Efficacy of platelet-rich plasma as a conservative and surgical adjuvant treatment for chronic midportion Achilles tendinopathy: a systematic review and meta-analysis.

Abstract

Platelet-rich plasma (PRP) has been increasingly used for chronic midportion Achilles tendinopathy, yet its true clinical value remains controversial, this study aimed to evaluate the efficacy of PRP as both a conservative intervention and an adjunct to surgical treatment for chronic midportion Achilles tendinopathy, with a focus on its impact on patient outcomes. In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, two independent reviewers conducted a literature search and compared the therapeutic effects of PRP injection versus control groups in the treatment of chronic midportion Achilles tendinopathy and as an adjunct to surgical treatment. The primary outcomes were assessed using Victorian Institute of Sports Assessment-Achilles (VISA-A) score and Visual Analog Scale (VAS) for pain. Statistical analysis was conducted using Review Manager 5.3, and <i>p</i> < 0.05 was considered statistically significant. A total of 8 studies involving 507 patients were included. Results indicated that the PRP group exhibited superior short-term VISA-A scores compared to the control group [MD = 2.78, 95% CI (1.29, 4.28), <i>p</i> = 0.0003]. However, no significant differences were observed at other follow-up time points. Although the PRP group demonstrated overall lower VAS scores [SMD = 0.76, 95% CI (0.26, 1.26), <i>p</i> = 0.003], subgroup analyses revealed no significant differences between the groups at any time point (<i>p</i> > 0.05). Additionally, no significant improvement in tendon thickness in the PRP group compared to the control group (<i>p</i> > 0.05). Furthermore, two studies reported on postoperative pain, functional, and satisfaction scores between PRP adjunctive treatment and control groups, with no significant differences observed between the groups at any time point (<i>p</i> > 0.05). Current evidence demonstrates that PRP provides only short-term functional improvement in chronic midportion Achilles tendinopathy, with no significant long-term or structural benefits and no additional advantage as a surgical adjunct. PRP should not be considered routine treatment; clinicians should prioritize evidence-based rehabilitation while counseling patients regarding its limited, transient effects. Future research must focus on establishing standardized PRP protocols, conducting large multicenter trials, and investigating optimized formulations and combination therapies to potentially enhance outcomes.