PRP therapy (autologous blood) in orthopedics

What is PRP?

PRP (Platelet-Rich Plasma) is an autologous blood product: plasma with a high concentration of blood platelets (thrombocytes) is obtained from a small amount of your own blood in a closed system. These contain growth factors and messenger substances that can be involved in tissue regeneration, inflammation modulation and pain reduction.

• Autolog: made from your own blood
• Closed, sterile reprocessing in just a few minutes
• Areas of application: selected muscle, tendon, ligament and joint problems
• Goal: promote biological healing processes – without surgical measures

How does PRP work? (active principle)

After activation, the platelets in the PRP release growth factors (including PDGF, TGF‑β, VEGF). These can influence cell signaling in injured or degenerative tissue, trigger the formation of extracellular matrix, promote microcirculation and modulate inflammatory processes.

• Promote tissue repair: Support healing phases in tendons, ligaments, muscles and cartilage
• Inflammatory modulation: weakening of persistent, pain-inducing inflammatory reactions
• Biological starting aid: Especially for chronic irritations that only react slowly to standard measures

Important: The precise effectiveness depends on the indication, the PRP composition (e.g. low-leukocyte vs. high-leukocyte), the technique and the accompanying rehabilitation. Studies show benefit for certain diagnoses, but the data is not consistent and continues to be the subject of intensive research.

When can PRP be useful? (Indications)

PRP is not a one-size-fits-all solution. We check whether basic measures (load adjustment, physiotherapy, training therapy, ergonomic optimization) have been exhausted. In selected cases, PRP can usefully complement conservative therapy.

• Chronic tendinopathies: e.g. B. Tennis elbow (lateral epicondylopathy), golfer's elbow, Achilles tendinopathy, patellar tendinopathy
• Plantar fasciitis/heel pain
• Ligament irritations and enthesiopathies (root irritations)
• Mild to moderate osteoarthritis in certain joints (e.g. knees): symptomatic relief possible
• Muscle injuries (e.g. structured use for partial tears) – consider individually
• Selected pain syndromes in the tendon-bone transition with sonographic visualization of stimuli

For further information on areas of application and specifics, we refer to our detailed pages on PRP for tendons and ligaments, for joints and - in narrow indications - for intervertebral discs and nerves.

Process of the PRP treatment in our practice

Depending on the indication, we recommend 1-3 sessions at intervals of 1-4 weeks. The effect typically builds up over several weeks; We systematically evaluate pain, function and everyday resilience.

Effectiveness and evidence

The study situation on PRP is heterogeneous: There are randomized studies and meta-analyses that show advantages over placebo or alternative injections for some indications, but there are also studies without superiority. Differences in PRP production, indications, injection protocols and rehabilitation make comparisons difficult.

• Tendinopathies (e.g., lateral epicondylopathy, plantar fasciitis): Commonly reported improvement in pain and function over weeks to months.
• Knee osteoarthritis (mild to moderate): In studies, temporary symptomatic relief (pain, function) over 3-12 months; Advanced osteoarthritis usually benefits less.
• Muscle Injuries: Evidence is Building; potentially shortened symptom duration in selected lesions, but inconsistent data.

Our approach is evidence-conscious: We discuss potential and limitations, set realistic expectations and monitor the progress closely. There is no guarantee of success.

Safety, risks and contraindications

PRP uses the body's own material and is considered safe when carried out professionally. However, as with any injection, there are risks.

• Temporary pain, pressure, swelling or bruising at the injection site
• Rare infection, vascular/nerve irritation, calcification; Allergic reactions are very rare due to the autologous material
• Post-injection flare: Increased discomfort possible for 24–72 hours

Possible contraindications/relative contraindications:

• Acute infections, impaired wound healing in the injection area
• Severe coagulation disorders, very low platelet count
• Uncontrolled systemic inflammation, active tumor disease
• Anticoagulation: individual risk-benefit assessment; Discontinuation only with medical approval
• Pregnancy/breastfeeding: individual benefit-risk assessment
• Recent cortisone injection in the same area (time apart required)

