Efficacy of platelet-rich plasma injections for symptomatic tendinopathy: systematic review and meta-analysis of randomised injection-controlled trials

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(2)=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.