Regenerative medicine (PRP): what it can treat, what it can't, and what the evidence says

Regenerative medicine is one of the most widely used — and sometimes most misunderstood — terms in the world of pain treatment. It covers a set of techniques that aim to stimulate the body's natural capacity to repair tissue: tendons, ligaments, cartilage, muscle. Within that umbrella, the most widely used and best studied technique today is platelet-rich plasma (PRP).

Regenerative medicine — and PRP in particular — often comes up in consultation carrying expectations that don't always match what the evidence can currently support. Patients have heard that it 'regenerates cartilage', that it 'means you won't need surgery', or that it's 'the latest technology'. My job in these cases is to put the conversation on realistic footing: to explain what the evidence actually says, which conditions have more solid data, where the results are mixed, and for which patients it may make sense as part of a broader plan.

Before going any further, though, one thing should be clear: regenerative medicine is not a cure-all. There are indications where the evidence supports it well, others where the results are modest, and some situations where it simply isn't the best option. My approach is always to offer it when it makes sense both clinically and in the published literature — not as a fad.

What PRP is

Platelet-rich plasma is a preparation obtained from the patient's own blood. The procedure is straightforward:

1. A small amount of blood is drawn (10 to 60 ml, depending on the technique).
2. The blood is centrifuged to separate its components.
3. This yields a platelet-concentrated fraction that contains growth factors.
4. That fraction is injected into the area being treated, usually under ultrasound guidance to ensure precision.

When activated, platelets release growth factors that stimulate tissue-repair processes: cell proliferation, new blood vessel formation, modulation of inflammation. The idea is to give the injured tissue a biological stimulus to repair itself.

One important technical nuance: 'PRP' is not a single thing. There are different platelet concentrations, different preparation protocols, different ways of applying it. That explains much of the heterogeneity in the studies and why results can vary so widely. In conditions such as chronic tendinopathies of the elbow and knee — and, in some selected cases, mild to moderate osteoarthritis — there is reasonable evidence of benefit. In other scenarios the evidence is weaker. It's always wise to be wary of anyone who promises extraordinary results for any condition and any patient.

Indications with the strongest evidence

Mild to moderate knee osteoarthritis

This is probably the indication with the most support in the current literature. Multiple studies and meta-analyses have shown that intra-articular PRP in the knee provides pain relief and functional improvement comparable or superior to hyaluronic acid, particularly in patients under 65 with mild to moderate osteoarthritis. The effect can last several months, and the treatment can be repeated.

Chronic tendinopathies

Tennis elbow (lateral epicondylitis) and patellar, Achilles and rotator cuff tendinopathies are indications with favorable evidence. Ultrasound-guided PRP delivered into or around the tendon can shorten recovery times when conventional treatments have failed.

Muscle injuries

In sports-related muscle injuries the evidence is more mixed, but established protocols exist. It can shorten return-to-activity times in selected cases.

More controversial indications

• Severe osteoarthritis: when the cartilage is badly worn, results are less predictable. It is not an absolute contraindication, but expectations need to be realistic.
• Lumbar or cervical disc disease (intradiscal PRP): research is ongoing, but the evidence is still preliminary.
• Hip osteoarthritis and other weight-bearing joints: results vary from case to case.

Limitations worth knowing about

Before having PRP, it's worth understanding the following:

• Not all preparations are the same. There is leukocyte-rich PRP, leukocyte-poor PRP, activated, non-activated, with different platelet concentrations. Technique matters.
• The result depends on the clinical picture. It works better in mild to moderate osteoarthritis than in severe disease. It works better in younger patients. It works better in active tendinopathies than in chronic injuries with advanced degenerative changes.
• It is not a one-shot, instant treatment. It is often given as a series of applications (typically 2 to 3) a few weeks apart. The effect builds up gradually.
• It does not replace physical therapy or lifestyle changes. Its effect is enhanced when combined with a strengthening program and load modification.
• It is not for everyone. Patients with certain blood disorders, active infections, or on certain anticoagulants may not be candidates.

What to expect from a PRP session

The typical procedure is performed in the office or in a procedure room:

• Total duration: 45-60 minutes (including blood draw, processing and injection).
• It is an outpatient procedure.
• It is usually performed under ultrasound guidance to ensure the injection is placed precisely.
• Some discomfort or inflammation over the first few days is normal and part of the biological process.
• Anti-inflammatory medication should be avoided in the days that follow (it interferes with the intended effect).
• Activity is resumed gradually, following specific instructions.

My approach to PRP and regenerative medicine is fairly conservative: I recommend it when the condition has reasonable evidence of response, when a serious course of conservative treatment has already been completed, and when the patient understands that it is one more tool — not a substitute for exercise, for physical therapy, or for surgery when surgery is the right indication. I don't offer it as first-line treatment, I don't use it as a 'magic plan B' when nothing else has worked, and I always frame it within a comprehensive plan. When those limits are respected, the results tend to be reasonable and sustained.

An honest conversation

PRP is one more tool, not a magic solution. When it's given to the right patient, with the right technique and within a comprehensive plan, it can provide meaningful relief and delay more invasive treatments. When it's sold as "guaranteed regeneration" or a "universal alternative to surgery", that's an overstatement.

In my practice, I bring up regenerative medicine when the clinical picture justifies it and when I believe the patient stands to benefit according to the best available evidence. And I am just as clear when I believe it is not the best option and another alternative offers a better chance of success.

If you're considering regenerative treatment, what matters is discussing it in a consultation that evaluates your specific case: the condition, its severity, your age, your expectations and your previous treatments. Only then is the recommendation truly personalized.

What defines a successful PRP treatment, for me, is not having injected something miraculous, but having added a tool that — combined with well-directed exercise and pain management — improves the patient's function. Regenerative medicine has an interesting place in the therapeutic toolkit, as long as it is offered with honesty about what it can and cannot contribute. That is my commitment: to recommend it when it's indicated, to avoid it when it's only a promise, and never to use it as an excuse to put off a treatment that, in some cases, should take a different path.

Dr. Mauricio Casarsa

Anesthesiologist, specialist in Pain Medicine and Interventional Pain Management. Postgraduate training at UBA (Fundación Dolor) and UNLP (CAIDBA). Staff physician at Hospital Alemán de Buenos Aires.

MN 137756 · San Isidro · Villa Urquiza