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Review
. 2023 Jan 28;12(3):995.
doi: 10.3390/jcm12030995.

The Efficacy of Platelet-Rich Plasma Injection Therapy in the Treatment of Patients with Achilles Tendinopathy: A Systematic Review and Meta-Analysis

Djandan Tadum Arthur Vithran  1   2 , Wenqing Xie  1   2 , Michael Opoku  1   2 , Anko Elijah Essien  1   2 , Miao He  1   2 , Yusheng Li  1   2
Affiliations
Review

The Efficacy of Platelet-Rich Plasma Injection Therapy in the Treatment of Patients with Achilles Tendinopathy: A Systematic Review and Meta-Analysis

Djandan Tadum Arthur Vithran et al. J Clin Med. .

Abstract

Background: Over the past few years, many studies have been conducted to evaluate the effectiveness of platelet-rich plasma (PRP) in treating musculoskeletal conditions. However, there is controversy about its benefits for patients with Achilles tendinopathy.

Objective: This study aimed to investigate whether platelet-rich plasma injections can improve outcomes in patients with Achilles tendinopathy.

Methods: A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, Web of Science, China Biomedical CD-ROM, and Chinese Science and Technology Journal databases to identify randomised controlled clinical trials that compared the efficacy of PRP injection in patients with Achilles tendinopathy (AT) versus placebo, published between 1 January 1966 and 1 December 2022. Review Manager 5.4.1 software was used for the statistical analysis, and the Jadad score was used to assess the included literature. Only 8 of the 288 articles found met the inclusion criteria.

Results: Our work suggests that: The PRP treatment group had a slightly higher VISA-A score than the placebo group at 6 weeks [MD = 1.92, 95% CI (-0.54, 4.38), I2 = 34%], at 12 weeks [MD = 0.20, 95% CI (-2.65 3.05), I2 = 60%], and 24 weeks [MD = 2.75, 95% CI (-2.76, 8.26), I2 = 87%]). However, the difference was not statistically significant. The Achilles tendon thickness was higher at 12 weeks of treatment in the PRP treatment group compared to the control group [MD = 0.34, 95% CI (-0.04, 0.71), p = 0.08], but the difference was not statistically significant. The VAS-improvement results showed no significant difference at 6 and 24 weeks between the two groups, respectively (MD = 6.75, 95% CI = (-6.12, 19.62), I2 = 69%, p = 0.30), and (MD = 10.46, 95% CI = (-2.44 to 23.37), I2 = 69%, p = 0.11). However, at 12 weeks of treatment, the PRP injection group showed a substantial VAS improvement compared to the control group (MD = 11.30, 95% CI = (7.33 to 15.27), I2 = 0%, p < 0.00001). The difference was statistically significant. The return to exercise rate results showed a higher return to exercise rate in the PRP treatment group than the placebo group [RR = 1.11, 95% CI (0.87, 1.42), p = 0.40]; the difference was not statistically significant.

Conclusion: There is no proof that PRP injections can enhance patient functional and clinical outcomes for Achilles tendinopathy. Augmenting the frequency of PRP injections may boost the outcomes, and additionally, more rigorous designs and standardised clinical randomised controlled trials are needed to produce more reliable and accurate results.

Keywords: Achilles tendinopathy; meta-analysis; platelet-rich plasma; randomised controlled trial; systematic literature review.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Literature screening flow chart.
Figure 2
Figure 2
Proportional risk of bias graph: judgement of the percentage of bias items arising from all included studies.
Figure 3
Figure 3
Risk of bias summary diagram: assessment of specific items of bias arising from all included studies.
Figure 4
Figure 4
Funnel plot based on the Victoria College Ankle Function Scale scores from eight studies of Achilles tendinopathy.
Figure 5
Figure 5
Forest plot of change values for the Victorian College Ankle Function Scale scores.
Figure 6
Figure 6
Forest plot of Achilles tendon thickness variation.
Figure 7
Figure 7
Forest plot of the change in visual analogue score.
Figure 8
Figure 8
Forest plot of changes in patient satisfaction.
Figure 9
Figure 9
Forest plot of patient return to exercise rate.
See this image and copyright information in PMC

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Grants and funding

This work was supported by the National Key R&D Program of China (No. 2019YFA0111900), National Natural Science Foundation of China (No. 81874030, 82072506), Hunan Young Talents of Science and Technology (No. 2021RC3025), Provincial Clinical Medical Technology Innovation Project of Hunan (No. 2020SK53709), Innovation-Driven Project of Central South University (No.2020CX045), and the Wu Jieping Medical Foundation (No. 320.6750.2020-03-14).