at 27 Harley Street, London and all East Kent Private Hospitals (The Chaucer, Spencer, One Ashford). His areas of expertise include arthroscopic management of shoulder and elbow problems and primary, as well as, revision arthoplasty.  He has a particular interest in biologic treatments for arthritis and sports injuries and 10 years experience of using platelet rich plasma.

He completed the prestigious Reading Shoulder and Elbow Centre Fellowship and the Shoulder and Knee Sports Fellowship at the large joints unit of the Royal Orthopaedic Hospital. He is a fellow of the Royal College of Surgeons of England, International member of the American Academy of Orthopaedic Surgeons and member of the European Shoulder Associates section of the European Society of Sports Traumatology, Knee Surgery & Arthroscopy.

Outside his private practice, Mr Arealis works in the Department of Orthopaedics and Trauma at East Kent Hospitals University NHS Foundation Trust. He is also an Honorary Researcher, to the University of Kent. Mr Arealis has a strong research background and was awarded his PhD from the University of Thessaloniki and has since contributed to several postgraduate PhD and masters projects. He regularly lectures about shoulder and elbow surgery both nationally and on the international stage and is faculty of the Athens Shoulder Course. He is actively involved in clinical research and has published multiple peer-reviewed journals and his work can be found on Google scholar, ORCID and ResearchGate.

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