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Platelet-Rich Plasma (PRP) and Injection Therapies

What the evidence shows for platelet-rich plasma and related injection therapies in tendinopathy, osteoarthritis and rotator cuff disease — where they help and where the data is weak.

Overview

Platelet-rich plasma (PRP) therapy demonstrates variable efficacy across orthopaedic indications, with established roles in osteoarthritis and specific tendon pathologies while lacking support for others. For knee osteoarthritis, at least two PRP injections are recommended, providing symptom relief lasting at least 24 weeks [1]. Both leukocyte-rich (L-PRP) and leukocyte-poor (LP-PRP) formulations offer comparable efficacy for this condition [3]. Consequently, PRP therapy should be systematically offered to competition sports practitioners presenting with large joint osteoarthritis [6]. However, conclusions regarding clinical utility require caution due to methodological concerns, including lack of PRP characterization and short-term follow-up, necessitating that future studies prioritize long-term outcomes [2].

In sports medicine applications, evidence supports the selective use of PRP for acute muscle injuries, though standardization in protocols and outcomes remains necessary [7]. For lateral epicondylitis, a direct linear relationship exists between PRP concentration factor and the magnitude of patient-reported symptom relief, with high-dose PRP showing significant efficacy over alternative strategies [4]. Conversely, other findings do not support PRP as a recommended treatment for this condition [8], and studies evaluating these procedures show poor adherence to MIBO guidelines [11].

PRP is not effective for certain other tendinopathies. It is no more effective than placebo for treating Achilles tendinopathy and should not be used for this indication until new, large, high-quality RCTs upend current knowledge [9]. Routine use of PRP for greater trochanteric pain syndrome is not supported [12]. In contrast, findings refute claims of PRP equivalence to placebo, supporting its efficacy over placebo in chronic tenosynovitis [5].

In the setting of rotator cuff repair, leukocyte-poor platelet-rich plasma reduces retear risk [15]. The economic value of LP-PRP in this context is conditional rather than uniform, depending on revision probability and preparation cost [15].

How It Works

Mechanism and Characterization: Leukocyte-rich PRP (L-PRP) and leukocyte-poor PRP (LP-PRP) demonstrate comparable efficacy for knee osteoarthritis [3]. Optimizing osteoarthritis treatment requires tailoring protocols to disease stage: low platelet, high leukocyte PRP is recommended for early OA due to anti-inflammatory effects, while high platelet, low leukocyte PRP is preferred for advanced OA to promote tissue repair and regeneration [14]. Long-term follow-up and rigorous characterization are necessary to guide clinical decision-making, as methodological concerns such as lack of characterization and short-term follow-up limit the interpretation of some clinical utility conclusions [2].

Knee Osteoarthritis: At least two PRP injections are recommended for treating knee osteoarthritis, with effects lasting for at least 24 weeks [1]. Intra-articular PRP injection is an effective treatment for improving overall function in patients with primary osteoarthritis, particularly in younger individuals [16].

Tendinopathies: * Lateral Epicondylitis: PRP injections are a safe and effective conservative treatment method for reducing pain symptoms and increasing functionality in patients with lateral epicondylitis in the early follow-up period [17]. There is a direct, linear relationship between the concentration factor of PRP used and the magnitude of patient-reported symptom relief, with high-dose PRP showing significant efficacy for lateral epicondylitis [4]. Corticosteroids result in greater short-term improvement than PRP for lateral elbow tendinopathy, while PRP demonstrates superior longer-term outcomes at 6 and 12 months [10]. However, a meta-analysis of randomized clinical trials does not support PRP as a recommended treatment for lateral epicondylitis compared with placebo [8]. * Achilles Tendinopathy: PRP is no more effective than placebo for treating Achilles tendinopathy and should not be used for this indication until new, large, high-quality RCTs upend current knowledge [9]. * Chronic Tenosynovitis: PRP demonstrates efficacy over placebo in chronic tenosynovitis, refuting claims of equivalence [5]. * Greater Trochanteric Pain Syndrome: Routine use of PRP is not supported for the treatment of greater trochanteric pain syndrome [12].

Sports Medicine and Other Indications: PRP therapy is recommended for competition sports practitioners to provide long-lasting stimulation of the joint with an adequate dose of platelets [6]. Current evidence supports the selective use of PRP in sports settings for acute muscle injuries, though standardization in protocols and outcomes is needed [7]. The application of PRP following core decompression results in significant pain relief, improved short-term functional outcomes, and enhanced quality of life compared to core decompression alone in early osteonecrosis of the femoral head [18].

