Too soon, too late, or now: deciding when an injury is ready

TIMING

People arrive at two extremes. One wants an injection this week, because the injury is fresh and doing something feels better than waiting. The other has waited three years and assumes the door has closed. Both are asking a real question, and neither answer is a date.

Why the fresh injury is the wrong moment, biologically

In the first days after an injury the tissue is already doing the thing a catalyst is meant to provoke. The hematoma at the site is a platelet delivery. Growth factors are being released at the top of their range, neutrophils are clearing damaged material, and macrophages are queued behind them. The cascade is running at full volume.

Inject a concentrate of that same signal into that environment and you have not raised the volume of anything. There is nothing stalled to restart. A catalyst is a tool for a process that has stopped, and in week one nothing has stopped — the phases and what each one responds to are set out on the tissue timeline page.

The mirror error is just as common. A repair that stalled two years ago is a completely different biological state from a fresh tear, and treating the two as one question is how people conclude that this whole category either always works or never does.

Where the graded evidence actually lives: persistent, not fresh

Look at who the guideline documents recruited. Every ESSKA-ICRS scenario rated appropriate describes a patient who had already been through conservative care. The 2025 ASIPP guideline puts regenerative therapy after a diagnostic work-up and beside rehabilitation rather than ahead of either. All sixteen questions in the multispecialty guidelines concern chronic pain. The graded record in this field is, from end to end, a record about problems that did not resolve.

Timing is one variable. The target is the other.

A correctly timed injection into the wrong structure is still a wasted injection, and it will read afterwards as a treatment that did not work. Before anything is scheduled, the pain generator has to be named — by mechanism and examination, and where it stays ambiguous, by a diagnostic block that tests the leading candidate directly rather than another image of the same region.

This is where a lot of disappointment originates and it is almost never recorded as the cause. The two failure modes that look identical from the outside are a target that was never confirmed and a preparation nobody characterized — the second is on the preparation page, the first on the page about normal scans.

Anti-inflammatories in the first two weeks, honestly

There is a confident version of this argument on the internet that says anti-inflammatory medication blocks healing and must be avoided. The clinical evidence is weaker than that confidence. A systematic review of four studies covering 4,451 patients — 93% of them anterior cruciate ligament reconstructions — found no significant effect of perioperative anti-inflammatories on reoperation after meniscal repair, cruciate reconstruction or Bankart repair. It did find a higher retear rate with celecoxib than with ibuprofen after rotator cuff repair, 37% against 7%. The authors' own conclusion is that the available data are insufficient to state the effect definitively.

So the position we hold is a case-by-case one rather than a slogan. Around a specific tendon-to-bone repair there is a signal worth respecting. As a general rule that everybody must avoid every anti-inflammatory after every injury, it is not supported, and pain that goes untreated has costs of its own. Where medication fits in a plan is on the stewardship page.

Ready is a state, not a date

Time is one axis of readiness. The other is whether the body can execute the instruction when it arrives. The injection is autologous — manufactured from you on the morning of the procedure — and the tissue receiving it is repairing on your metabolic budget. A catalyst delivered into an inflamed terrain is spent, not stored. That is why the first visit produces lab work rather than a booking, and why the three months between the first visit and a likely procedure are working months rather than waiting months. What we measure is on the metabolic health page.

The corollary is uncomfortable and worth stating anyway: where a modifiable condition is limiting the ceiling and it has not been addressed, an injection given on schedule is a guideline-compliant procedure with a predictable disappointment attached. We would rather say that in month one than explain it in month seven.

The window we work in

For a soft-tissue injury the useful conversation usually starts around the three-month mark, once it is clear whether the repair is finishing or has stalled — earlier if the trajectory is obviously wrong, and earlier still for the evaluation itself, which should happen as soon as you can get here. For a joint surface injured in an event, the question is not measured in months at all; it is a trajectory question, and it is set out on the post-traumatic knee page.

There is no upper bound. Chronic is the state the evidence supports treating.

The timing questions we get most

I was hurt last week. Can I have PRP now?

Almost certainly not, and it is not a scheduling problem — in week one the site is already saturated with platelets and the cascade is already at full volume, so there is nothing stalled for a catalyst to restart. Be evaluated now and treated on the tissue's schedule, which is laid out on the tissue timeline page.

It has been four years. Have I missed the window?

No. Persistent presentations are what the graded evidence was built on, so a long history is a reason to be assessed rather than a reason not to be. What changes with time is the target rather than the eligibility — see whether you are a candidate.

Should I stop taking ibuprofen?

Not on a blanket rule. The clinical review of perioperative anti-inflammatories found no significant effect on most soft-tissue repairs and one specific signal around rotator cuff repair, and its own conclusion is that the data are insufficient to be definitive. We decide it per case, alongside the rest of the medication plan on the stewardship page.

Does waiting make the arthritis worse?

Waiting does not help the joint, and the mechanism is that provisional tissue consolidates in whatever configuration it is left in. That is a different question from whether an injection prevents arthritis, which nothing has shown — the trajectory after a joint injury is covered on the post-traumatic knee page.

Why do some clinics inject people the week of the accident?

Because an injection is easy to sell and hard to argue with in the first fortnight, when almost everything improves anyway. We hold the sequencing the guideline documents themselves specify, and what that means for a first appointment is on the what-to-expect page.

Read alongside this

• The tissue clock after an injury
• The ankle sprain that never came right
• Am I a candidate?
• Why the trials disagree
• How PRP works
• Injury and work comp