PRP and high-dose PRP (ACP MAX)

PRP stands for platelet-rich plasma, prepared from your own blood. Dr. Rick Verjans first discusses the diagnosis and whether PRP fits your symptoms, previous treatments and goals.

When may PRP be considered?

PRP may be considered for symptoms of mild to moderate knee osteoarthritis and certain chronic tendon problems. Evidence and expected effects differ by condition. Knee osteoarthritis findings do not automatically apply to other joints, tendons or muscle tears. Exercise therapy, rehabilitation and activity adjustment remain important.

PRP for knee osteoarthritis: what do ESSKA and ICRS advise?

The ESSKA-ORBIT consensus considers PRP a possible injection treatment, particularly for early to moderate knee osteoarthritis.

The 2024 ESSKA-ICRS consensus considers PRP appropriate in selected patients aged up to 80 with radiographic grades KL 0–III after an insufficient response to previous conservative treatment. PRP is not recommended as a first treatment or a standard option for severe knee osteoarthritis (KL IV). The KL grade describes X-ray changes; symptoms and examination remain essential to individual decisions.

These recommendations combine research and expert opinion. Diagnosis, severity, previous care and goals are assessed first. Exercise therapy, rehabilitation and activity adjustment remain the foundation.

Is PRP better than hyaluronic acid?

ESSKA-ORBIT and several meta-analyses report better average pain and function outcomes with PRP than with hyaluronic acid, particularly around six to twelve months. Studies differ in patients, products and injection schedules; some find no difference. A group average is not an individual treatment guarantee. Hyaluronic acid remains an option to discuss for selected patients.

Discuss PRP during a consultation in Ghent or Antwerp.

High-dose PRP with ACP MAX: a single-shot treatment

Alongside a conventional PRP schedule, high-dose PRP using the ACP MAX system may be discussed. A concentrated preparation is made from your blood with the aim of delivering a higher total platelet dose.

Single shot means one planned injection within the agreed treatment plan. This may reduce the number of injection visits. It does not mean one injection is sufficient for everyone or provides a lasting solution. The response is assessed at follow-up.

The final dose depends on your initial platelet count, the blood collection, preparation and injected volume. A product name alone does not tell you how many platelets are actually delivered. Higher concentration does not guarantee a better result.

The ESSKA-ICRS consensus does not establish a universally optimal platelet concentration or a specific ACP MAX dose. Total dose, white blood cell (leukocyte) content, volume, number of injections and preparation are therefore discussed individually.

Why does platelet dose matter?

Total dose is platelet concentration multiplied by injected volume. The number of millilitres alone does not tell the whole story. Study comparisons must also distinguish dose per injection from the total over several injections.

Knee osteoarthritis research suggests dose may contribute to pain and function outcomes. An ideal dose for every patient has not been established. More platelets do not automatically mean greater improvement: diagnosis, PRP composition, schedule and accompanying care also matter.

A systematic review of 29 clinical studies found that PRP study arms with a statistically significant benefit at six months used an average of approximately 5.5 billion platelets per injection, compared with approximately 2.3 billion in arms without a significant benefit. This supports considering dose, but does not establish a fixed success threshold of 5 billion or predict an individual patient’s response.

How is treatment performed?

Blood is collected and centrifuged to prepare PRP, then injected into the area being treated, with ultrasound guidance where indicated. The choice of conventional or high-dose PRP, injection schedule and review time are agreed individually beforehand.

Preparation and aftercare

Report your medication, including blood thinners and anti-inflammatory drugs, as well as fever, illness or other medical conditions. Ask which medicines you may use around treatment. Do not stop prescribed medication yourself.

Temporary pain, stiffness, swelling or bruising may follow. You receive personal advice on activity, return to sport and pain relief. Seek same-day medical advice for a markedly worsening hot, red or swollen knee, severe pain or fever.

When might I notice a result?

A possible effect generally develops gradually over weeks. Not everyone improves. An injection does not replace a suitable exercise or rehabilitation programme. PRP does not guarantee healing, cartilage restoration or avoidance of surgery.

Questions about PRP and ACP MAX

Is PRP recommended for everyone with knee osteoarthritis?

No. Suitability depends, among other things, on severity and previous treatment. See ESSKA and ICRS recommendations and the comparison with hyaluronic acid.

What is the difference between standard and high-dose PRP?

High-dose PRP aims to deliver more platelets in total. Dose and composition differ between preparations. Brand name, concentration factor or syringe size alone cannot reliably compare treatments.

Is there research on a dose-response relationship?

In a randomised trial in early knee osteoarthritis, one injection containing approximately 5.7 billion platelets produced better pain and function outcomes at six months than approximately 2.8 billion. Temporary pain and stiffness were more frequent at the higher dose. This suggests a dose effect within that study, not a universal dosing rule. It was not an ACP MAX study and did not compare one injection with a series of three.

Is 5 billion a proven minimum for an effective injection?

No. The review compared average doses in study arms with and without statistically significant benefit. It was not an individual test predicting responders and non-responders. Some favourable studies used lower doses. Around 5 billion is therefore not a proven cutoff or guarantee.

Are more than 10 billion platelets always better?

This has not been shown. Recent reviews do not find a simple pattern of more platelets always producing better outcomes. Patients, preparation and protocols differ. Treatment is therefore based on the indication and available evidence.

Does one ACP MAX injection always replace three PRP injections?

No. A single-shot approach may be discussed for an appropriate indication, but one high dose has not been proven equivalent to multiple injections for every patient or problem. Expected benefit, treatment burden and follow-up are considered together.

Does PRP repair cartilage?

PRP is mainly studied for pain relief and improved function. Evidence is insufficient to promise reliable repair of damaged cartilage or a cure for osteoarthritis.

Is PRP the same as cortisone or a gel injection?

No. PRP comes from your blood. Cortisone is an anti-inflammatory medicine; a gel injection contains hyaluronic acid. Choice depends on diagnosis, previous treatment and expected benefit.

Can I book a PRP injection directly?

You can book a consultation to discuss it. Suitability and preparation are assessed first. An injection at the first visit is not automatically possible. Explain your symptoms and previous treatment, and read the practical information.

When can I return to sport?

This depends on the condition, response to injection and rehabilitation. You receive an individual progression plan. Less pain does not automatically mean the tissue can tolerate every load again.

Scientific background

These sources help assess both possibilities and limitations. Dose research alone does not prove that a particular brand or device is more effective.

• Berrigan et al. — systematic review of platelet dose and clinical outcomes. Arthroscopy, 2025; published online in 2024. DOI: 10.1016/j.arthro.2024.03.018.
• Patel et al. — randomised comparison of two PRP doses in early knee osteoarthritis, 2024.
• Hooper et al. — systematic review and meta-analysis of PRP dose, online 2025, journal issue 2026.
• AAOS guideline: management of knee osteoarthritis without joint replacement. The PRP recommendation rests on limited evidence; exercise remains important.

Dutch source: PRP consensus and comparison updated 4 October 2026; other content reviewed 27 September 2026.

Read about persistent injuries, osteoarthritis, other injections and the injection information overview.

Read about Dr. Rick Verjans and his training and scientific work.

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