What the Evidence Shows

Knee Osteoarthritis

Protocol: At least two PRP injections are recommended, with effects lasting for at least 24 weeks [1]. Efficacy: Intra-articular PRP injection effectively improves overall function in primary osteoarthritis, particularly in younger individuals [16]. Combination Therapy: PRP combined with hyaluronic acid (HA) therapy is safe and yields better outcomes in pain relief and functional improvement compared to PRP monotherapy [20]. Specifically, the combination of PRP with non-crosslinked HA in a mono-injection is non-inferior to crosslinked HA regarding the percentage of responders over 6 months for WOMAC pain [22]. Preparation: Both leukocyte-rich (L-PRP) and leukocyte-poor (LP-PRP) platelet-rich plasma are effective treatment options with comparable efficacy for knee osteoarthritis based on current evidence [3]. Bias Warning: Spin bias is highly prevalent in the abstracts of systematic reviews and meta-analyses of intra-articular PRP to treat knee osteoarthritis, with identified spin tending to favor the use of PRP [21].

Lateral Epicondylitis (Lateral Elbow Tendinopathy)

Efficacy Profile: Corticosteroids result in greater short-term improvement than PRP, while PRP demonstrates superior longer-term outcomes at 6 and 12 months for lateral elbow tendinopathy [10]. PRP injections are a safe and effective conservative treatment method for reducing pain symptoms and increasing functionality in patients with lateral epicondylitis [17]. A direct, linear relationship exists between the concentration factor of PRP used and the magnitude of patient-reported symptom relief, with high-dose PRP showing significant efficacy over alternative treatment strategies [4]. Conflicting Evidence: Current evidence does not support PRP as a recommended treatment for lateral epicondylitis when compared with placebo [8]. Methodological Concerns: Conclusions regarding the clinical utility of PRP for lateral epicondylitis should be interpreted with caution due to major methodological concerns, including lack of PRP characterization and short-term follow-up [2]. Studies evaluating the outcomes and procedures of PRP use in lateral epicondylitis demonstrate poor adherence to Minimum Information for Studies Evaluating Biologics in Orthopedics (MIBO) guidelines [11].

Other Tendinopathies

Achilles Tendinopathy: PRP is no more effective than placebo for treating Achilles tendinopathy and should not be used for this indication until new, large, high-quality randomized controlled trials upend current knowledge [9]. General Tendinopathy: PRP can effectively improve pain and functional impairment in patients with tendinopathy, and its midterm efficacy is superior to that of corticosteroids [19]. Chronic Tenosynovitis: Findings from a randomized controlled trial refute claims of PRP equivalence to placebo and support its efficacy over placebo in chronic tenosynovitis [5].

Muscle Injuries and Sports Medicine

Acute Muscle Injuries: Current evidence supports the selective use of PRP in sports settings for acute muscle injuries, though standardization in protocols and outcomes is needed [7]. Recommendation: The authors recommend systematically offering PRP therapy for competition sports practitioners [6].

Osteonecrosis

Early Osteonecrosis of the Femoral Head: The application of PRP following small-diameter core decompression results in significant pain relief, improved short-term functional outcomes, and enhanced quality of life compared to core decompression alone [18].

Anterior Cruciate Ligament Reconstruction

Augmentation: Current evidence is of insufficient quality to determine if anterior cruciate ligament reconstruction (ACLR) augmented with PRP application provides a clinically meaningful improvement in postoperative outcomes over ACLR without PRP [13].

Greater Trochanteric Pain Syndrome

Routine Use: Evidence does not support the routine use of PRP for the treatment of greater trochanteric pain syndrome [12].

Practical Considerations

Knee Osteoarthritis: At least two PRP injections are recommended, with effects lasting for at least 24 weeks [1]. Clinical utility requires caution due to methodological concerns, including lack of PRP characterization and short-term follow-up [2]. Future studies must prioritize long-term outcomes to guide decision-making [2]. Treatment should be tailored to disease stage: Low platelet, high leukocyte PRP is recommended for early osteoarthritis for its anti-inflammatory effects, while High platelet, low leukocyte PRP is preferred for advanced disease to promote tissue repair [14]. Both leukocyte-rich (L-PRP) and leukocyte-poor (LP-PRP) demonstrate comparable efficacy [3]. PRP therapy should be systematically offered to competition sports practitioners for large joint osteoarthritis [6].

