Efficacy of Platelet-rich Plasma Injections for Symptomatic Tendinopathy: Systematic Review and Meta-analysis of Randomised Injection-controlled Trials

Overview

Journal BMJ Open Sport Exerc Med

Specialty Orthopedics

Date 2017 Nov 28

PMID 29177072

Citations 37

Authors

Larry E Miller

William R Parrish

Breana Roides

Samir Bhattacharyya

Affiliations

Soon will be listed here.

Abstract

Aim: To determine the efficacy of platelet-rich plasma (PRP) injections for symptomatic tendinopathy.

Design: Systematic review of randomised, injection-controlled trials with meta-analysis.

Data Sources: Systematic searches of MEDLINE and EMBASE, supplemented by manual searches.

Eligibility Criteria For Selecting Studies: Randomised controlled trials with 3 months minimum follow-up that evaluated pain reduction with PRP versus control (saline, local anaesthetic, corticosteroid) injections in patients with symptomatic tendinopathy.

Results: A total of 16 randomised controlled trials (18 groups) of PRP versus control were included. Median sample size was 35 patients, a study size that would require an effect size ≥1.0 to achieve statistical significance. PRP was more efficacious than control in reducing tendinopathy pain, with an effect size of 0.47 (95% CI 0.22 to 0.72, p<0.001), signifying a moderate treatment effect. Heterogeneity among studies was moderate (I=67%, p<0.001). In subgroup analysis and meta-regression, studies with a higher proportion of female patients were associated with greater treatment benefits with PRP.

Conclusions: Injection of PRP is more efficacious than control injections in patients with symptomatic tendinopathy.

Citing Articles

Platelet-Rich Plasma Versus Corticosteroid Injections for Chronic Tendinopathies: A Systematic Review and Meta-Analysis.

Elnewishy A, Elsenosy A, Teama H, Symeon N, Hamada A Cureus. 2025; 16(12):e76051.

PMID: 39759599 PMC: 11695647. DOI: 10.7759/cureus.76051.

Advancements in Therapeutic Approaches for Degenerative Tendinopathy: Evaluating Efficacy and Challenges.

Morya V, Shahid H, Lang J, Kwak M, Park S, Noh K Int J Mol Sci. 2024; 25(21).

PMID: 39519397 PMC: 11545934. DOI: 10.3390/ijms252111846.

Platelet-rich plasma for de Quervain's tenosynovitis: A systematic review and meta-analysis.

Hidajat N, Magetsari R, Steven G, Budiman J, Prasetiyo G World J Orthop. 2024; 15(9):858-869.

PMID: 39318495 PMC: 11417631. DOI: 10.5312/wjo.v15.i9.858.

Current and future advances in practice: tendinopathies of the hip.

Grimaldi A, Mellor R, Nasser A, Vicenzino B, Hunter D Rheumatol Adv Pract. 2024; 8(2):rkae022.

PMID: 38601140 PMC: 11003818. DOI: 10.1093/rap/rkae022.

Optimization of Platelet-Rich Plasma Preparation for Regenerative Medicine: Comparison of Different Anticoagulants and Resuspension Media.

Carvalho A, Ferreira A, Soares M, Santos S, Tome P, Machado-Simoes J Bioengineering (Basel). 2024; 11(3).

PMID: 38534483 PMC: 10967741. DOI: 10.3390/bioengineering11030209.

References

Rabago D, Best T, Zgierska A, Zeisig E, Ryan M, Crane D . A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma. Br J Sports Med. 2008; 43(7):471-81. PMC: 2755040. DOI: 10.1136/bjsm.2008.052761. View

de Vos R, Weir A, van Schie H, Bierma-Zeinstra S, Verhaar J, Weinans H . Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010; 303(2):144-9. DOI: 10.1001/jama.2009.1986. View

Rha D, Park G, Kim Y, Kim M, Lee S . Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial. Clin Rehabil. 2012; 27(2):113-22. DOI: 10.1177/0269215512448388. View

