PRP in MSK Medicine: Key Insights from Dr. Nathan Thakur’s Learning Session

The field of regenerative and musculoskeletal (MSK) medicine has advanced rapidly over the last decade, with Platelet-Rich Plasma (PRP) emerging as one of the most evidence-supported interventions for osteoarthritis and tendinopathy. To support primary care clinicians navigating the growing landscape of orthobiologics, Alethea recently hosted a virtual learning session with Dr. Nathan Thakur, a Calgary-based physician specializing in regenerative MSK medicine.

This article provides an overview of the core concepts covered in the session, including the evolving science of PRP, appropriate patient selection, and practical considerations for primary care providers integrating regenerative approaches into clinical practice.

Understanding the Growing Field of Regenerative MSK Medicine

Regenerative MSK medicine focuses on biologic treatments that support tissue repair, reduce inflammation, and enhance functional recovery. PRP—prepared by centrifuging a patient’s own blood to concentrate platelets and growth factors—is now widely studied for its potential to support tendon healing and slow degenerative joint changes.

Dr. Thakur outlined several reasons for the field’s continued growth:

• Increasing patient interest in joint preservation and alternatives to repetitive corticosteroid injections
• Expanding clinical evidence, with over 1,000 PRP-related studies published annually
• Greater awareness of the limitations of steroid-based management for chronic MSK conditions
• Technological advancements in biologic preparation and ultrasound-guided intervention

For primary care clinicians, these developments raise important questions about when regenerative interventions are appropriate, what evidence supports their use, and how to identify patients likely to benefit from specialist referral.

Why PRP? Evidence and Clinical Rationale

A central focus of the learning session was clarifying what PRP can and cannot treat. While the public perception of PRP ranges from highly promising to overly hyped, controlled trials increasingly support specific use cases.

1. Osteoarthritis (OA)

PRP demonstrates its strongest evidence in mild to moderate knee OA, with multiple randomized trials showing improvements in pain and function lasting up to 12–24 months. Early intervention before advanced cartilage degeneration appears to optimize outcomes.

Emerging data also supports PRP use in glenohumeral OA, particularly for patients seeking to reduce reliance on corticosteroids.

2. Tendinopathy

PRP has demonstrated benefit in well-defined tendon pathologies, including:

• Lateral epicondylitis
• Gluteal tendinopathy
• Rotator cuff tendinosis and partial-thickness tears

However, as Dr. Thakur emphasized, PRP is less effective in:

• Insertional Achilles tendinopathy
• Patellar tendinopathy
• Split-thickness tendon tears
• Advanced degenerative conditions

These distinctions underscore the importance of accurate diagnosis, imaging, and biomechanical assessment before considering PRP.

Not All PRP Is the Same: Understanding Quality and Variability

A key educational point from the session was the substantial variability in PRP quality across commercial systems. Clinicians may be surprised to learn that many PRP devices do not meet the platelet concentration thresholds required for therapeutic effect.

Studies have shown:

• Only a portion of available PRP systems reliably produce true platelet-rich preparations
• Some systems may yield platelet-poor plasma or fail to concentrate platelets altogether
  
  
• Variability in leukocyte content, platelet dose, and processing can significantly influence patient outcomes

For family physicians discussing PRP with patients, or recommending referral, this highlights the need to understand how preparation methods and injection technique influence clinical effectiveness.

Ultrasound-Guided Technique: A Non-Negotiable Element of Care

Dr. Thakur reinforced that ultrasound-guided delivery is essential for accuracy, especially in tendon injections or small joint spaces. Evidence shows that blind injections frequently miss the intended target, reducing efficacy and increasing the likelihood of repeat procedures.

His practice routinely integrates:

• High-resolution ultrasound for diagnosis and procedural planning
• Real-time image guidance during injections
• Structured post-procedure rehabilitation pathways coordinated with physiotherapy

This multidisciplinary approach is central to achieving optimal regenerative outcomes.

When to Refer: Practical Guidance for Primary Care Physicians

Primary care providers frequently encounter patients who may benefit from regenerative assessment, particularly when conservative measures have been exhausted.

Referral may be appropriate for:

• Mild to moderate knee or shoulder OA
• Tendinopathy that persists after structured physiotherapy
• Partial-thickness rotator cuff tears
• Gluteal tendinopathy with significant functional limitation
• Younger or active patients seeking joint-preservation strategies

Not ideal candidates include those with:

• Severe OA (grade 3–4)
• Split-thickness tendon tears
• Poor rehabilitation adherence
• Conditions with limited evidence for PRP efficacy

Dr. Thakur emphasized the importance of ensuring appropriate conservative care (e.g., targeted exercise prescription) before pursuing regenerative interventions.

Future Directions in Regenerative Medicine

As an educator and clinician deeply engaged in the field, Dr. Thakur shared insight into emerging innovations that may shape MSK care over the next decade, including:

• Next-generation PRP formulations
• Platelet lysate and advanced biologic derivatives
• Autologous and allogeneic stem cell approaches
• Exosome-based therapies
• Novel biologic scaffolds and hydrogels

While many of these therapies remain experimental or restricted by regulatory frameworks, they highlight the trajectory of regenerative treatment in chronic MSK disease.

Conclusion: Bringing Clarity to an Evolving Therapeutic Landscape

Dr. Thakur’s learning session offered a clear, evidence-based, clinically grounded perspective on PRP for MSK conditions. As regenerative medicine continues to expand, primary care providers play a critical role in early identification, patient education, and appropriate referral for advanced therapy when indicated.

For clinicians interested in a deeper dive into the session content, including detailed condition-specific recommendations and technical considerations, the full notes are available below.

Click here to read the full learning session notes. Alethea users can request the recording by emailing sales@aletheamedical.com.

Not registered? You can sign up for free here.