Platelet-rich plasma vs. placebo injections in achilles tendinopathy: A systematic review and meta-analysis of randomized controlled trials.

Abstract

Achilles tendinopathy (AT) is a prevalent overuse injury marked by pain, functional limitation, and structural tendon degeneration. Platelet-rich plasma (PRP) has emerged as a biological treatment alternative due to its regenerative potential. Nonetheless, its efficacy compared to placebo for AT remains unclear. This meta-analysis aimed to evaluate the effectiveness of PRP injections versus placebo in the treatment of AT. A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and Google Scholar (first 20 pages) through January 2025. Eligible studies were English-language randomized controlled trials that compared PRP with placebo in patients clinically diagnosed with Achilles tendinopathy. Outcomes included VISA-A (Victorian Institute of Sport Assessment-Achilles) scores, VAS (Visual Analog Scale) pain scores, and radiological findings. Data were extracted and analyzed using Review Manager 5.4. Heterogeneity was assessed using I² statistics. Four randomized controlled trials including 337 patients reported VISA-A scores at 3 and 6 months. No statistically significant differences were found between PRP and placebo at either timepoint. Similarly, VAS scores from three studies (n = 283 at 3 months; n = 270 at 6 months) showed no significant difference. Radiological outcomes from two studies revealed no significant changes in tendon thickness or vascularity between groups. This meta-analysis found no significant clinical or radiological benefit of PRP injections compared to placebo in the treatment of Achilles tendinopathy. Larger, high-quality trials are needed to confirm these findings and standardize treatment protocols.