Platelet-Rich Plasma in the Treatment of Musculoskeletal Disease in 2025 and Beyond

Platelet-rich plasma (PRP) is a blood-based orthobiologic used to treat a myriad of musculoskeletal conditions. While in vitro and preclinical studies on PRP have been promising, clinical results have been mixed. The heterogeneity in clinical benefits is attributable to both the complexity and variability of PRP as a biologic as well as the diversity of targeted tissues and ailments. Many variables have been proposed to affect PRP's bioactivity and clinical effects, with differing levels of evidence demonstrated for each variable. These variables can be broadly categorized as biological, technical, and abnormality-specific factors. Additionally, insufficient characterization of PRP in clinical studies has been a major limitation in both determining the efficacy of PRP for a given clinical condition and understanding the basic biology of PRP. This review highlights the current landscape of PRP as a treatment of musculoskeletal conditions, including both the regulatory environment and clinical applications, and considers the influence of numerous factors affecting PRP's bioactivity and clinical effects. Emerging technologies that may further enhance the utility of PRP as an orthobiologic are also discussed. Rigorous basic, translational, and clinical research remains fundamental to realize the promise of PRP treatment for musculoskeletal disease.