Montalvan B, Le Goux P, Klouche S, Borgel D, Hardy P, Breban M . Inefficacy of ultrasound-guided local injections of autologous conditioned plasma for recent epicondylitis: results of a double-blind placebo-controlled randomized clinical trial with one-year follow-up. Rheumatology (Oxford). 2015; 55(2):279-85. DOI: 10.1093/rheumatology/kev326. View

Shams A, El-Sayed M, Gamal O, Ewes W . Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears. Eur J Orthop Surg Traumatol. 2016; 26(8):837-842. DOI: 10.1007/s00590-016-1826-3. View

Yadav R, Kothari S, Borah D . Comparison of Local Injection of Platelet Rich Plasma and Corticosteroids in the Treatment of Lateral Epicondylitis of Humerus. J Clin Diagn Res. 2015; 9(7):RC05-7. PMC: 4573006. DOI: 10.7860/JCDR/2015/14087.6213. View

Martinez C, Smith P, Palma Alvarado V . The influence of platelet-derived products on angiogenesis and tissue repair: a concise update. Front Physiol. 2015; 6:290. PMC: 4611136. DOI: 10.3389/fphys.2015.00290. View

de Vos R, Weir A, Tol J, Verhaar J, Weinans H, van Schie H . No effects of PRP on ultrasonographic tendon structure and neovascularisation in chronic midportion Achilles tendinopathy. Br J Sports Med. 2010; 45(5):387-92. DOI: 10.1136/bjsm.2010.076398. View

Kesikburun S, Tan A, Yilmaz B, Yasar E, Yazicioglu K . Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up. Am J Sports Med. 2013; 41(11):2609-16. DOI: 10.1177/0363546513496542. View

10.

Gosens T, Peerbooms J, van Laar W, Den Oudsten B . Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med. 2011; 39(6):1200-8. DOI: 10.1177/0363546510397173. View

11.

Krogh T, Ellingsen T, Christensen R, Jensen P, Fredberg U . Ultrasound-Guided Injection Therapy of Achilles Tendinopathy With Platelet-Rich Plasma or Saline: A Randomized, Blinded, Placebo-Controlled Trial. Am J Sports Med. 2016; 44(8):1990-7. DOI: 10.1177/0363546516647958. View

12.

Khan K, Cook J, Kannus P, Maffulli N, Bonar S . Time to abandon the "tendinitis" myth. BMJ. 2002; 324(7338):626-7. PMC: 1122566. DOI: 10.1136/bmj.324.7338.626. View

13.

Molloy T, Wang Y, Murrell G . The roles of growth factors in tendon and ligament healing. Sports Med. 2003; 33(5):381-94. DOI: 10.2165/00007256-200333050-00004. View

14.

Mishra A, Skrepnik N, Edwards S, Jones G, Sampson S, Vermillion D . Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med. 2013; 42(2):463-71. DOI: 10.1177/0363546513494359. View

15.

Peerbooms J, Sluimer J, Bruijn D, Gosens T . Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med. 2010; 38(2):255-62. DOI: 10.1177/0363546509355445. View

16.

Vos R, Windt J, Weir A . Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review. Br J Sports Med. 2014; 48(12):952-6. DOI: 10.1136/bjsports-2013-093281. View

17.

Higgins J, Thompson S, Deeks J, Altman D . Measuring inconsistency in meta-analyses. BMJ. 2003; 327(7414):557-60. PMC: 192859. DOI: 10.1136/bmj.327.7414.557. View

18.

de Jonge S, de Vos R, Weir A, van Schie H, Bierma-Zeinstra S, Verhaar J . One-year follow-up of platelet-rich plasma treatment in chronic Achilles tendinopathy: a double-blind randomized placebo-controlled trial. Am J Sports Med. 2011; 39(8):1623-9. DOI: 10.1177/0363546511404877. View

19.

Andia I, Latorre P, Gomez M, Burgos-Alonso N, Abate M, Maffulli N . Platelet-rich plasma in the conservative treatment of painful tendinopathy: a systematic review and meta-analysis of controlled studies. Br Med Bull. 2014; 110(1):99-115. DOI: 10.1093/bmb/ldu007. View

20.

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009; 151(4):W65-94. DOI: 10.7326/0003-4819-151-4-200908180-00136. View