---
title: "PRP Vs Corticosteroid Injections: The Evidence"
description: "What the published evidence shows when PRP is compared with corticosteroid injection in musculoskeletal care, and how to read the trials critically."
url: "https://regenmedacademy.com/prp-vs-corticosteroid-injections-the-evidence/"
---

# PRP vs corticosteroid injections: what the evidence shows for musculoskeletal care

- [Oscar Tellez](https://regenmedacademy.com/oscar-tellez/)
- June 3, 2026

![Syringe labeled prp and a steroid vial on a table while a clinician reviews injection options with a patient in an exam room](https://regenmedacademy.com/wp-content/uploads/2026/09/PRP-vs-corticosteroid-injections_-what-the-evidence-shows-for-musculoskeletal-care-r3.webp)

*Written by [Oscar Tellez](https://regenmedacademy.com/oscar-tellez/), founder of Regen Med Academy. Oscar is not a clinician. This post is education for licensed providers and is not medical advice. Last updated November 4, 2026.*

Corticosteroid injections and PRP injections are both used for joint and tendon pain, and they work in different ways. Injectable corticosteroids are FDA-approved anti-inflammatory drugs. PRP, or platelet-rich plasma, is made from the patient’s own blood. The devices that prepare it are FDA cleared for use with bone graft material, so injecting it into a joint or tendon is off-label, and what it does in that tissue is still being studied. This guide walks clinicians through what named trials and guidelines report about each option, and who answers the cost and coverage questions.

**Summary:** Corticosteroids are FDA-approved drugs, and the triamcinolone acetonide label describes intra-articular use as short-term therapy. In a two-year trial, repeated triamcinolone injections led to more knee cartilage loss than saline. PRP devices are FDA cleared only for bone graft handling, so musculoskeletal PRP injections are off-label. In the pooled tennis elbow trials linked below, corticosteroid groups had lower pain scores in the first two months and PRP groups had lower pain scores after six months. That pattern does not hold for every condition: the knee and Achilles trials linked below found no difference between PRP and placebo. Coverage depends on the plan. Outcomes vary in every patient.

Picture two patients with knee pain on the same morning, both asking for an injection. The first asks for the steroid shot a neighbor had. The second saw PRP mentioned on social media and asks about that instead. Neither knows how differently the two injections are made and regulated.

This guide sets out what each injection is, how each is regulated, what named trials and guidelines found, and what to cover when you counsel a patient. It does not recommend either injection.

**Important Disclaimer**

Regenerative Medicine Academy (RMA) is an education company providing training for licensed clinicians. This article is educational and does not constitute medical advice, legal counsel, or any guarantee of clinical outcomes. Techniques discussed may involve off-label use of FDA-cleared devices and are subject to state and federal regulations. Clinicians are responsible for understanding FDA regulatory status, scope of practice, informed consent, and malpractice implications before using any technique. Individual clinical judgment and patient-specific factors must guide all clinical decisions.

## **FDA regulatory status: the place to start**

Before talking about results, clinicians need to know how each injection sits with the FDA. This shapes everything from informed consent to malpractice exposure.

Several injectable corticosteroids are FDA-approved drugs, and each product’s label sets its approved uses. The [FDA label for triamcinolone acetonide injectable suspension](https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/014901s042lbl.pdf) (revised July 2014, as posted on FDA’s site when we checked on November 4, 2026) lists intra-articular or soft tissue use “as adjunctive therapy for short-term administration” in conditions that include acute and subacute bursitis, epicondylitis and osteoarthritis. A use outside a product’s label is off-label, even for an approved drug.

PRP sits in a different place. PRP preparation devices reach the market through the FDA’s 510(k) pathway, which is a clearance, not a drug approval. FDA’s [product classification for these devices](https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPCD/classification.cfm?ID=ORG) (product code ORG, when we checked on November 4, 2026) describes them as for “preparation of autologous platelet rich plasma from a small sample of peripheral blood for mixing with bone graft to improve handling characteristics.” When clinicians inject PRP into a joint, tendon, or any other musculoskeletal tissue, that is off-label use.

