Platelet-Rich Plasma in Painful Musculoskeletal Disorders: Updated Biologic Mechanisms and Clinical Evidence

초록

Platelet-rich plasma (PRP) is increasingly understood not as a simple growth factor concentrate but as a family of orthobiologics that modulate diseased tissue microenvironments. This review summarizes updated PRP biology and current evidence in painful musculoskeletal disorders. Recent mechanistic studies emphasize immunomodulation, neuro-immune signaling, extracellular vesicles, and disease-specific microenvironmental effects beyond hemostatic scaffold and growth factor delivery. In knee osteoarthritis, PRP appears to function primarily as an intra-articular microenvironment modifier through macrophage plasticity, BDNF/TrkB signaling, and platelet-derived small extracellular vesicles. In tendinopathy, PRP may induce a transient inflammatory reset, matrix remodeling, and collagen realignment, although needling-related micro-injury and leukocyte variability remain important confounders. Clinical support is strongest for selected patients with knee osteoarthritis and lateral epicondylitis, but remains mixed or weak for rotator cuff disease, Achilles tendinopathy, hamstring strain, and intradiscal use. Disease-specific formulation and transparent reporting are essential.

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