title: Utilization of Platelet-Rich Plasma for Musculoskeletal Injuries: An Analysis of Current Treatment Trends in the United States.
abstract: BACKGROUND
  Platelet-rich plasma (PRP) has emerged as a popular biologic treatment for musculoskeletal injuries and conditions. Despite numerous investigations on the efficacy of PRP therapy, current utilization of this treatment within the United States is not widely known.
  
  
  OBJECTIVE
  To investigate the national utilization of PRP, including the incidence and conditions for which it is used in the clinical setting, and to determine the current charges associated with this treatment.
  
  
  METHODS
  Descriptive epidemiology study.
  
  
  METHODS
  Using a national database (PearlDiver) of private insurance billing records, we conducted a comprehensive search using Current Procedural Terminology (CPT) codes to identify patients who received PRP injections over a 2-year period (2010-2011). Associated International Classification of Diseases, 9th Revision (ICD-9) codes were identified to determine the specific conditions the injection was used to treat. The aggregate patient data were analyzed by yearly quarter, practice setting, geographic region, and demographics. PRP therapy charges were calculated and reported as per-patient average charges (PPACs).
  
  
  RESULTS
  A total of 2571 patients who received PRP injections were identified; 51% were male and 75% were older than 35 years. The overall incidence ranged from 5.9 to 7.9 per 1000 patients over the study period. PRP was most commonly administered in hospitals (39%) and ambulatory surgical centers (37%) compared with in private offices (26%). The most common conditions treated were knee meniscus/plica disorders, followed by unspecified shoulder conditions, rotator cuff injuries, epicondylitis, and plantar fasciitis. Further evaluation revealed that 25% of all patients received injections for cartilage-related conditions, 25% meniscus, 25% unspecified, 12% tendon, 8% glenoid labrum, and 5% ligament. The PPAC for PRP treatment was US$1755 per injection.
  
  
  CONCLUSIONS
  Despite a lack of consensus regarding PRP indications and efficacy, we observed widespread application of this treatment for a myriad of musculoskeletal injuries. Most treated patients were older than 35 years, and the most commonly treated conditions included cartilage and meniscus disorders. Given the current controversy surrounding this treatment, further studies are necessary to guide clinicians on the value of this therapy for each clinical diagnosis.
authors.affiliation: Department of Orthopaedic Surgery, Boston Medical Center, Boston, Massachusetts, USA.
authors.forename: Joanne Y
authors.initials: JY
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Fabricant
authors.affiliation: Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Chad R
authors.initials: CR
authors.lastname: Ishmael
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine at USC, Los Angeles, California, USA.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Wang
authors.affiliation: Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Petrigliano
authors.affiliation: Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Kristofer J
authors.initials: KJ
authors.lastname: Jones
keywords: PRP; cartilage; musculoskeletal injury; platelet-rich plasma; tendinitis