**What this means in practice:** A corticosteroid injection for knee osteoarthritis can be an on-label use, depending on the product’s label. A PRP injection for knee osteoarthritis is an off-label use of a device cleared for a different purpose. Both need informed consent. The PRP consent must clearly note the off-label nature, the mixed evidence, and that outcomes vary. PRP for any musculoskeletal indication should never be described as “FDA-approved.”

## **How corticosteroids work, and what their label says**

Corticosteroids are powerful anti-inflammatory drugs. They bind to a receptor inside cells called the glucocorticoid receptor. Once bound, they suppress inflammatory signals like interleukin-1, interleukin-6, and tumor necrosis factor alpha. They also block phospholipase A2, which lowers production of prostaglandins and leukotrienes (the chemicals that drive pain and swelling). That is how they lower pain and swelling in the short term.

The FDA label for triamcinolone acetonide, linked above, describes intra-articular use as “short-term administration (to tide the patient over an acute episode or exacerbation).” It is an anti-inflammatory drug, and its label does not list cartilage or tendon repair among its uses.

Repeated dosing raises a separate question. The label says intra-articular injection “may result in damage to joint tissues,” and in the McAlindon trial covered below, an injection every 12 weeks for two years led to more cartilage loss than saline.

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## **What PRP is, and what is known about how it acts**

PRP is made from the patient’s own blood. A clinician draws a small amount of blood and runs it through a centrifuge to concentrate platelets. Platelets are tiny cell fragments that carry growth factors and signaling proteins.

PRP contains growth factors from platelets and from the plasma. Growth factors are signaling proteins. Which of them matter in a given tissue, and in what amounts, is still being studied.

Whether those signals change anything in a joint or tendon is what clinical trials test, and their results differ by condition. The trials linked in this post measured pain and function at set time points. RESTORE also measured knee cartilage volume and found no difference from saline at twelve months. PRP use in a joint or tendon is off-label, and outcomes vary.

## **The crossover pattern: where it was found and where it was not**

In pooled trials of tennis elbow, corticosteroid groups had lower pain scores in the first two months and PRP groups had lower pain scores after six months. That pattern was not seen in every condition. The RESTORE knee trial and an Achilles trial, both covered below, found no difference between PRP and placebo.

A [2025 meta-analysis by Maroun and colleagues](https://pubmed.ncbi.nlm.nih.gov/40077872/), published in *Clinics in Shoulder and Elbow*, pooled 26 randomized controlled trials (RCTs) covering 1,877 patients with lateral epicondylitis (tennis elbow). Below two months, pain on the visual analog scale (VAS) favored corticosteroids, with a mean difference of 0.67 points. Between two and six months, the two did not differ significantly. Beyond six months, pain scores favored PRP, with a mean difference of -1.60 (95% CI -2.01 to -1.20). An independent [2024 analysis by Xu and colleagues](https://pubmed.ncbi.nlm.nih.gov/38357713/) in the *American Journal of Sports Medicine*, covering 11 RCTs and 730 patients, reported the same direction under two months and at six months or more. PRP use for tennis elbow is off-label.

Plantar fasciitis does not follow the tennis elbow pattern exactly. A [2021 meta-analysis by Hohmann and colleagues](https://repository.up.ac.za/bitstream/handle/2263/83662/Hohmann_PlateletRich_2021.pdf?sequence=2) pooled 15 studies with 811 cases and found that pain scores favored PRP at three, six and twelve months, with no difference at one month. The authors wrote that the results “must be viewed with caution,” because several studies had a high risk of bias and PRP preparation varied. PRP use here is off-label.

For rotator cuff tendinopathy or partial tears, a [2025 meta-analysis by Alshahir and colleagues](https://orthopedicreviews.openmedicalpublishing.org/article/143581.pdf) in *Orthopedic Reviews* pooled 15 randomized trials. It found no significant difference in pain between PRP and corticosteroid and higher shoulder function scores in the PRP groups at 24 weeks, and it said more research is needed. PRP use here is off-label.

**What this means in practice:** When you read a comparison trial, check the time point. In the tennis elbow analyses, the answer depended on when pain was measured, and that finding does not carry over to another joint or tendon without its own trials.

## **Evidence by condition**

The evidence differs by condition, in direction as well as in strength. Each subsection below reports what a named source found.

