Platelet-Rich Plasma (PRP) Therapy

Modal Pain’s approach to PRP

Platelet-rich plasma is one of the most over-marketed and under-explained procedures in musculoskeletal medicine. At Modal Pain Management, we perform PRP selectively, image-guided, and only after going through the peer-reviewed evidence for your specific condition with you. We discuss both the favorable and unfavorable studies before you decide, publish our per-injection pricing transparently, and never package PRP as part of a pre-paid “wellness protocol.” This page is written in the same spirit: honest about what PRP can and cannot do for musculoskeletal pain in 2026.

PRP is an autologous biologic. That means the active ingredient is drawn from your own blood on the day of the procedure and returned to your body after centrifuging. PRP is a blood product that sits outside the FDA’s drug-approval pathway. The centrifuge kits used to make it are FDA-cleared devices, and nearly all were cleared for preparing PRP to mix with bone graft during surgery, so an office injection into a tendon or joint is an off-label use (Beitzel 2015). It does not contain steroids, stem cells, amniotic tissue, or any foreign biologic additive.

The biology: what PRP actually delivers

Platelets are best known for clotting, but PRP also contains hundreds of bioactive molecules, many of them stored in the platelets’ alpha granules (Andia 2013). When the platelets are activated, they release growth factors including platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), vascular endothelial growth factor (VEGF), insulin-like growth factor-1 (IGF-1), basic fibroblast growth factor (bFGF), and epidermal growth factor (EGF).

In a healthy acute injury, this cascade happens naturally. In chronic tendinopathy and in mild-to-moderate osteoarthritis, the local healing response has stalled — the tissue is stuck in a degenerative, failed-healing state rather than progressing to repair. Concentrated PRP delivers a supraphysiologic dose of growth factors to the exact site, with the goal of restarting a productive healing cascade: angiogenesis, tenocyte or chondrocyte anabolic activity, matrix deposition, and collagen remodeling.

This biology matters clinically. PRP is slower than cortisone, and a few days of post-injection soreness is common. In the trials that found a benefit, the difference from the comparison treatment usually showed up at three to six months rather than in the first weeks (Mishra 2014, Fitzpatrick 2018, Zuo 2025). PRP is not a quick fix.

Conditions we treat with PRP at Modal Pain

Our offered indications are organized by strength of evidence rather than by marketing appeal.

Tendinopathies, where the evidence depends on the tendon. Chronic plantar fasciitis and gluteal tendinopathy have the more favorable trials, with PRP doing better than cortisone at three to six months (Zuo 2025, Fitzpatrick 2018). Against a placebo, the gluteal picture changes: a 79-patient double-blind trial found leukocyte-rich PRP no better than saline at any point up to 12 months (Atchia 2025). Patellar tendinopathy (jumper’s knee) is mixed: PRP sped recovery at 12 weeks in one trial, with no difference by 26 weeks (Dragoo 2014), and another found no benefit over saline (Scott 2019). For lateral epicondylitis (tennis elbow), a Cochrane review and a 2026 meta-analysis found PRP no better than placebo (Karjalainen 2021, Antunes Júnior 2026), and placebo-controlled trials in rotator cuff and Achilles tendinopathy were also negative (Kesikburun 2013, de Vos 2010). Medial epicondylitis (golfer’s elbow) has very little trial data. These are pain syndromes where the pathology is chronic tendinosis — not an acute tear and not primarily inflammatory — and where cortisone relieves pain in the short term but loses that advantage, or does worse than no injection, at 6 to 12 months (Coombes 2010). See tennis elbow and plantar fasciitis for condition-specific discussion.

Mild-to-moderate osteoarthritis (Kellgren–Lawrence 1–3). Knee osteoarthritis is the best-studied joint indication, and the evidence conflicts. Meta-analyses favor PRP over hyaluronic acid and saline on some scores at 6–12 months, but the quality of that evidence is low (Filardo 2021, Belk 2021). The RESTORE trial (Bennell et al., JAMA 2021) found no PRP benefit over saline in knee OA at 12 months, in pain or in cartilage volume, and that matters. The 2019 American College of Rheumatology/Arthritis Foundation guideline strongly recommends against PRP for knee and hip osteoarthritis (Kolasinski 2020), and the 2019 OARSI guideline also recommends against it (Bannuru 2019). The 2021 AAOS guideline says PRP may reduce pain and improve function in knee OA, at its Limited strength grade. Hip osteoarthritis has less trial evidence than the knee (Le 2018). We share both sides. See knee osteoarthritis and hip osteoarthritis.

