AAPM &R guidance statement on platelet rich plasma for knee osteoarthritis

BACKGROUND: The current nonoperative standard-of-care therapies for knee osteoarthritis (OA) include weight reduction, physical therapy, analgesics, optimization of biomechanics, and intra-articular injection of corticosteroids. Platelet rich plasma (PRP) is an orthobiologic intervention that is increasingly used in patients with knee OA, primarily due to its many key mediators that can potentially reduce joint inflammation thereby improving pain and enhancing overall joint function. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) convened a technical expert panel (TEP) to summarize and assess the evidence for use of PRP in patients with knee OA and synthesize current knowledge into a summary document that can serve as a resource for clinicians. We address many of the questions and decision points that practitioners need to consider for responsible use of PRP in knee OA. OBJECTIVE: To develop consensus-based practice recommendations to identify and address gaps in PRP applications in patients with knee OA. METHODS: The AAPM&R orthobiologic TEP initiated development of this consensus guidance statement in March 2023. The TEP was responsible for formulating search terms and research questions and synthesizing evidence obtained from a structured literature review that was initially completed in April 2023 and subsequently updated to reflect studies published between May 2023 and June 2025. The recommended actions and best practices in this guidance reflect consensus being achieved by the expert physiatrists and supported by best available evidence, where available. These actions and practices were conceptualized in response to common questions this expert panel frequently encounter in the use and administration of PRP. The TEP was asked to consider the strengths and limitations of available evidence and augment with expert opinion focused on closing knowledge gaps guiding the delivery of PRP in patients with knee OA. RESULTS: As a result of the structured literature review and use of a modified Delphi process to achieve consensus on clinical guidance for PRP use in patients with knee OA, the AAPM&R TEP on use of PRP in knee OA arrived at five evidence-based clinical recommendations for PRP management and 11 consensus-based best practices supported by expert opinion and limited evidence. CONCLUSION: This consensus guidance addresses common questions about the use of PRP in patients with knee OA and provides actionable recommendations and best practices based on expert opinion supported by best available evidence. Despite their growing availability as point-of-care interventions, orthobiologic therapies remain an evolving area of practice. Robust, dose-dependent randomized controlled trials are needed to more clearly establish the clinical effects of PRP on patient outcomes. Clinical judgment should be exercised and management options tailored to individual patient needs, preferences, and risk profiles.