### **Knee osteoarthritis: the most contested area**

Knee osteoarthritis has the largest and most conflicting literature. The [2021 RESTORE trial](https://pubmed.ncbi.nlm.nih.gov/34812863/), published in *JAMA*, randomized 288 patients to three weekly injections of leukocyte-poor PRP or saline. At twelve months, PRP did not differ from saline in pain or in medial tibial cartilage volume, and the authors wrote that the findings “do not support use of PRP for the management of knee OA.” The [2026 ACR guideline update](https://assets.contentstack.io/v3/assets/bltee37abb6b278ab2c/bltb3d12c34020da842/oa-guideline-summary-2026.pdf), approved by the ACR Board of Directors on September 8, 2026 and published as a summary ahead of the full papers, says: “In people with knee and hip OA, we strongly recommend against PRP treatment.”

One network meta-analysis points the other way. A [2024 network meta-analysis by Jawanda and colleagues](https://pubmed.ncbi.nlm.nih.gov/38331363/), published in *Arthroscopy*, looked at 48 studies covering 9,338 knees. PRP ranked highest by SUCRA score for combined pain and function at six months or more, ahead of bone marrow aspirate concentrate (a procedure RMA does not teach), hyaluronic acid, corticosteroids, and placebo. A SUCRA score is a ranking within the network. A high rank does not prove superiority, and PRP use here is off-label.

Meanwhile, corticosteroids face a safety signal in this joint. The 2017 [McAlindon trial in *JAMA*](https://pubmed.ncbi.nlm.nih.gov/28510679/) randomized 140 patients to 40 mg of triamcinolone or saline every 12 weeks for two years. The corticosteroid group lost more cartilage thickness (-0.21 mm versus -0.10 mm; between-group difference -0.11 mm, 95% CI -0.20 to -0.03), with no significant difference in pain. [Kompel and colleagues](https://pubmed.ncbi.nlm.nih.gov/31617798/), in a 2019 review in *Radiology*, described four adverse joint findings seen after hip and knee corticosteroid injections: faster osteoarthritis progression, subchondral insufficiency fracture, complications of osteonecrosis, and rapid joint destruction with bone loss.

### **Lateral epicondylitis: the cleanest pattern**

Lateral epicondylitis (tennis elbow) has the most consistent comparison data. In the Maroun and Xu meta-analyses linked above, pain scores favored corticosteroid under two months and favored PRP at six months or more. Epicondylitis is on the triamcinolone acetonide label; PRP use for it is off-label. Leukocyte-rich or leukocyte-poor: which preparation suits which use is not settled. Consensus statements and trials do not agree on one answer, so choose a preparation on purpose and record it. The corticosteroid label lists tendon rupture among adverse reactions and says to inject into the tendon sheath “rather than the tendon substance.”

### **Plantar fasciitis: a different early pattern**

In the Hohmann meta-analysis linked above, pain scores favored PRP at three, six and twelve months, with no difference at one month, and the authors asked readers to view the results with caution. PRP use here is off-label. Plantar fasciitis is not on the list of conditions in the triamcinolone acetonide label linked above, so check the label of the product you use.

### **Rotator cuff tendinopathy: no pain difference in pooled trials**

In the Alshahir meta-analysis linked above, pain did not differ between PRP and corticosteroid, and shoulder function scores were higher in the PRP groups at 24 weeks. The AAOS [Management of Rotator Cuff Injuries guideline](https://www.aaos.org/rccpg2025), published August 18, 2025, says “a single injection of corticosteroids with local anesthetic can be considered” for short-term improvement in pain and function in patients with shoulder pain (moderate strength). The same guideline says “The routine use of platelet rich plasma is not supported for the treatment of rotator cuff tendinopathy or partial tears” (limited strength). PRP use here is off-label.

### **Achilles tendinopathy: a counterweight**

Not every PRP indication has held up. In a [2021 *JAMA* trial by Kearney and colleagues](https://research.birmingham.ac.uk/files/143200394/jama_kearney_2021_oi_210046_1625860953.42983.pdf), 240 patients with chronic midportion Achilles tendinopathy received a single PRP injection or a sham injection. At six months there was no significant difference in the VISA-A score, and the authors wrote that the findings “do not support the use of this treatment for chronic midportion Achilles tendinopathy.” PRP use here is off-label, and the result is a reason to set expectations carefully for this tendon. The corticosteroid label linked above lists tendon rupture among adverse reactions.

