Marc Darrow, MD, JD.

PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration.

A February 2021 study (1) tested how effective and safe a single intraarticular injection of platelet-rich plasma was for patients with ankle arthritis.

  • Thirty-nine patients with symptomatic ankle osteoarthritis were assessed.
  • These patients had ankle osteoarthritis for at least six months
  • The patients received a single injection of PRP (3 mL) into symptomatic ankles.

The goal of the study was to see how these patients did at six months after the single shot.

  • Results: Significantly improvement in the pain and function scores were noted at 1-, 3-, and 6-month follow-ups.
  • Acetaminophen consumption dropped significantly and no serious adverse events occurred.
  • The study showed promise for a single intraarticular injection of PRP in the treatment of ankle ankle arthritis.

Conflicting results

A May 2023 review study (2) assessed the efficacy of PRP for ankle osteoarthritis treatment. Three studies from meta-analysis and two individual studies were included, which consisted of one random control study and four before-after comparison studies. In guarded outcomes, the authors found compared to before treatment, PRP significantly reduced VAS (Visual Analogue Scale, Pain scale of 0 – 10 patient reported outcomes) with a summary that “PRP may beneficially improve pain and functional scores for ankle osteoarthritis in a short-term period.”  However they also note: “Treatments of ankle ankle osteoarthritis with various PRP preparations seemed to be effective, in terms of pain and function, when compared with before treatment. With very low quality of evidences, high costs, and diverging settings, PRP is weakly recommended for ankle osteoarthritis as an alternative or adjunct therapy after failed conservative treatment. Its benefits would be attained approximately 12 weeks after injection with acceptable minor complications.”

An August 2023 review study (3) of prior peer review research suggested “Intra-articular PRP injections, compared with placebo injections, did not significantly improve ankle symptoms and function over the course of 52 weeks in patients with ankle osteoarthritis. The results of this study do not support the use of PRP injections for posttraumatic ankle osteoarthritis, which is common in athletes.” The authors however cautioned that “. . . the studies reviewed had considerable methodological limitations (such as small sample sizes, few placebo-controlled studies, and other risk-of-bias concerns) and therefore low level of evidence, which necessitates caution when interpreting these results.”

A May 2023 systematic review (4) “revealed that PRP applied alone or combined with other treatments was safe and effective for the talar cartilage repair in patients with osteoarthritis or talus cartilage injury. There were almost no reports of adverse events related to PRP intervention. As an adjunct to talar-cartilage-related surgery, PRP could improve postoperative function and pain intensity more than saline, HA and (other treatments).

An August 2023 study (5) assessed four previously published studies with a total of 127 patients, (about 56 years old, 60 men and 67 women).

  • Short-term follow-up results suggested significant improvement of the American Orthopaedic Foot and Ankle Society (AOFAS) score in the PRP injection group compared to the control group.
  • Consistently, there was a statistical difference in AOFAS score between PRP injection and control groups in the final follow-up (more than 6 months).
  • Furthermore, we found a significant reduction in VAS scores in the PRP groups at both the short-term follow-up and the more than six months follow-up
  • The improvement of AOFAS and VAS scores at more than six months follow-up reached the minimal clinically important difference (MCID).

Conclusion: “This meta-analysis supports the safety of PRP intra-articular injection for ankle osteoarthritis.” The authors did note a concern that improvements in the outcomes scores in the PRP group at short-term follow-up do not exceed the MCID to be clinically significant and it should be noted that PRP injection provides significant improvement  more than six months follow-up.”

A July 2024 study, (6) citing that  high-quality evidence supporting the use of PRP with lateral epicondylitis and knee osteoarthritis to accelerate the healing process and decrease pain, sought to determine if the injection of PRP relieved pain faster and improved function compared with no injection or placebo in patients with a lateral ankle sprain. In examining the data of three previously published studies, the researchers found: “PRP injection reduces pain and increases function after lateral ankle sprain 5 to 8 weeks after intervention. . . The use of PRP after lateral ankle sprain to decrease pain and increase function is supported with moderate evidence.”

A study conducted in December 2024 (7) analyzed patient data from ten different studies and concluded that PRP injections was not more effective than placebo in symptom control in various ankle diseases. Nevertheless, a subgroup analysis indicated a more significant effect in patients with talar cartilage injuries. Additionally, the efficacy of PRP treatment persisted during long-term follow-up. PRP reduced patients’ pain, showing a greater benefit for those with talar cartilage injuries.