Preparation and aftercare

• Preparation: Drink enough; If possible, do not use NSAIDs (e.g. ibuprofen, diclofenac) for 5-7 days before and after the injection, as they can affect platelet function. Paracetamol is usually possible.
• Anticoagulants: Changes only after medical consultation; we advise individually.
• After the injection: 24-48 hours of protection, local cooling, elevation if necessary. No intensive training in the first few days.
• Stress build-up: According to plan – initially suitable for everyday use, then strength, coordination and, if necessary, running training accompanied by physiotherapy.
• Rehabilitation integration: PRP works best in conjunction with structured physiotherapy, technology changes and load management.
• Controls: Re-evaluation after 2–6 weeks; Documentation of pain and function (e.g. scores, video gait analysis).

Useful combinations (conservative first)

The basis of sustainable treatment remains conservative: patient education, targeted training, manual/physiotherapeutic measures and stress control. PRP can – depending on the indication – be combined with other non-surgical procedures.

• Shock wave therapy (ESWT) for chronic tendinopathies
• EMTT or laser regeneration for pain and healing modulation (decision on a case-by-case basis)
• Neuroregenerative approaches for nerve irritation – carefully consider
• Hybrid concepts: Combination of biological processes only after clear indication and information

We discuss individually whether and which combination makes sense based on the diagnosis and goal definition.

Who is PRP suitable for – and who is it not suitable for?

• Suitable: People with tendon or joint problems that have existed for weeks to months and for whom basic therapies are not effective enough
• Active people/patients with clear functional goals and willingness to participate in rehabilitation
• Mild to moderate osteoarthritis with an inflammatory component (e.g. tendency to swell) when conservative standard measures are not sufficient

• Rather unsuitable: Advanced osteoarthritis with pronounced axial misalignment/instability (other options should be examined here)
• Complete tendon ruptures requiring surgical treatment
• Unexplained pain without structural or functional correlation in diagnosis

We clarify transparently if PRP is probably not the best way - and show alternatives.

Common areas of application and specializations

As an overview page we outline the most important areas of application. You can find detailed information on our PRP special pages:

• PRP for muscles, tendons & ligaments: tendinopathies (tennis elbow, Achilles tendon, patella tip), insertion tendinopathy, fasciopathies. Focus on stress control and rehabilitation.
• PRP for joints: symptom relief for mild to moderate osteoarthritis (e.g. knees). Selection of a suitable PRP formulation (often low in leukocytes) and serious expectations.
• PRP for intervertebral discs and nerves: Only in narrow constellations and after comprehensive diagnostics; Carefully weigh up the benefit and risk.
• Hybrid therapy: Biological procedures combined – only with clear indications, realistic objectives and documentation.

In appropriate cases, shock wave therapy (ESWT), EMTT or laser regeneration can be considered as a supplement - always embedded in a conservative overall concept.

PRP in Hamburg: Our approach

In the practice Dorotheenstraße 48, 22301 Hamburg, we work with modern, closed PRP systems, hygienic standards and imaging-supported injections (if necessary). Our aim is to provide a clear indication, a precise technique and the connection with physiotherapy and training.

• Ultrasound-assisted injections for targeted accuracy
• Documentation of initial findings and progression
• Individual training and rehabilitation plans
• Transparent information about opportunities, limits, side effects and alternatives

Costs and reimbursement

PRP is generally not a health insurance benefit in statutory health insurance and is billed as an individual health service (IGeL). Private health insurance companies reimburse differently depending on the contract and indication.

• Transparent cost plan before treatment begins
• Billing according to GOÄ regulations (analog) – depending on the indication, number of injections and accompanying measures
• We would be happy to support you with documents for possible reimbursement from your insurance company

We will advise you in advance on the appropriate number of sessions and create an individual therapy and cost plan - without any promise of therapy.

Checklist: well prepared for the PRP meeting

• Bring a current list of medications (especially blood thinners)
• Bring findings (MRI, X-rays, ultrasound reports).
• No NSAIDs 5–7 days before/after injection (after consultation); Paracetamol is possible
• Eat normally and drink enough on the day of treatment
• Comfortable clothing, affected region easily accessible