Ligament and soft-tissue injuries. Partial MCL, UCL, and ankle ligament injuries and hip labral pathology in the non-surgical candidate. Controlled-trial evidence for these uses is limited, and a 2018 review concluded that PRP has not been shown to work for muscle injuries (Le 2018).

Conditions where we will tell you PRP is not the right choice. End-stage osteoarthritis with bone-on-bone changes, complete tendon ruptures, active rotator cuff full-thickness tears in the surgical candidate, active local or systemic infection, radicular pain from spine pathology (an epidural steroid injection is the better-studied option), and facet-mediated spine pain (see medial branch blocks and radiofrequency ablation).

Why image guidance is non-negotiable

Blind landmark injections miss more often than people expect. In the knee, a systematic review of 23 studies found that about one in five blind injections missed the joint, with accuracy ranging from 64% to 87% depending on the entry point (Maricar 2013). No trial has tested whether better accuracy improves PRP results, but for a procedure where the entire mechanism depends on depositing a small volume of concentrated biologic into a specific tendon fiber layer or intra-articular space, blind injection is not an acceptable standard.

Every PRP injection at Modal Pain is performed under real-time ultrasound or fluoroscopic guidance. This allows us to (1) confirm the needle tip is in the pathologic tissue before injection, (2) avoid nerves and vessels, (3) document procedure accuracy in the chart, and (4) reproduce the approach on subsequent injections. If you are considering PRP at a clinic that does not use image guidance, ask why.

The Modal Pain PRP procedure, step by step

Step 1 — Medical clearance and diagnostic review. Before scheduling, we review your imaging (MRI, ultrasound, or X-ray) and rule out contraindications: active infection, thrombocytopenia, anemia, recent cortisone in the same site, or pathology better addressed surgically.

Step 2 — Blood draw (day of procedure). A standard venous draw of 10–60 mL, depending on the kit. No fasting required. Stay well-hydrated the day before.

Step 3 — Centrifuge and preparation. The sample is spun in a closed, single-use kit in the procedure room. Preparation time is 10–15 minutes. We prepare leukocyte-poor PRP, meaning most of the white blood cells are removed. We use kits from more than one manufacturer, and the platelet concentration depends on the kit.

Step 4 — Image-guided injection. The skin is prepped with chlorhexidine. The target is identified on ultrasound or fluoroscopy. Local anesthetic is infiltrated at the skin and along the needle track. We keep lidocaine away from the injection target, because in laboratory studies concentrated lidocaine is toxic to human cartilage and tendon cells (Busse 2019). The PRP is deposited precisely into the pathologic tissue or joint space. The needle is withdrawn.

Step 5 — After the injection. You go home the same day. Expect soreness for several days. Avoid anti-inflammatories such as ibuprofen and naproxen for 2 weeks before and 2 weeks after the injection. Activity, flare care, and when to judge the result are covered in the PRP aftercare instructions.

What to expect in the weeks after PRP

Soreness and stiffness for the first several days are expected. Improvement, when it comes, builds over months rather than days. If there has been no meaningful change at three months, we reassess and decide whether to repeat the injection, switch treatment, or re-examine the diagnosis. The week-by-week guide is in the PRP aftercare instructions.

How we decide between PRP, corticosteroid, hyaluronic acid, and surgery

A thoughtful diagnosis-specific ladder looks like this:

• Acute or inflammatory joint pain. Cortisone is usually the correct first choice — rapid onset, strong anti-inflammatory effect, covered by insurance. PRP is not an acute anti-inflammatory.
• Chronic tendinopathy not responsive to physical therapy. PRP is a reasonable option for some tendons, such as the plantar fascia and the gluteal tendons, and a poor bet for others, such as the Achilles. Cortisone provides short-term relief, but in tendinopathy trials that advantage disappears or reverses by 6 to 12 months (Coombes 2010).
• Mild-to-moderate knee OA with symptoms beyond PT. Options include cortisone (rapid, usually covered, strongly recommended by the ACR guideline), hyaluronic acid (one to five injections depending on the product, coverage varies by plan, conditionally recommended against by the ACR), or PRP (self-pay, strongly recommended against by the ACR and OARSI, rated Limited by the AAOS). We discuss all three.
• End-stage OA with mechanical deformity. Orthopedic referral for joint replacement.
• Spine pain. PRP is not the evidence-based choice. See epidural steroid injections, medial branch blocks, and radiofrequency ablation.