### **Summary table**

Condition What the cited sources found Limits

Knee osteoarthritis RESTORE: PRP did not differ from saline in pain or cartilage volume at 12 months. Jawanda network meta-analysis: PRP ranked first by SUCRA at six months or more. 2026 ACR update: strongly recommends intraarticular glucocorticoid injections and strongly recommends against PRP Results conflict; a ranking does not prove superiority; PRP is off-label

Hip osteoarthritis 2026 ACR update: strongly recommends intraarticular glucocorticoid injections and strongly recommends against PRP. Kompel review: adverse joint findings after hip and knee corticosteroid injections No hip PRP trial is cited here; PRP is off-label

Lateral epicondylitis Maroun and Xu meta-analyses: pain favored corticosteroid under two months and PRP at six months or more PRP is off-label

Plantar fasciitis Hohmann meta-analysis: pain favored PRP at three, six and twelve months; no difference at one month Authors urge caution; risk of bias; PRP is off-label

Rotator cuff tendinopathy Alshahir meta-analysis: no pain difference; higher function scores with PRP at 24 weeks. 2025 AAOS guideline: routine PRP use not supported More research needed; PRP is off-label

Achilles tendinopathy Kearney trial: a single PRP injection did not differ from sham at six months One trial; PRP is off-label

The crossover pattern was found in tennis elbow. It was not found in the knee trial, the Achilles trial or the pooled rotator cuff pain results cited here, and the plantar fasciitis analysis showed no early corticosteroid advantage. Counseling should present the trials that found no difference as well as the ones that found one.

## **Safety: what to know about each**

Neither injection is risk-free, and patients should hear the risks of each before they choose.

### **Corticosteroid risks**

The triamcinolone acetonide label linked above lists post-injection flare after intra-articular use, cutaneous and subcutaneous atrophy, hypopigmentation and hyperpigmentation, tendon rupture, and decreased carbohydrate and glucose tolerance among adverse reactions, which matters for patients with diabetes. It says injection into an infected site “is to be avoided” and that a marked increase in pain with local swelling, fever and malaise suggests septic arthritis. Any injection into a joint carries some risk of infection.

The longer-term question is cartilage. The McAlindon 2017 *JAMA* trial found more cartilage loss with repeated triamcinolone than with saline, and the Kompel 2019 *Radiology* review described adverse joint findings after hip and knee injections. The 2021 AAOS knee osteoarthritis guideline lists intra-articular corticosteroids “for short-term pain relief,” according to the [AAOS announcement of that guideline](https://www.aaos.org/aaos-home/newsroom/press-releases/aaos-updates-clinical-practice-guideline-for-osteoarthritis-of-the-knee/). The 2025 AAOS rotator cuff guideline, linked above, says a single corticosteroid injection with local anesthetic “can be considered” for short-term improvement.

### **PRP risks**

PRP is made from the patient’s own blood, but that does not make it risk-free. Some soreness after the injection is common, and patients should hear that before the procedure. Any injection into a joint carries some risk of infection, and PRP is no exception. Long-term safety data for repeated PRP injection are limited.

PRP also varies. Leukocyte content, platelet concentration, activation method and injection volume all differ across studies, so PRP is a family of preparations rather than one product. That makes trials hard to compare.

### **Safety at a glance**

Safety consideration Corticosteroid PRP

Post-injection soreness or flare Listed on the label after intra-articular use Some soreness is common; tell patients before the procedure

Joint infection Label: avoid injecting an infected site; watch for signs of septic arthritis Any joint injection carries some risk of infection

Skin or fat atrophy Listed on the label Limited data

Blood sugar in diabetes Label lists decreased carbohydrate and glucose tolerance Limited data

Tendon effects Label lists tendon rupture Limited data

Cartilage with repeat dosing More cartilage loss than saline over two years (McAlindon) No cartilage volume difference from saline at 12 months (RESTORE); long-term data limited

Preparation variability Standardized FDA-approved drugs High; no single agreed protocol

A single steroid injection is generally well tolerated. The safety case shifts when injections are repeated over years, especially in joints where cartilage matters. Long-term safety data for repeated PRP injection are limited, so the two cannot be ranked. And PRP is not one thing.

