Episode # 115 • 22 Sept 2026
Understanding Platelet Poor Plasma in Orthobiologics
Could platelet poor plasma be the missing link in muscle injury recovery? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. Ryan Kruse, a sports medicine physician at the University of Iowa and team physician for the Iowa Hawkeyes and US Soccer, to explain what platelet poor plasma actually contains and why it has become his primary treatment for acute muscle injury. They discuss how PPP differs from PRP, the challenges of defining the optimal dose, and the growing interest in exploring the bioactive components that make PPP worth keeping.
Timestamps
00:00 - Introduction
05:01 - Defining Platelet Poor Plasma
11:22 - Volume, Dosing, and Fibrosis vs Regeneration
19:00 - Choosing PPP by Injury Grade and Treating Chronic Scar
25:30 - Blood Draw Volume, Kit Selection and Spin Speed
32:12 - Filters and Protein Concentrate
38:19 - Building a PRP Lab and Concentration Questions
43:26 - Keeping PRP Away from Muscle Injury
53:05 - Ultrasound and Return-to-Play
58:46 - Recovery Timelines and Recurrence
01:06:18 - The Evidence Gap in Orthobiologics
01:11:37 - Osteoarthritis, Intra-Articular Use and Replacing Cortisone
01:21:26 - Closing Thoughts
Resources
- Platelet-Poor Plasma for the Treatment of Acute Hamstring Muscle Injuries in Collegiate Football Athletes: A Cohort Study
- Platelet-Poor Plasma: A Novel Treatment for Acute Quadriceps Muscle Injuries
- Platelet-Poor Versus Platelet-Rich Plasma for the Treatment of Acute Thigh Muscle Injuries
- Platelet-Poor Plasma for the Treatment of a Quadriceps Muscle Tear in a Division I Football Athlete
- BackTable MSK Ep. 102: Understanding PRP and Orthobiologics for Musculoskeletal Medicine
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More about this episode
The episode dives deeper into which injuries are best suited for PPP, when surgery is still necessary, and why PRP may actually increase fibrosis in primary muscle tears. Drs. Kruse and Balle compare kit selection, spin speed, filter pore size, and blood draw volumes, and discuss how to use ultrasound to guide both injury assessment and safe return to play. They also tackle the logistics of building a PRP lab, the use of PPP in osteoarthritis as a cortisone alternative, return-to-play timelines, recurrence risk, and the need for higher-level randomized data to move the field forward.
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