Book an honest PRP consultation

Modal Pain Management is located at 369 Lexington Avenue, Floor 25, New York, NY 10017. Dr. Alexander Movshis performs all PRP procedures personally under ultrasound or fluoroscopic guidance. Consultation includes a full review of your imaging, an honest discussion of whether PRP is the right choice (it often is not), and — if PRP is appropriate — transparent self-pay pricing with no packages or pressure.

Verify insurance and schedule a consultation or call (646) 290-6660.

Our practice difference

We do not market PRP as a cure-all. We do not bundle it into membership programs. We do not upsell stem cell, amniotic, or unregulated biologic products. We do perform every injection with image guidance, document procedure accuracy, and follow up with a reassessment at three months to decide whether the biology actually worked for you. If a cortisone injection, hyaluronic acid series, or referral to orthopedic surgery is the better answer, we will tell you so — even if it means you pay us less.

References

• Mishra AK, Skrepnik NV, Edwards SG, et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med. 2014;42(2):463–71. doi:10.1177/0363546513494359 · PubMed
• Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med. 2013;41(2):356–64. doi:10.1177/0363546512471299 · PubMed
• Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jensen P, Ellingsen T. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial. Am J Sports Med. 2013;41(3):625–35. doi:10.1177/0363546512472975 · PubMed
• 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;326(20):2021–2030. doi:10.1001/jama.2021.19415 · PubMed
• Filardo G, Di Matteo B, Di Martino A, et al. Platelet-Rich Plasma Intra-articular Knee Injections Show No Superiority Versus Viscosupplementation: A Randomized Controlled Trial. Am J Sports Med. 2015;43(7):1575–82. doi:10.1177/0363546515582027 · PubMed
• Andia I, Maffulli N. Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Nat Rev Rheumatol. 2013;9(12):721–30. doi:10.1038/nrrheum.2013.141 · PubMed
• Filardo G, Previtali D, Napoli F, Candrian C, Zaffagnini S, Grassi A. PRP Injections for the Treatment of Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials. Cartilage. 2021;13(1_suppl):364S–375S. doi:10.1177/1947603520931170 · PubMed
• Belk JW, Kraeutler MJ, Houck DA, Goodrich JA, Dragoo JL, McCarty EC. Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2021;49(1):249–260. doi:10.1177/0363546520909397 · PubMed
• Fitzpatrick J, Bulsara M, Zheng MH. The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy: A Meta-analysis of Randomized Controlled Clinical Trials. Am J Sports Med. 2017;45(1):226–233. doi:10.1177/0363546516643716 · PubMed
• 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. J Bone Joint Surg Am. 2017;99(20):1769–1779. doi:10.2106/JBJS.16.01374 · PubMed
• Kesikburun S, Tan AK, Yilmaz B, Yaşar E, Yazicioğlu K. Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up. Am J Sports Med. 2013;41(11):2609–16. doi:10.1177/0363546513496542 · PubMed
• Peerbooms JC, Lodder P, den Oudsten BL, Doorgeest K, Schuller HM, Gosens T. Positive Effect of Platelet-Rich Plasma on Pain in Plantar Fasciitis: A Double-Blind Multicenter Randomized Controlled Trial. Am J Sports Med. 2019;47(13):3238–3246. doi:10.1177/0363546519877181 · PubMed
• Hurley ET, Shimozono Y, Hannon CP, Smyth NA, Murawski CD, Kennedy JG. Platelet-Rich Plasma Versus Corticosteroids for Plantar Fasciitis: A Systematic Review of Randomized Controlled Trials. Orthop J Sports Med. 2020;8(4):2325967120915704. doi:10.1177/2325967120915704 · PubMed
