The efficacy of platelet-rich plasma injections in the conservative management of lower limb tendinopathy: a systematic review

Introduction: Tendinopathies are challenging to manage due to their complex pathoaetiology. Intratendinous platelet-rich plasma (PRP) injections, which may enhance tendon regeneration, are increasingly used, but their clinical efficacy remains inconclusive. The aim of this systematic review was to examine the efficacy of PRP injections in addition to exercise-based interventions for lower limb tendinopathies. Methods: A systematic review of randomized control trials (RCTs) was conducted following PRISMA guidelines. The protocol was registered with PROSPERO (ID: CRD42021251907). MEDLINE, CINAHL, EMBASE, Cochrane CENTRAL, and Scopus were searched from January 2005 to July 2024. Eligible studies included participants (≥18 years) with a clinical diagnosis of a lower limb tendinopathy, comparing PRP injections plus exercise versus placebo injections plus exercise. The primary outcome was the Victorian Institute of Sports Assessment (VISA) at 12 weeks. Results: Six studies (n = 250) were included. PRP preparation and injection protocols were heterogeneous across studies. The mean baseline VISA-A/P scores were 45.95 for PRP and 45.8 for control. At 12 weeks, the intervention group showed a mean change of 10.75 in VISA-A (range; 3.4–15.2) and 19.8 in VISA-P (range; 14–23.6). Similar effects were observed in control groups, with no significant between-group differences at 12-weeks. The quality of intervention reporting, assessed using the Template for Intervention Description and Replication, had a mean score of 14.3/22. Conclusion: There is insufficient evidence to support PRP for lower limb tendinopathies due to methodological inconsistencies and poor reporting. Future research should focus on establishing an optimal PRP protocol before conducting rigorous RCTs.