## **Cost and insurance: who answers the coverage question**

Cost and coverage are part of the decision, and they differ for the two injections. The payer decides what it covers, and your biller is the person to ask how a claim is coded and filed.

For a corticosteroid injection, coverage depends on the patient’s plan. Check each patient’s policy before you quote a price, and ask the payer what it requires for the injection and the drug.

For PRP, Medicare’s national coverage determination on blood-derived products, [NCD 270.3](https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=217) (the version effective April 13, 2021, when we checked on November 4, 2026), says CMS “will cover autologous PRP for the treatment of chronic non-healing diabetic wounds” for 20 weeks when the preparation device is FDA cleared for exuding cutaneous wounds. Coverage for other chronic non-healing wounds is left to the local Medicare Administrative Contractors, and the NCD does not address musculoskeletal use. For other payers, coverage depends on the plan. Check each patient’s policy before you quote a price. PRP is priced by the practice.

Tell the patient what each option will cost them before they choose. If a patient picks one injection because of cost or coverage, record that in the consent note along with the clinical reasons.

**What this means in practice:** Cost is part of informed consent. Coverage questions go to the payer and your biller, and the price and the off-label status of PRP go in front of the patient before the procedure.

## **Patient selection: factors to discuss**

No trial cited here tells you in advance which patient will respond to either injection. These are factors to raise in a shared decision.

Factors that bear on a corticosteroid injection: whether the condition is on the product’s label (the triamcinolone acetonide label lists acute and subacute bursitis and acute gouty arthritis, among others), how soon the patient needs relief, how many injections the joint has already had, given the McAlindon cartilage data, whether the patient has diabetes, and whether surgery is planned. The 2026 ACR update strongly recommends intraarticular glucocorticoid injections in knee and hip OA, and the 2025 AAOS rotator cuff guideline says a single injection can be considered.

Factors that bear on PRP: its use in a joint or tendon is off-label; the 2026 ACR update strongly recommends against PRP in knee and hip OA; trial results differ by condition, as the sections above show; PRP is priced by the practice and coverage depends on the plan; and the patient’s own goals and prior treatments matter. No trial cited here has shown that PRP preserves cartilage, and RESTORE found no difference from saline in cartilage volume at twelve months.

Neither injection answers an unclear diagnosis that needs more workup, or expectations that no injection can meet. Saying so is part of counseling.

Here is what a counseling note for this choice usually records: the diagnosis and the joint or tendon involved; the label status of each option, including that PRP use is off-label; the guideline positions and trials you discussed, including those that found no difference from placebo; the price the patient will pay; and the decision the patient made. The note records the discussion. It does not predict a result.

Corticosteroids act on inflammation and carry a label for short-term use. PRP’s proposed mechanism is growth factor signaling, and its use here is off-label. The trials cited here measured pain and function and have not shown structural repair. If you want supervised cases in these procedures, see our [musculoskeletal regenerative medicine training](https://regenmedacademy.com/musculoskeletal-courses/). Training gives you supervised cases and a method. It does not guarantee a clinical result.

## **What professional societies say**

Major society positions disagree. Clinicians should know where each one stands and cite the one they relied on.

The [2026 ACR guideline update](https://assets.contentstack.io/v3/assets/bltee37abb6b278ab2c/bltb3d12c34020da842/oa-guideline-summary-2026.pdf), approved by the ACR Board of Directors on September 8, 2026 and published as a summary ahead of the full papers, says: “In people with knee and hip OA, we strongly recommend intraarticular glucocorticoid injections.” It also says “we strongly recommend against PRP treatment” in knee and hip OA, and it conditionally recommends against intraarticular hyaluronic acid injections. The 2019 ACR and Arthritis Foundation guideline said the same about glucocorticoid injections and PRP.

The 2021 AAOS knee osteoarthritis guideline (third edition) lists intra-articular corticosteroids “for short-term pain relief,” according to the AAOS announcement linked above.

The 2025 AAOS rotator cuff guideline, linked above, says a single corticosteroid injection with local anesthetic “can be considered” for short-term improvement, and that the routine use of PRP “is not supported” for rotator cuff tendinopathy or partial tears.