• Fitzpatrick J, Bulsara MK, O’Donnell J, McCrory PR, Zheng MH. The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection. Am J Sports Med. 2018;46(4):933–939. doi:10.1177/0363546517745525 · PubMed
• Atchia I, Ali M, Oderuth E, Holleyman R, Malviya A. Efficacy of Platelet-Rich Plasma Versus Placebo for the Treatment of Greater Trochanteric Pain Syndrome: A Double-Blinded Randomized Controlled Trial. J Bone Joint Surg Am. 2025;107(5):444–451. doi:10.2106/JBJS.24.00763 · PubMed
• Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol. 2020;72(2):220–233. doi:10.1002/art.41142 · PubMed
• Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578–1589. doi:10.1016/j.joca.2019.06.011 · PubMed
• American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Knee (Non-Arthroplasty): Evidence-Based Clinical Practice Guideline, 3rd Edition. 2021. aaos.org/oak3cpg
• Karjalainen TV, Silagy M, O’Bryan E, Johnston RV, Cyril S, Buchbinder R. Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain. Cochrane Database Syst Rev. 2021;9(9):CD010951. doi:10.1002/14651858.CD010951.pub2 · PubMed
• Antunes Júnior CR, Santos RSS, Barreto ESR, et al. Platelet-Rich Plasma Does Not Improve Pain or Function in Patients With Lateral Epicondylitis as Compared With Placebo: A Meta-analysis of Randomized Clinical Trials. Am J Sports Med. 2026;54(5):1247–1257. doi:10.1177/03635465251383039 · PubMed
• Dragoo JL, Wasterlain AS, Braun HJ, Nead KT. Platelet-rich plasma as a treatment for patellar tendinopathy: a double-blind, randomized controlled trial. Am J Sports Med. 2014;42(3):610–8. doi:10.1177/0363546513518416 · PubMed
• Scott A, LaPrade RF, Harmon KG, et al. Platelet-Rich Plasma for Patellar Tendinopathy: A Randomized Controlled Trial of Leukocyte-Rich PRP or Leukocyte-Poor PRP Versus Saline. Am J Sports Med. 2019;47(7):1654–1661. doi:10.1177/0363546519837954 · PubMed
• de Vos RJ, Weir A, van Schie HTM, et al. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010;303(2):144–9. doi:10.1001/jama.2009.1986 · PubMed
• Zuo A, Gao C, Jia Q, et al. Platelet-Rich Plasma Versus Corticosteroids in the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil. 2025;104(7):613–621. doi:10.1097/PHM.0000000000002677 · PubMed
• Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376(9754):1751–67. doi:10.1016/S0140-6736(10)61160-9 · PubMed
• Le ADK, Enweze L, DeBaun MR, Dragoo JL. Current Clinical Recommendations for Use of Platelet-Rich Plasma. Curr Rev Musculoskelet Med. 2018;11(4):624–634. doi:10.1007/s12178-018-9527-7 · PubMed
• Beitzel K, Allen D, Apostolakos J, et al. US definitions, current use, and FDA stance on use of platelet-rich plasma in sports medicine. J Knee Surg. 2015;28(1):29–34. doi:10.1055/s-0034-1390030 · PubMed
• Fadadu PP, Mazzola AJ, Hunter CW, Davis TT. Review of concentration yields in commercially available platelet-rich plasma (PRP) systems: a call for PRP standardization. Reg Anesth Pain Med. 2019;44(6):652–659. doi:10.1136/rapm-2018-100356 · PubMed
• Maricar N, Parkes MJ, Callaghan MJ, Felson DT, O’Neill TW. Where and how to inject the knee — a systematic review. Semin Arthritis Rheum. 2013;43(2):195–203. doi:10.1016/j.semarthrit.2013.04.010 · PubMed
• Busse P, Vater C, Stiehler M, et al. Cytotoxicity of drugs injected into joints in orthopaedics. Bone Joint Res. 2019;8(2):41–48. doi:10.1302/2046-3758.82.BJR-2018-0099.R1 · PubMed
• Centers for Medicare & Medicaid Services. Local Coverage Determination L38937: Platelet Rich Plasma (applies to New York). Revision effective April 1, 2026. cms.gov
• UnitedHealthcare. Prolotherapy and Platelet Rich Plasma Therapies. Commercial Medical Policy 2026T0498CC, effective January 1, 2026. uhcprovider.com