PRP vs GFC: Regenerative Therapy for Chronic Tendon and Ligament Injuries

No, there is no age limit — it can be given from young patients up to the 60s or 70s without a problem. The only practical consideration is the blood volume required: around 14 to 15 ml for PRP and 10 ml for GFC.

No. Steroid is given for active pain and inflammation, early in the treatment pathway. Regenerative therapies like PRP are used once the condition is confirmed chronic with no active inflammation. Combining them is counterproductive, since steroid's anti-inflammatory effect can work against the regenerative signal from the growth factors.

First rule out diabetes and thyroid disease, which account for around 30% of bilateral shoulder presentations in practice, then check for manual/overhead work. If negative, get a plain X-ray to rule out joint space narrowing and calcific tendinopathy, then trial physiotherapy (ultrasonic therapy, TENS, shoulder exercises) with a 3-week NSAID course. In this case, rheumatoid factor came back positive with MRI showing bilateral partial-thickness supraspinatus tears and subacromial bursitis — so the approach became NSAIDs, DMARDs for the underlying rheumatoid disease, a triamcinolone injection into the subacromial bursa, and physiotherapy. A repeat steroid injection should not be given before 3 months. If there is still no response, proceed to shoulder arthroscopy to debride the bursa, assess the AC joint and address the tendon tears directly.

Yes. Chronicity is labelled at 3 months, with 6 to 12 weeks as the clinical boundary. A patient should start with NSAIDs, not regenerative therapy. Only if steroid injection has also failed to control the inflammation between 6 and 12 weeks should regenerative therapy be considered, and 3 months is the ideal timing.

Around 10 to 14 ml of blood is drawn from the patient into a kit-supplied vial containing heparin, then centrifuged to separate the platelet-rich plasma from the rest of the blood. This typically yields about 5 ml of PRP solution, which is injected as multiple pricks around the tendon or ligament rather than as a single injection, to achieve the best results.

PRP requires 10 to 14 ml of blood and an induction course of five to six injections spaced two weeks apart, and is more painful because of the platelet component. GFC requires only 10 ml of blood and typically three to four injections at the same interval, and is less painful.

Both are injected as multiple pricks distributed around the tendon or ligament rather than as a single bolus, to maximise coverage.

No. An MRI should confirm whether a tear is partial or complete before committing to either therapy, for example in a chronic ankle sprain where the anterior talofibular ligament is clinically weak.

No. A complete tear needs surgical reconstruction; only a partial tear is suitable for regenerative therapy.