Comparing PRP and Prolotherapy
in treating ankle arthritis pain

In 1997 I began practicing regenerative medicine for musculoskeletal problems by offering Prolotherapy. Prolotherapy is the injection of a simple sugar (dextrose). I found the newer, far more effective techniques of Stem Cell Therapy and Platelet-Rich Plasma (PRP) Therapy are actually more advanced versions of Prolotherapy, which is short for “proliferation therapy” (the proliferation of new cells following the injection of a substance that will stimulate new tissue growth).

A little more than 10 years later I started to use PRP or platelet rich plasma therapy. PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The platelets contain healing agents, or “growth factors.”  The collected platelets are then injected back into the injured area to stimulate healing and regeneration. The platelets contain healing agents, or “growth factors.” Even though I found both these treatments effective and used both treatments on myself, I began to favor using PRP because of the clinical evidence we were seeing of its superior healing power.

A July 2019 study (8) compared PRP and Prolotherapy. Here is what the study reported:

“Osteochondral lesions of talus are among the most common ankle problems. Platelet-rich plasma (PRP) and prolotherapy are 2 successful injection-based techniques for treatment of chronic musculoskeletal problems. The aim of the present study was to compare PRP and prolotherapy injections for the management of osteochondral lesions of talus.”

This was a retrospective cohort study of 49 patients with osteochondral lesions of talus symptoms of more than 6 months who had been refractory (not responsive) to 3 months of treatment using (other) conservative methods.

The patients were divided into 2 groups:

Prolotherapy injections – 27 patients got the dextrose Prolotherapy shots and 22 received the PRP injections.

The patients were given 3 injections of 4 mL solution into periarticular and intra-articular ankle joint spaces.

After treatment, patients were evaluated via Visual Analogue Scale (VAS), American Orthopedic Foot and Ankle Society Score (AOFAS), and Ankle Osteoarthritis Scale (AOS) at baseline and 21 days, 90 days, 180 days, and 360-day follow-up periods.

RESULTS: Both PRP and Prolotherapy treatments resulted in greater improvement in pain and ankle functions at follow-up periods extending to 1 year and there was no difference between the groups for the outcomes at follow-up periods. Excellent or good outcomes were reported by 88.8% of the patients in Prolotherapy group and 90.9% of the patients in PRP group.

Contact us and related articles

If you have chronic ankle pain, have had painkillers, physical therapy, and other conservative care options that have not helped, and, now you are being told to have surgery. We may be able to help reduce pain and increase function.

Regenerative medicine injections may be an alternative for you. Many people benefit from these treatments, but, they do not work for everyone. Will it work for you?

Call for a free phone consultation with our staff.
800-300-9300 or 310-231-7000 or email

Other articles 

Continued ankle instability after arthroscopic lateral ligament repair | Joint Rehab Los Angeles

Ankle pain and avascular necrosis of the talus

Stem cell therapy and ankle osteoarthritis injections | Joint Rehab Los Angeles

 

Citations for this article:

1 Sun SF, Hsu CW, Lin GC, Lin HS, Chou YJ, Wu SY, Huang HY. Efficacy and safety of a single intra-articular injection of platelet-rich plasma on pain and physical function in patients with ankle osteoarthritis—a prospective study. The Journal of Foot and Ankle Surgery. 2021 Jul 1;60(4):676-82.
2 Laohajaroensombat S, Prusmetikul S, Rattanasiri S, Thakkinstian A, Woratanarat P. Platelet-rich plasma injection for the treatment of ankle osteoarthritis: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2023 May 19;18(1):373.
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4 Peng J, Wang Q, Xu Y, He H. Platelet-rich plasma treatment for talar cartilage repair: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2023 Dec;24(1):1-1.
5 Ding SL, Ji LF, Zhang MZ, Xiong W, Sun CY, Han ZY, Wang C. Safety and efficacy of intra-articular injection of platelet-rich plasma for the treatment of ankle osteoarthritis: a systematic review and meta-analysis. International Orthopaedics. 2023 Mar 21:1-2.
6 Frey E, Brown CD, Tripp B. Effectiveness of Platelet-Rich Plasma in Reducing Pain and Increasing Function After Acute Lateral Ankle Sprain: A Critically Appraised Topic. Journal of Sport Rehabilitation. 2024 Jul 12;1(aop):1-4.
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8 Akpancar S, Gül D. Comparison of platelet rich plasma and prolotherapy in the management of osteochondral lesions of the talus: A retrospective cohort study. Medical science monitor: international medical journal of experimental and clinical research. 2019;25:5640.