Arthrex PRP (Platelet-Rich Plasma) using the Double-Syringe technology is the most widely used PRP system in orthopaedics and pain medicine worldwide. Its simple, fast and fully closed (sterile) preparation process ensures consistent quality of the product and a high concentration of the patient’s natural growth factors.

What is PRP and How Does it Work?

PRP (Platelet-Rich Plasma) is concentrated platelet-rich plasma obtained from the patient’s own blood. Platelets (thrombocytes) contain in their α-granules dozens of bioactive proteins – so-called growth factors (PDGF, TGF-β1, EGF, VEGF, IGF-1) – which are released upon activation and initiate a repair cascade in damaged tissue: they stimulate migration of stem cells, division of satellite cells, collagen synthesis, neoangiogenesis and suppress chronic inflammation.

What Distinguishes the PRP ACP Arthrex System (Double-Syringe)?

ACP (Autologous Conditioned Plasma) is the most popular PRP system in Europe, introduced by Arthrex in 2007 and continuously improved. Its unique feature is the patented double-syringe design:

  • Closed sterile system – the patient’s blood from collection to injection has no contact with the environment, minimising the risk of contamination
  • No separating gels or artificial activators – PRP is 100% autologous; separation occurs purely physically during centrifugation
  • Full preparation process in 5 minutes – significantly faster than competing systems (up to 45 min)
  • Platelet concentration 2–3× above baseline – documented in comparative studies with competing systems (including RegenLab)
  • Leukocyte-poor PRP (Pure-PRP / leukocyte-poor) – reduced neutrophil content decreases the risk of pro-inflammatory reaction after intra-articular injection
  • No anticoagulant – PRP injection is virtually painless (no burning sensation from altered pH)
  • Efficacy confirmed in Level 1 studies with FDA approval

PRP ACP MAX – Advanced Version for Large Joints

ACP MAX is an advancement of ACP technology – also in the double-syringe system, but with double-spin centrifugation and a larger blood volume (30, 60 or 90 ml), yielding:

  • Platelet concentration up to 12× above baseline (vs 2–3× in standard ACP)
  • Buffy-coat PRP – a preparation based on the buffy coat layer, but still depleted of erythrocytes and neutrophils
  • Larger preparation volume – ideal for injections into large joints (knee, hip, shoulder) in advanced degenerative disease
  • Higher density of growth factors in a single injection – translating to a stronger regenerative response

Clinical Indications

  • Degenerative joint disease (knee, hip, shoulder, elbow) – ACP for mild and moderate stages, ACP MAX for more advanced cases
  • Tendinopathies and enthesopathies (tennis elbow, golfer’s elbow, jumper’s knee, heel spur)
  • Tendon and ligament injuries (e.g. rotator cuff, patellar tendon, Achilles tendon)
  • Muscle tears and injuries (sports medicine – as early as possible after injury)
  • Supporting regeneration after knee, shoulder or hip arthroscopy
  • Radicular pain in the course of disc herniation (perineural injection under X-ray/ultrasound guidance)

Procedure Sequence

  • The patient arrives 30 minutes before injection – 15 ml of venous blood is drawn into the double ACP syringe (30–90 ml for ACP MAX).
  • The syringe is placed in a dedicated, calibrated centrifuge – the process takes 5–10 minutes.
  • After centrifugation the PRP layer (5–6 ml for ACP) is transferred to the inner syringe in a sterile, closed movement without contact with the environment.
  • The physician performs the injection under ultrasound guidance (small and medium joints) or X-ray (spine, hip), ensuring precise delivery to the painful structure.
  • The entire procedure from collection to injection takes approximately 30 minutes. The patient returns to normal activity with a restriction on intense exertion for 48–72 hours.

Treatment Schedule

Three PRP ACP injections at 1–3 week intervals are the standard recommendation. ACP MAX (due to the higher growth factor concentration) often requires fewer injections – 1 to 2 per cycle. The schedule is determined individually by the physician based on the condition, its severity and the patient’s response.

Preparation

  • For 7 days before the procedure, non-steroidal anti-inflammatory drugs (NSAIDs – ibuprofen, naproxen, diclofenac) must be discontinued, as they inhibit platelet function
  • 24 hours before injection – good hydration (increases PRP collection yield)
  • Fasting is not required
  • Absolute contraindications: active infection including at the injection site, haematological malignancy, severe thrombocytopenia

Effects

  • First effects (reduced stiffness, slight pain reduction): 2–4 weeks after the first injection
  • Full effect: 2–3 months after completing the cycle
  • Duration of effect: typically 9–12 months, longer in some patients
  • The cycle can be repeated every 9–12 months or upon recurrence of symptoms
  • Effects depend on the degree of pathological changes, the patient’s age and adherence to post-procedure recommendations (physiotherapy, activity modification)

Possible Side Effects

  • Transient pain and swelling at the injection site (1–3 days) – a physiological inflammatory cascade response
  • Minor subcutaneous haematoma
  • Very rarely – allergic or vasovagal reaction (due to 100% autologous nature of the preparation, risk is minimal)
  • No risk of rejection or disease transmission – the preparation comes exclusively from the patient’s own blood

FAQ

Is PRP ACP Arthrex more effective than 'standard' PRP from a local centrifuge?

Yes – comparative studies (including Arthrex vs RegenLab) demonstrated that PRP ACP contains significantly more platelets (2.0× vs 0.8×) and higher concentrations of key growth factors PDGF-AB, TGF-β1 and EGF. The sterility of the closed system also eliminates the risk of contamination.

When to choose ACP and when ACP MAX?

ACP is recommended for mild and moderate changes, tendinopathies, sports medicine and regeneration. ACP MAX – for advanced degenerative disease of large joints (knee, hip, shoulder) when a higher ‘dose’ of growth factors is required.

Is the procedure painful?

PRP ACP injection is virtually painless – the preparation contains no anticoagulant, which in other systems causes a burning sensation. The puncture is performed with a fine needle under ultrasound guidance.