The 2024 [ESSKA-ORBIT consensus on injectable orthobiologics for knee osteoarthritis](https://pubmed.ncbi.nlm.nih.gov/38436492/), published in *Knee Surgery, Sports Traumatology, Arthroscopy*, is more supportive of PRP than the North American guidelines above. Three of its 28 statements received Grade A, including the statement that PRP is effective for symptomatic knee osteoarthritis, with the most consistent benefit in KL grades 1 to 3. A separate [2024 ESSKA-ICRS consensus by Kon and colleagues](https://openaccess.acibadem.edu.tr/bitstreams/ed8dd3c2-c360-44ed-bf1a-1c2b01fa9aad/download), using the RAND/UCLA appropriateness method, considered PRP appropriate in patients aged 80 or younger with KL 0 to III knee osteoarthritis after failed conservative treatments, and not appropriate as a first treatment or in KL IV. Its experts did not make different recommendations for PRP with and without leukocytes. PRP use for knee osteoarthritis is off-label.

AAOS [announced an Orthobiologics Registry on December 5, 2025](https://www.aaos.org/aaos-home/newsroom/press-releases/aaos-establishes-orthobiologics-registry-to-advance-evidence-based-orthobiologics-research/), which it says is “designed to measure the long-term safety, efficacy, and real-world outcomes of orthobiologic therapies” for patients with knee osteoarthritis. It is a data-gathering effort, not a guideline.

Society Year Corticosteroid position PRP position

ACR (guideline update) 2026 Strongly recommends intraarticular glucocorticoid injections for knee and hip OA Strongly recommends against PRP for knee and hip OA

AAOS (knee osteoarthritis) 2021 Listed for short-term pain relief Not cited in this post

AAOS (rotator cuff) 2025 A single injection with local anesthetic can be considered (moderate) Routine use not supported for tendinopathy or partial tears (limited)

ESSKA-ORBIT 2024 Not cited in this post Grade A support for symptomatic knee osteoarthritis, consistent in KL 1 to 3

ESSKA-ICRS RAND/UCLA 2024 Not cited in this post Appropriate for KL 0 to III after failed conservative treatments, age 80 or younger; not as a first treatment or in KL IV

European consensus documents are more supportive of PRP than North American guidelines. Cite the guideline you relied on in your documentation rather than implying that one consensus exists.

## **Evidence gaps to acknowledge**

Saying what is not settled is part of the job.

PRP preparation is still not standardized. Leukocyte content, platelet concentration, anticoagulant choice, and activation method all vary across studies. No single classification system has been clinically validated as predicting outcomes. PRP from one device or protocol is not necessarily equivalent to PRP from another. A [2024 cohort study in the *American Journal of Sports Medicine* by Boffa and colleagues](https://pubmed.ncbi.nlm.nih.gov/39397728/) followed 253 patients and reported that platelet concentration was associated with knee pain scores through 12 months. That is an association in one cohort, not a target dose, and no society names a minimum or a target platelet dose.

Long-term comparative data beyond two years is thin for both injections. The individual trials cited here ran for six months (Kearney), twelve months (RESTORE) and two years (McAlindon). The durability of PRP benefit over multiple years and the cumulative cartilage risk of repeated steroid dosing beyond McAlindon’s two-year window remain underexplored.

Patient stratification is still developing. No validated biomarker tells you in advance which patient will respond to PRP, which will respond to steroids, and which will not respond to either.

Cost-effectiveness modeling is limited. The question of whether PRP’s higher up-front cost is offset by fewer future injections or later joint replacement has not been firmly answered.

## **Frequently asked questions**

### **Are corticosteroid injections safer than PRP?**

For a single injection, both are generally well tolerated. Repeated corticosteroid injection has a documented cartilage signal. Long-term safety data for repeated PRP injection are limited, so the two cannot be ranked.

### **Can both injections be used in the same patient?**

Some clinicians use both in the same patient, in different joints or at different times. There is no agreed interval between a corticosteroid injection and PRP at the same site. Published protocols differ, so follow your own protocol and record the timing. PRP use is off-label.