Lateral Epicondylitis: A direct, linear relationship exists between PRP concentration factor and the magnitude of symptom relief [4]. High-dose PRP shows significant efficacy over alternative strategies [4]. However, studies evaluating these outcomes show poor adherence to Minimum Information for Studies Evaluating Biologics in Orthopedics (MIBO) guidelines [11].

Other Tendinopathies: PRP demonstrates efficacy over placebo in chronic tenosynovitis, refuting claims of equivalence [5].

Sports Medicine Applications: Current evidence supports selective PRP use in sports settings for acute muscle injuries, though protocol and outcome standardization is needed [7].

Rotator Cuff Repair: Leukocyte-poor PRP reduces retear risk after arthroscopic rotator cuff repair [15]. The economic value of LP-PRP is conditional, depending on revision probability and preparation cost [15].

Anterior Cruciate Ligament Reconstruction: Current evidence is of insufficient quality to determine if PRP augmentation provides a clinically meaningful improvement in postoperative outcomes over reconstruction without PRP [13].

Key Evidence

  • [L3] At least two PRP injections are recommended, with effects lasting for at least 24 weeks. (10.1186/s13018-025-05756-6)
  • [L5] The authors' conclusions regarding the clinical utility of PRP should be interpreted with caution due to major methodological concerns, including lack of PRP characterization and short-term follow-up; future studies should prioritize long-term outcomes to guide clinical decision-making more effectively. (10.1016/j.arth.2025.05.007)
  • [L1] Both L-PRP and LP-PRP are effective treatment options with comparable efficacy based on current evidence. (10.1186/s13018-026-06689-4)
  • [L1] A direct, linear relationship was observed between the concentration factor of PRP used and the magnitude of patient-reported symptom relief after PRP injection, with high-dose PRP showing significant efficacy over alternative treatment strategies. (10.1016/j.jisako.2025.100442)
  • [L1] These findings refute claims of PRP equivalence to placebo and support its efficacy over placebo. (10.1186/s12891-025-09339-8)
  • [L4] The authors recommend systematically offering PRP therapy for competition sports practitioners. (10.1186/s12891-025-08663-3)
  • [L2] Current evidence supports the selective use of PRP in sports settings, though standardization in protocols and outcomes is needed. (10.1177/23259671251399907)
  • [L1] These findings do not support PRP as a recommended treatment for this condition. (10.1177/03635465251383039)
  • [L1] PRP is no more effective than placebo for treating Achilles tendinopathy and should not be used for this indication until new, large, high-quality RCTs upend current knowledge. (10.1097/corr.0000000000003478)
  • [L1] Corticosteroids resulted in greater short-term improvement, while PRP demonstrated superior longer-term outcomes at 6 and 12 months. (10.1177/23259671251386862)
  • [L2] This review demonstrated that studies evaluating the outcomes and procedures of the use of PRP in the setting of LE have poor adherence to MIBO guidelines. (10.5397/cise.2024.01060)
  • [L1] As a result, we do not support the routine use of PRP for the treatment of this condition. (10.2106/jbjs.24.00763)
  • [L1] Current evidence is of insufficient quality to determine if ACLR augmented with PRP application provides a clinically meaningful improvement in postoperative outcomes over ACLR without PRP. (10.1186/s13018-026-06714-6)
  • [L1] Optimizing OA treatment involves tailoring PRP protocols to disease stage, with low platelet, high leukocyte PRP recommended for early OA due to its anti-inflammatory effects and high platelet, low leukocyte PRP preferred for advanced OA to promote tissue repair and regeneration. (10.1186/s13018-025-06026-1)
  • [L1] The economic value of LP-PRP is conditional rather than uniform and depends on revision probability and preparation cost. (10.1016/j.jse.2026.02.018)
  • [L1] Intra-articular PRP injection is an effective treatment for improving overall function in patients with primary OA, particularly in younger individuals. (10.1186/s12891-026-09486-6)
  • [L4] PRP injections are a safe and effective conservative treatment method for reducing pain symptoms and increasing functionality in patients with lateral epicondylitis. (10.1177/2325967125s00169)
  • [L3] The application of PRP following CD results in significant pain relief, improved short-term functional outcomes, and enhanced quality of life compared to CD alone. (10.1186/s12891-024-08243-x)
  • [L1] PRP can effectively improve pain and functional impairment in patients with tendinopathy, and its midterm efficacy is superior to that of corticosteroids. (10.1186/s12891-025-08566-3)
  • [L1] This meta-analysis reveals that, for patients with KOA, PRP + HA therapy is safe and yields better outcomes in pain relief and functional improvement compared to PRP monotherapy. (10.1186/s13018-024-05429-w)
  • [L1] Spin bias is highly prevalent in the abstracts of systematic reviews and meta-analyses of intra-articular PRP to treat knee osteoarthritis, with identified spin tending to favor the use of PRP. (10.1002/arj.70027)
  • [L1] The combination of PRP with non-crosslinked HA in mono-injection was found to be non-inferior to crosslinked HA, with regards to the percentage of responders over 6 months (WOMAC pain). (10.1186/s12891-026-09625-z)

