If you’ve ever asked your doctor about PRP, there’s a good chance they said something like: “There’s not enough evidence. Have you tried a cortisone shot?”
I want to unpack that response, because it reflects a real misunderstanding of what the research actually shows, and more importantly, what cortisone actually does to your tissue over time.
This is not an anti-cortisone post. Corticosteroids have a legitimate role in medicine. But for a large subset of patients with chronic joint and tendon conditions, the reflexive reach for cortisone, and the dismissal of PRP, is costing people long-term tissue health they can never get back.
What Cortisone Actually Does
Corticosteroids (cortisone, triamcinolone, methylprednisolone) work by suppressing the local inflammatory response. When you have tendinitis or joint synovitis, the swelling and pain are partly driven by inflammation. Cortisone dials that signal down, and you feel better quickly.
That’s the case for it.
The case against it is what happens to the tissue underneath. Multiple studies, including a widely cited 2010 landmark trial in JAMA by Coombes et al., have shown that cortisone injections for lateral epicondylitis produce excellent short-term pain relief (weeks to months) but worse long-term outcomes than placebo or physical therapy at one year.
The mechanism is not mysterious. Cortisone suppresses the inflammatory cascade that is also the first step in tissue repair. Repeated injections have been associated with:
- Tendon weakening and risk of rupture, particularly in the Achilles, patellar, and rotator cuff tendons
- Cartilage thinning with repeated intra-articular injections (multiple studies in knee OA show accelerated joint space narrowing)
- Fat pad atrophy and local skin depigmentation near injection sites
- Systemic blood sugar elevation, which matters especially for diabetic patients
None of this means one cortisone injection will ruin your knee. But it does mean the “just try cortisone first” approach has real costs that are rarely explained to patients at the time of the injection.
What PRP Does Instead
PRP takes the opposite approach. Rather than suppressing inflammation, it delivers a concentrated dose of the body’s own growth factors, including platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF), directly to the injured tissue.
These factors initiate and accelerate the repair cascade: new collagen formation, increased blood vessel ingrowth, and structural remodeling of damaged tissue. PRP is not suppressing the process; it’s amplifying the body’s ability to complete it.
The tradeoff is time. PRP has a delayed onset. Patients typically feel worse before they feel better, and the meaningful improvement window is 4 to 8 weeks out, not 4 to 7 days like cortisone.
What the Research Shows
The honest picture from the literature is more nuanced than either “PRP works” or “there’s not enough evidence.”
Knee Osteoarthritis
This is where PRP has the strongest evidence base for musculoskeletal applications. A 2021 systematic review and meta-analysis published in the American Journal of Sports Medicine (Belk et al.) analyzed 18 randomized controlled trials and found PRP superior to hyaluronic acid and placebo for both pain and function at 6 and 12 months.
A 2022 network meta-analysis in JAMA Network Open (Hohmann et al.) reached similar conclusions: PRP provided significantly better outcomes than corticosteroids at 6 months and beyond, while corticosteroids performed well at 1 to 3 months but lost their advantage by 6 months.
Translation: if your goal is to feel better for two months and you’re managing something acute, cortisone is reasonable. If your goal is to actually improve the joint long-term, PRP has a better profile at 6 to 12 months.
Lateral Epicondylitis (Tennis Elbow)
This is one of the clearest head-to-head comparisons. A rigorous RCT by Gosens et al. followed patients with chronic lateral epicondylitis at 1 and 2 years. The cortisone group had significantly better short-term outcomes (1 month). The PRP group had significantly better outcomes at 1 and 2 years.
A 2022 Cochrane review found high-quality evidence that corticosteroid injections are associated with worse long-term outcomes than PRP for tennis elbow, echoing results from earlier systematic reviews.
Rotator Cuff Tendinopathy
Evidence here is more mixed, largely because rotator cuff pathology covers a wide spectrum (tendinopathy, partial tears, full-thickness tears). Studies in partial rotator cuff tears have shown PRP comparable or superior to corticosteroids at 3 and 6 months, particularly when injected under ultrasound guidance at the site of pathology.
Plantar Fasciitis
Multiple RCTs comparing PRP to cortisone in plantar fasciitis have favored PRP at 3, 6, and 12-month follow-up. A 2016 meta-analysis in the Journal of Foot and Ankle Surgery found PRP superior to cortisone for pain at all time points beyond 1 month.
The “Not Enough Evidence” Problem
When physicians say there isn’t enough evidence for PRP, they often mean one of two things:
- The randomized controlled trial data doesn’t meet the same bar as a pharmaceutical approval trial.
- The studies are heterogeneous (different PRP kits, different centrifuge protocols, different injection techniques), making it hard to draw universal conclusions.
Both points are fair. PRP is not a drug, and it hasn’t been studied through a single, controlled manufacturing process the way a pharmaceutical would be. The platelet concentration, growth factor content, and injection technique vary across providers and across studies.
But “variable evidence” is not the same as “no evidence.” The weight of current evidence, particularly for knee OA, tennis elbow, and plantar fasciitis, suggests PRP produces better long-term outcomes than corticosteroids for chronic conditions. The fact that PRP is not FDA-regulated in the same way as a drug does not change the tissue biology or the clinical outcomes.
When Cortisone Still Makes Sense
I want to be clear about this: there are situations where a corticosteroid injection is the right choice.
- Acute bursitis (subacromial, trochanteric): Rapid pain relief for an inflamed bursa is clinically appropriate, and the short-term suppression is not causing long-term tendon damage.
- Inflammatory arthritis (rheumatoid, psoriatic): The disease mechanism involves pathological inflammation; suppressing it is part of disease management.
- Pre-procedure patient who needs pain control to participate in physical therapy: Sometimes reducing acute pain enough to engage in rehab is the priority.
- Patient who cannot afford PRP: Cortisone is often covered by insurance; PRP typically is not. That’s a real factor.
What I would avoid: repeated cortisone injections (more than 2 to 3 lifetime) into the same tendon, and routine cortisone for chronic degenerative conditions where tissue quality is already compromised.
The Conversation Worth Having
Here’s what I tell patients who come in asking about this:
Cortisone is a short-term symptom manager. PRP is a long-term tissue investment. If you have acute pain and need to function while you set up a more definitive treatment plan, one cortisone injection in the right setting is defensible. If you’ve already had two cortisone shots and you’re back asking me what to do next, that tells me cortisone solved a short-term problem without addressing the underlying one.
At some point, the tissue has to repair. PRP is designed to facilitate that repair in a way that cortisone is not.
If you’d like to discuss whether PRP is appropriate for your specific condition, schedule a consultation here. If you’re a healthcare provider interested in learning the Perfect PRP® protocol, our certification course is here.
Dr. Jeffrey Piccirillo, DO, is the creator of the Perfect PRP® Protocol and a regenerative medicine specialist practicing in Ocala, Florida. He has trained providers across the United States and internationally.