### **How soon can corticosteroids and PRP be given after each other?**

Protocols differ, and this post cites no agreed waiting period. Recent steroid injection at the site is commonly listed as a reason to wait; your protocol and the published consensus set the details. Record the date of the last steroid injection in the chart.

### **How many injections per year are reasonable?**

Limits differ between protocols. In the McAlindon trial, an injection every 12 weeks for two years led to more cartilage loss than saline, and the 2025 AAOS rotator cuff guideline says a single injection can be considered for short-term improvement. For PRP, protocols differ in the number of injections; RESTORE used three weekly injections. How often a course can be repeated has not been settled, so follow your protocol and record your reasons.

### **Do patients need to stop NSAIDs before either injection?**

There is no agreed washout period. Published protocols differ, so follow your own protocol and the prescriber, and never stop an antiplatelet drug without the prescriber. For a corticosteroid injection, follow the product label and your protocol.

### **Does insurance cover either injection?**

Coverage depends on the plan, so check each patient’s policy before you quote a price. For Medicare, NCD 270.3, linked above, covers autologous PRP for chronic non-healing diabetic wounds under set conditions, leaves other chronic wounds to the local contractors, and does not address musculoskeletal use. The payer answers the coverage question, and your biller answers how to file it. PRP is priced by the practice.

### **What if the patient needs relief for an acute flare?**

The triamcinolone acetonide label describes intra-articular use as short-term therapy “to tide the patient over an acute episode or exacerbation.” In the tennis elbow meta-analyses, pain scores favored corticosteroid under two months. No trial cited here tested PRP for an acute flare, and PRP use for it would be off-label.

### **What do the trials say about chronic tendinopathy?**

It depends on the tendon. In the tennis elbow meta-analyses, pain scores favored PRP at six months or more. In the Achilles trial, a single PRP injection did not differ from sham at six months. In pooled rotator cuff trials, pain did not differ between PRP and corticosteroid. PRP use in any of these tendons is off-label, the corticosteroid label lists tendon rupture among adverse reactions, and outcomes vary in every patient.

## **Key takeaways**

- Injectable corticosteroids are FDA-approved drugs, and each label lists its approved uses. PRP for musculoskeletal injection is off-label use of devices cleared only for bone graft handling, and informed consent must reflect this clearly.
- The triamcinolone acetonide label describes intra-articular use as short-term therapy. In a two-year trial, repeated injections led to more cartilage loss than saline, and the label lists tendon rupture among adverse reactions.
- PRP contains growth factors from platelets and from the plasma, and what it does in a joint or tendon is still being studied. The trials cited here measured pain and function, not repair. Outcomes vary, and in some trials PRP did not differ from placebo.
- In pooled tennis elbow trials, pain scores favored corticosteroid under two months and PRP at six months or more. That pattern was not seen in the knee, Achilles or rotator cuff results cited here.
- Coverage depends on the plan. Medicare’s NCD 270.3 does not address musculoskeletal PRP. Check each patient’s policy before you quote a price, and put the cost in the consent conversation.
- The 2026 ACR guideline update strongly recommends intraarticular glucocorticoid injections and strongly recommends against PRP in knee and hip OA, while European consensus documents are more supportive of PRP. Cite the guideline you relied on.
- Training gives you supervised cases and a method. It does not guarantee a clinical result. Your license, your board and your carrier set what you may offer.

## **About Regenerative Medicine Academy**

Regenerative Medicine Academy (RMA) is a medical education company providing hands-on, private regenerative medicine training for licensed healthcare professionals. RMA does not provide clinical treatments or medical services. All course content is educational and designed to help clinicians make informed, evidence-based decisions within their scope of practice. To learn more about courses and online education, visit [regenmedacademy.com](https://regenmedacademy.com/).

## **Off-label use note**

The PRP procedures discussed in this article involve off-label use of FDA-cleared devices. Off-label use means the FDA has not cleared the device for the described use. Clinicians may use FDA-cleared devices off-label in their clinical judgment, but must obtain informed consent, discuss evidence, risks, and alternatives, and document thoroughly. Some corticosteroid uses discussed here are on the product label and some are off-label. Check the label of the product you use.

## **Platform and jurisdiction note**

Scope of practice, supervision requirements, and corporate practice of medicine rules vary by state. Clinicians should consult their state medical board, malpractice carrier, and legal counsel about compliance in their jurisdiction before offering regenerative procedures.

