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

product prepared by centrifugation to concentrate platelets above baseline whole-blood values.Early modern clinical use expanded from oral and maxillofacial surgery into sports medicine and orthopaedics after the landmark reports of Marx and Anitua, and the subsequent basic-science review by Foster et al. linked PRP to tendon, ligament, muscle, and bone healing [1-3].However, the field also learned early that PRP is not a single standardized substance.Dohan Ehrenfest et al. demonstrated that platelet concentrates differ materially according to leuko-cyte content and fibrin architecture, while later classification systems and recent consensus statements emphasized the need to report platelet count, leukocyte count, red blood cell contamination, activation method, and matrix characteristics [4,5].This shift in reporting standards reflects a broader conceptual shift.The classical explanation for PRP was that activated platelets release growth factors such as platelet-derived growth factor, transforming growth factor-β, and vascular endothelial growth factor, thereby accelerating tissue repair.That explanation remains partly correct, but it is incomplete.Contemporary literature increasingly frames PRP as a complex orthobiologic that modifies the local tissue microenvironment through coor-