Show Me the Evidence for PRP and BMA
- cassis101
- Sep 29
- 4 min read
Updated: Oct 7
By Deborah Westergaard, MD | Pain Experts | Dallas–Plano
In the doctor’s lounge last week, a knee-replacement surgeon claimed that orthobiologic treatments “aren’t based on peer-reviewed randomized trials.” He also mentioned that “many are from China” and that “the rest come from financially interested entities.”
Let’s take a step back. Every serious study has funding and paid contributors. This includes universities (grants, indirects, salaries), pharmaceutical companies (R&D), device companies (investigator support), and independent clinical networks like Regenexx. The real question isn’t “Was anyone paid?” Instead, we should ask: Is the science high-quality and transparent? Are the dose, product characterization, and methods clear? Were appropriate controls used? Were outcomes measured at meaningful time points?
Solution → Curate High-Quality Studies, Define “Real vs. Fake PRP,” and Practice with Intention
1) Is there Level-I Evidence for PRP in knee OA?
Yes, multiple randomized controlled trials (RCTs) and meta-analyses show that PRP often outperforms hyaluronic acid (HA) and steroids for pain and function in knee osteoarthritis (OA). This is especially true when the platelet dose is adequate and protocols are standardized. Recent evidence includes:
A meta-analysis of double-blinded RCTs (2025, Arthroscopy) found that PRP showed superior outcomes compared to HA. The review also discusses BMAC versus HA across Level-I studies.
A randomized trial comparing PRP and HA (Lana et al.) showed that PRP produced greater VAS and WOMAC improvements for up to 12 months.
A 2025 clinical review of RCTs and meta-analyses indicated that PRP is generally more effective than HA and steroids for pain reduction and function.
AAOS documents provide context, noting that technology overviews and clinical practice guidelines (CPG) highlight inconsistent protocols in the literature. This inconsistency is a key reason why standardization matters, rather than a blanket dismissal of the treatments.
Dose matters (“real vs. fake PRP”): Trials with too-low platelet counts can underperform and be labeled as “negative.” Higher, clearly reported doses correlate with better outcomes. For example, a study specifying approximately 10 billion platelets in 8 mL reported functional gains and structural protection signals.
2) What about bone marrow–based care for knee OA?
A study by Hernigou et al. (2021) found that subchondral BMC in patients with bilateral OA postponed or avoided arthroplasty more effectively than the contralateral intra-articular injection. This underscores the importance of targeting. Long-term follow-up identified bone-marrow-lesion patterns that predict arthroplasty risk.
Recent prospective data shows that a four-year follow-up after intra-articular BMAC reported durable functional improvement. Growing RCT and registry literature is emerging.
https://www.nature.com/articles/s41598-024-51410-2.pdf
3) Is there Spine Evidence (Discogenic Pain)?
A prospective RCT by Tuakli-Wosornu, Lutz et al. showed that intradiscal PRP improved pain and function compared to control, maintaining gains at one year. Subsequent studies and a two-year RCT indicate benefits, although some heterogeneous or negative trials remind us that technique and selection are critical.
4) But What About Conflicts of Interest (COI)?
Conflicts of interest exist across all modern research ecosystems, including academic medical centers (grant overhead, promotion, intellectual property), pharmaceutical companies, device manufacturers, and independent networks. What matters is disclosure, methodology, and reproducibility. Large longitudinal registries that iterate protocols over time, such as Regenexx’s 20-year orthopedic registry, are valuable for safety and outcomes surveillance. They also help with pragmatic optimization, even as RCTs continue.
The bottom line is that the literature in orthobiologics is not “absent”; it’s uneven. Quality correlates with dose, product characterization, targeting, and study design. Dismissing the field because some studies are under-dosed or poorly described is akin to dismissing antibiotics because someone studied a placebo dose.
How We Operationalize This
Excellence, Quality, Resilience, and Transformation
Precision protocols: We calibrate PRP doses to age and tissue needs, separating components intentionally because timing matters.
Anatomy-first targeting: For knees, we address not only the joint space but also subchondral bone or supportive structures when indicated by imaging and examination. This site selection can change outcomes.
Transparent expectations: Orthobiologics are not guaranteed cures. They are evidence-supported options that may reduce pain and improve function, particularly for motivated patients seeking to delay or avoid more invasive procedures.
Safety & stewardship: Long-running outcomes tracking and complication monitoring inform ongoing improvements.
Regenexx Patient Database Tracking for 20 years.
Call Us to Schedule Your Clinical Evaluation
If you’re a driven professional aiming to stay active without jumping straight to replacement, schedule a consult at my regenerative medical facility. We’ll review your imaging, examine the stabilizing structures that often get ignored, and discuss right-sized biologic options—without promises, pressure, or shortcuts.
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