Sesamoid bones absorb and disperse weight from the metatarsal bones. Sesamoid injuries occur primarily in dancers and runners, with nonoperative management as the first line of treatment. Due to the lack of secondary blood supply, the sesamoids are at risk for osteonecrosis and nonunion fractures. The literature supporting orthobiologics for the treatment of sesamoid injuries is limited. In this case, a 28-year-old female dancer with sesamoid osteonecrosis underwent a leukocyte-rich platelet-rich plasma (LR-PRP) injection to the fibular sesamoid. The patient reported significant improvement in pain at the 2-month follow-up and returned to regular auditions at the 3-month follow-up. At 2-year follow-up, the patient's symptoms returned to baseline. This is the first known case of sesamoid osteonecrosis treated with LR-PRP. LR-PRP should be considered in the treatment of sesamoid osteonecrosis in those who show limited improvement with standard conservative measures.