References

[1] Efficacy of multiple autologous apheresis platelet-rich plasma injections for treating knee osteoarthritis and its influencing factors: a retrospective cohort study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05756-6

[2] Letter Regarding “Platelet-Rich Plasma Injections are Inferior to Corticosteroid Injections for Short-Term Pain Relief: A Prospective, Double-Blinded, Randomized Controlled Trial”. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.05.007

[3] Leukocyte-rich versus leukocyte-poor platelet-rich plasma and hyaluronic acid for knee osteoarthritis: a systematic review and network meta-analysis. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-026-06689-4

[4] Platelet Concentration Factor Explains Variability in Outcomes of Platelet-rich Plasma for Lateral Epicondylitis: High Dose Critical for Positive Response. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100442

[5] Time-dependent growth factor kinetics, platelet concentration, and clinical response following platelet-rich plasma versus saline in chronic tenosynovitis: a randomized controlled trial. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09339-8

[6] Platelet-rich plasma treatment for large joint osteoarthritis: retrospective study highlighting a possible treatment protocol with long-lasting stimulation of the joint with an adequate dose of platelets. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08663-3

[7] Platelet-Rich Plasma in Acute Muscle Injuries: An Umbrella Review and Meta-analysis of Return to Sport and Reinjury Outcomes. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671251399907

[8] Platelet-Rich Plasma Does Not Improve Pain or Function in Patients With Lateral Epicondylitis as Compared With Placebo: A Meta-analysis of Randomized Clinical Trials. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465251383039

[9] Editor’s Spotlight/Take 5: Is Platelet-rich Plasma Effective in Treating Achilles Tendinopathy? A Meta-analysis of Randomized Clinical Trials. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003478

[10] A Randomized Controlled Trial of 1-Year Clinical Outcomes of a Single Platelet-Rich Plasma Injection Versus Corticosteroid for the Treatment of Lateral Elbow Tendinopathy. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671251386862

[11] Adherence rates to the Minimum Information for Studies Evaluating Biologics in Orthopedics guidelines for clinical studies on platelet-rich plasma for the treatment of lateral epicondylitis: a systematic review. Clinics in Shoulder and Elbow. 2026. DOI: 10.5397/cise.2024.01060

[12] Efficacy of Platelet-Rich Plasma Versus Placebo for the Treatment of Greater Trochanteric Pain Syndrome. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.00763

[13] The impact of platelet-rich plasma augmentation on postoperative clinical outcomes in patients undergoing anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-026-06714-6

[14] The efficacy of platelet-rich plasma preparation protocols in the treatment of osteoarthritis: a network meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06026-1

[15] Leukocyte-poor platelet-rich plasma reduces retear risk after arthroscopic rotator cuff repair: a meta-analysis with mechanistic and economic evaluation. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.02.018

[16] Investigating the therapeutic impact of platelet-rich plasma on knee, hip, and traumatic osteoarthritis: a meta-analysis and systematic review. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09486-6

[17] Poster 58: Decreased Pain After Platelet-Rich Plasma Injection in Lateral Epicondylitis Patients in the Early Follow-up Period. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00169

[18] Efficacy of small-diameter core decompression with platelet-rich plasma in early osteonecrosis of the femoral head: a retrospective study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-024-08243-x

[19] Platelet-rich plasma and corticosteroid injection for tendinopathy: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08566-3

[20] RETRACTED ARTICLE: A meta-analysis and systematic review of the clinical efficacy and safety of platelet-rich plasma combined with hyaluronic acid (PRP + HA) versus PRP monotherapy for knee osteoarthritis (KOA). Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-024-05429-w

[21] Statistically Significant Results Favored in Abstracts of Platelet Rich Plasma Treatment of Knee Osteoarthritis: A Systematic Review and Spin Analysis. Arthroscopy. 2026. DOI: 10.1002/arj.70027

[22] Efficacy and safety of a combination of platelet-rich plasma with non-crosslinked hyaluronic acid versus a crosslinked hyaluronic acid, in single-injection for knee osteoarthritis. Randomized, controlled, multicenter, non-inferiority trial. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09625-z

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a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

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