## **For clinicians who want to go deeper**

Clinicians who want to deepen their knowledge of orthobiologic techniques and the evidence base behind them can review the [full RMA course catalog](https://regenmedacademy.com/our-courses/), which covers musculoskeletal, cosmetic, sexual health, and adipose tissue applications. RMA also offers [online regenerative medicine education](https://regenmedacademy.com/e-courses/) on FDA regulatory and legal foundations for clinicians who want to study the compliance picture before stepping into hands-on training.

Or skip the catalog and [talk to us](https://regenmedacademy.com/contact/).

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## Introduction to PRP for Musculoskeletal Injuries

The foundation course: platelet biology, whole blood handling, spin protocols and injection technique, hands on with a supervised consenting patient.

Starting at $5,000 at an instructor’s clinic, or $10,000 inside your practice.

[See the course](https://regenmedacademy.com/introduction-to-platelet-rich-plasma-prp-therapy-for-musculoskeletal-injuries/)

[Request a date now](https://regenmedacademy.com/contact/?course=intro-prp-msk)

[Or see all courses](https://regenmedacademy.com/our-courses/)

## Important information

### Education, not medical advice

Regen Med Academy provides education and training for licensed healthcare providers. Everything on this site is for educational purposes only. It is not medical advice, not a treatment recommendation, and not an offer to treat. Providers are responsible for practicing within the scope of their own license and their own state law.

### Where a course can run

Courses are taught only in states where the modality is legal for the license you hold. State law in this field changes, sometimes more than once a year. Our reading of each state, with its sources and the date we checked, is on the [rules by state page](/regenerative-medicine-laws-by-state/). It is a starting point, not legal advice. It is your responsibility to confirm the modality is legal in your state for your license. Do that before you book. The authority on your own scope is your licensing board, not us. State medical board contact details are published by the [Federation of State Medical Boards](https://www.fsmb.org/contact-a-state-medical-board/).

### Training on live patients

Procedures performed during training are performed on consenting patients, by licensed providers, under supervision. Participation is voluntary and outcomes vary.

### Products and modalities

Some products and modalities discussed in these courses are not FDA approved or cleared for the uses described. Regen Med Academy does not manufacture, sell or endorse any product, and does not approve or clear any product. The FDA publishes guidance for patients and providers on [regenerative medicine therapies](https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/important-patient-and-consumer-information-about-regenerative-medicine-therapies).

### What a certificate is, and is not

Regen Med Academy does not offer CMEs, credit hours or accreditation of any kind. What you receive is a Certificate of Completion. It records that you attended and performed the procedures under supervision. It is not a license, not a board certification, and it does not expand your scope of practice.

### Coverage is yours to arrange

You are responsible for your own malpractice coverage. We will help you work out what to ask your carrier, and we recommend getting the answer in writing. Regen Med Academy does not provide, arrange or extend coverage to trainees, and nothing on this page is legal advice or an assurance of coverage.

[PrevPreviousPRP therapy for musculoskeletal injuries: what every clinician should know](https://regenmedacademy.com/prp-therapy-for-musculoskeletal-injuries/)

[NextWhat to expect at a hands-on PRP training course: a clinician’s guideNext](https://regenmedacademy.com/what-to-expect-hands-on-prp-training-course/)

#### Table of Contents

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## More from the blog

[Nov 4, 2026By Oscar Tellez ### 351 or 361: which rule covers the product in my clinic? Read Written by Oscar Tellez, founder of Regen Med Academy. Oscar is not a clinician. This post is education…](https://regenmedacademy.com/351-vs-361-hctp-rules/)[Nov 3, 2026By Oscar Tellez ### Who on my staff can draw, spin and inject PRP? Read Written by Oscar Tellez, founder of Regen Med Academy. Oscar is not a clinician. This post is education…](https://regenmedacademy.com/who-can-draw-spin-and-inject-prp/)[Nov 2, 2026By Oscar Tellez ### How do I get trained in PRP injections as a nurse practitioner? Read Written by Oscar Tellez, founder of Regen Med Academy. Oscar is not a clinician. This post is education…](https://regenmedacademy.com/prp-training-for-nurse-practitioners/)

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