Manual ACD-Tube PRP for Musculoskeletal Care: Accessible Protocols, Dose, and Customization

Abstract

Background: Platelet-rich plasma (PRP) is used across musculoskeletal medicine, but clinical translation is limited by inconsistent preparation reporting, variable platelet dose, and limited access to proprietary systems. Acid citrate dextrose (ACD) yellow-cap tube workflows offer a practical low-cost platform for manual PRP preparation, but their centrifugation variables and product options require clearer synthesis. Scope: This narrative review summarizes ACD and ACD-formulation tube studies relevant to manual PRP preparation for orthopedic and musculoskeletal practice. The review emphasizes centrifugation force and time, tube geometry, platelet recovery, dose implications, buffy-coat handling, platelet-poor plasma (PPP) use, and reporting standards. Findings: Double-spin protocols outperform single-spin methods in ACD-based preparation. The strongest internally controlled dataset supports 600 × g for five minutes followed by 900 × g for 15 minutes as the highest-yield open protocol, whereas the closed Turn Down-Turn Up protocol reached 4.17-fold enrichment with 73.6% platelet recovery. Dose literature in knee osteoarthritis suggests that total deliverable platelets, not fold increase alone, should guide interpretation; multiple ACD tubes or repeated processing may therefore be required for high-dose clinical targets. Manual ACD workflows also permit phenotype customization by including or excluding the buffy coat and by using PPP as a separate biologic resource, including plasma gel or PRP matrix applications. Conclusion: Manual ACD-tube PRP is best framed as an accessible, customizable preparation platform rather than a single protocol. Its value depends on transparent reporting of tube specifications, centrifugation physics, aspiration strategy, final dose, leukocyte profile, PPP use, and cost.