PRP Clinic Gilbert: what may help when soreness stays

Age and use often explain a sore joint

A knee can hurt on steps and stiffen during a long sit. A hip may ache during a walk or while lying on one side. Shoulder soreness often stands out when you reach overhead or pull on a shirt. Repeated movement may leave a tendon sore.

The ache alone can't show the exact cause. An old injury, joint wear, and a strained tendon can feel much alike. Swelling, lost strength, and a sudden start give a doctor useful facts.

Describe the chores or movements you now avoid, not just the time of day.

Gentle motion usually helps more than bed rest

Cut back on the movement that raises the soreness, but don't stay still for days. Short walks and gentle joint motion may limit stiffness. Warmth can loosen a stiff area. A cool pack may calm swelling after use. Keep a cloth between either pack and bare skin.

Medicine isn't simple for everyone. A doctor or pharmacist can check what is safe with your regular drugs. Physical therapy may help when the sore area can handle guided exercise.

Change one painful activity for several days, then note whether soreness or swelling eases.

An exam is sensible when soreness lingers

Arrange care when the ache keeps returning, grows worse, or cuts down walking and sleep. Fever with a warm, puffy joint calls for quick care. A pop followed by sudden weakness also needs prompt attention.

At a visit, the doctor will ask you how the soreness started. Name the movements that make it worse. The exam checks swelling, motion, strength, and the most tender spot. Past care and regular medicines matter as well. The doctor can then explain which kinds of care fit the exam.

If home care hasn't settled the soreness, platelet-rich plasma, or PRP, may come up. A clinic uses a spinning machine on your blood, then saves a layer with a higher platelet count. Small cells in the blood, called platelets, bunch together when skin is cut. PRP is an option, not a promise of relief.

Sources

1. A narrative review of PRP concluded that the literature suggests leukocyte-rich PRP is more beneficial in tendinopathies while pure (leukocyte-poor) PRP is more beneficial in cartilage pathology - but stated plainly that different PRP preparations have not been directly compared head-to-head in ANY pathology, and that the PRP type used is frequently not even stated in published research.

   Collins T, Alexander D, Barkatali B — Platelet-rich plasma: a narrative review. EFORT Open Reviews, 2021. DOI: 10.1302/2058-5241.6.200017.

2. A Bayesian network meta-analysis of nine studies (six RCTs, 1055 patients) found leukocyte-POOR PRP produced significantly better WOMAC scores than hyaluronic acid (mean difference -21.14; 95% CI -39.63 to -2.65) and than placebo (-17.84; 95% CI -34.95 to -0.73), while leukocyte-RICH PRP showed no such significant difference versus placebo. PRP of either type caused more local adverse reactions than hyaluronic acid (OR 5.63; 95% CI 1.38-22.90), almost always local swelling and pain, with no difference in safety between the two PRP types.

   Riboh JC, Saltzman BM, Yanke AB, et al. — Effect of Leukocyte Concentration on the Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis. American Journal of Sports Medicine, 2016. DOI: 10.1177/0363546515580787.

3. A scoping review of PRP for knee and hip osteoarthritis reported that PRP for knee OA gives clinically comparable or superior outcomes to other injection treatments, that the evidence in HIP osteoarthritis is far less consistent, and that evidence is lacking to show the presence of leukocytes significantly influences clinical outcomes. It named leukocyte concentration, OA grade and formulation comparability as the open questions.

   Tanguilig G, Dhillon J, Kraeutler MJ, et al. — Platelet-Rich Plasma for Knee and Hip Osteoarthritis Pain: A Scoping Review. Current Reviews in Musculoskeletal Medicine, 2024. DOI: 10.1007/s12178-024-09916-9.

4. In the RESTORE trial - the largest placebo-controlled PRP trial in knee osteoarthritis - 288 adults aged 50+ with symptomatic Kellgren-Lawrence grade 2-3 medial knee OA received three weekly intra-articular injections of leukocyte-poor PRP from a commercial system or saline placebo. At 12 months the mean change in knee pain was -2.1 points with PRP versus -1.8 with saline (difference -0.4; 95% CI -0.9 to 0.2; P=.17) against a minimum clinically important difference of 1.8, and the change in medial tibial cartilage volume was -1.4% versus -1.2% (difference -0.2%; 95% CI -1.9% to 1.5%; P=.81). Twenty-nine of 31 prespecified secondary outcomes showed no significant between-group difference. The authors concluded the findings do not support use of PRP for knee OA.

   Bennell KL, Paterson KL, Metcalf BR, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial. JAMA, 2021. DOI: 10.1001/jama.2021.19415.

5. A meta-analysis of 18 Level I randomized trials (811 patients receiving PRP, 797 receiving hyaluronic acid, mean follow-up 11.1 months) found mean improvement in total WOMAC scores was significantly higher with PRP (44.7%) than with hyaluronic acid (12.6%) (P<.01), and 6 of 11 VAS-reporting studies found significantly less pain with PRP at latest follow-up.

   Belk JW, Kraeutler MJ, Houck DA, et al. — Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. American Journal of Sports Medicine, 2021. DOI: 10.1177/0363546520909397.

6. The devices used to spin PRP at the point of care are cleared by FDA as clinical centrifuges, product code JQC, a Class I device under 21 CFR 862.2050 - for example the Biomet GPS Platelet Separation Kit (K030555, cleared 2003) and the Harvest SmartPrep2 / SmartPrep Platelet Concentration System (K103340, cleared 2010). That clearance covers the equipment that separates blood. It is not an FDA approval of platelet-rich plasma as a treatment for osteoarthritis, tendinopathy or any other orthopedic condition, and copy must never blur the two.

   U.S. Food and Drug Administration (Center for Devices and Radiological Health) — 510(k) Premarket Notification database and Product Classification: JQC, Centrifuges (Micro, Ultra, Refrigerated) For Clinical Use, 21 CFR 862.2050. FDA accessdata (CDRH device databases), 2003.

7. A systematic review of 105 clinical PRP studies in orthopaedics published 2006-2016 found that only 11 (10%) described the preparation protocol clearly enough for another investigator to repeat it, and only 17 (16%) reported any quantitative metric of the final PRP composition. The authors concluded that the current reporting of PRP preparation and composition does not allow the PRP products actually delivered to patients to be compared between studies.

   Chahla J, Cinque ME, Piuzzi NS, et al. — A Call for Standardization in Platelet-Rich Plasma Preparation Protocols and Composition Reporting: A Systematic Review of the Clinical Orthopaedic Literature. Journal of Bone and Joint Surgery (American), 2017. DOI: 10.2106/JBJS.16.01374.