Platelet-rich plasma (PRP) injections as a second-line treatment in patients with tendinopathy-related chronic pain and failure of conservative treatment: a systematic review and meta-analysis.

Design: Platelet-rich plasma (PRP) is a popular treatment option in managing chronic tendinopathies, although the literature is inconsistent, mainly because of significant heterogeneity in patient populations. Patients who failed conservative management may respond differently than those who have not undergone first-line treatment. This systematic review and meta-analysis aimed to evaluate the efficacy of PRP injections in reducing pain and improving function in patients with chronic tendinopathy who failed conservative treatment. A comprehensive search of Medline, Embase, Cochrane Library, Cinahl Complete and Dissertations & Theses Global was conducted to identify randomized controlled trials comparing the effect of PRP versus non-surgical treatments on pain and functional outcomes in adult non-responders to conservative management.

Results: A total of 9 RCTs involving 488 patients were included in the review. Of those, 6 studies at low risk of bias were included in the meta-analysis. PRP significantly reduced pain at both 6 and 12 months compared to control treatments (mean difference: -0.83 [95% CI: -1.61 to -0.04] at 6 months; and -1.11 [95% CI: -2.10 to -0.12] at 12 months). This effect was also seen at 24 months, although based on limited data. Subgroup analysis revealed no significant differences in pain reduction between upper and lower limb tendinopathies. Functional improvement was observed in some studies, though the heterogeneity in outcome measures precluded a pooled analysis. Heterogeneity was substantial across studies, likely due to differences in PRP preparation, site of tendinopathy, and study methodologies.

Conclusion: Despite these limitations, the findings suggest that PRP reduces pain in patients suffering from chronic tendinopathy who have not responded to first-line therapies. Further high-quality research with standardized protocols and longer follow-up is necessary to confirm PRP's long-term efficacy and safety.