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The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment

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Chen, Xiao, Jones, Ian A., Park, Caron, Vangsness, C. Thomas·2018·The American Journal of Sports Medicine
DOI 10.1177/0363546517743746PMC PMC6339617
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Abstract

Background: There has been a surge in high-level studies investigating platelet-rich plasma (PRP) for tendon and ligament injuries. A number of meta-analyses have been published, but few studies have focused exclusively on tendon and ligament injuries. Purpose: To perform a meta-analysis assessing the ability of PRP to reduce pain in patients with tendon and ligament injuries. Study Design: Systematic review and meta-analysis. Methods: This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search of the literature was carried out in April 2017 using electronic databases PubMed, MEDLINE, and the Cochrane Library. Only level 1 studies were included. Platelet and leukocyte count, injection volume, kit used, participant age/sex, comparator, and activating agent used were recorded. The short-term and long-term efficacy of PRP was assessed using the visual analog scale (VAS) to measure pain intensity. Injury subgroups (rotator cuff, tendinopathy, anterior cruciate ligament, and lateral epicondylitis) were evaluated. Funnel plots and the Egger test were used to screen for publication bias, and sensitivity analysis was performed to evaluate the effect of potential outliers by removing studies one at a time. Results: Thirty-seven articles were included in this review, 21 (1031 participants) of which could be included in the quantitative analysis. The majority of studies published investigated rotator cuff injuries (38.1%) or lateral epicondylitis (38.1%). Seventeen studies (844 participants) reported short-term VAS data, and 14 studies (771 participants) reported long-term VAS data. Overall, long-term follow-up results showed significantly less pain in the PRP group compared with the control group (weighted mean difference [WMD], –0.84; 95% CI, –1.23 to –0.44; P < .01). Patients treated with PRP for rotator cuff injuries (WMD, –0.53; 95% CI, –0.98 to –0.09; P = .02) and lateral epicondylitis (WMD, –1.39; 95% CI, –2.49 to –0.29; P = .01) reported significantly less pain in the long term. Substantial heterogeneity was reported at baseline ( I 2 = 72.0%; P < .01), short-term follow-up ( I 2 = 72.5%; P < .01), long-term follow-up ( I 2 = 76.1%; P < .01), and overall ( I 2 = 75.8%; P < .01). The funnel plot appeared to be asymmetric, with some missingness at the lower right portion of the plot suggesting possible publication bias. Conclusion: This review shows that PRP may reduce pain associated with lateral epicondylitis and rotator cuff injuries.

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  • PRP's therapeutic efficacy varies largely due to inconsistent preparation methods and differing platelet concentrations.

    “However, PRP’s therapeutic efficacy varies, largely due to inconsistent preparation methods and differing platelet concentrations, which can significantly influence treatment outcomes [13,14].”

    From Advancements in Regenerative Therapies for Orthopedics: A Comprehensive Review of Platelet-Rich Plasma, Mesenchymal Stem Cells, Peptide Therapies, and Biomimetic Applications (2025) · cites this paper as [14]

    The Results (Overview; page unavailable) document extensive variation in PRP preparation, and the Discussion (page unavailable) says preparation methods affect cytokine concentrations and that activation is likely to affect efficacy. But the Discussion also says platelet-count variation is unquantified and that, without biochemical analysis, its effect on clinical outcomes cannot be determined. The paper therefore does not establish that differing platelet concentrations significantly influence outcomes or that these factors largely explain variation in efficacy. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

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Cited by

Sorted by citations

Authors
Chen, X., Jones, I. A., Park, C., & Vangsness, C. T.
Affiliations
  • University of Southern California (US)
  • Southern California Clinical and Translational Science Institute (US)
Corresponding author
Vangsness, C. Thomas
ORCID
Venue
The American Journal of Sports Medicine
Publisher
SAGE Publications
Published
2017-12-21
Volume
46
Issue
8
Pages
2020-2032
ISSN
  • 0363-5465 (ISSN-L)
  • 1552-3365
DOI
10.1177/0363546517743746
PMC
PMC6339617
OpenAlex
W2777077585
Cited by
294
References
2
Citations by year
2026: 22 · 2025: 49 · 2024: 36 · 2023: 45 · 2022: 35 · 2021: 34 · 2020: 32 · 2019: 24 · 2018: 16
FWCI
3.58
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • The American Journal of Sports Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR000130, UL1TR001855)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Tendon Structure and Treatment
  • Health Sciences › Medicine › Urology › Periodontal Regeneration and Treatments
  • Health Sciences › Medicine › Surgery › Orthopedic Surgery and Rehabilitation
Keywords
platelet-rich plasma, tendon injury, ligament injury, rotator cuff injury, lateral epicondylitis, tendinopathy, anterior cruciate ligament, analgesia
MeSH terms
Anterior Cruciate Ligament Injuries, Rotator Cuff Injuries, Humans, Pain, Tennis Elbow, Anterior Cruciate Ligament, Treatment Outcome, Rotator Cuff, Tendinopathy, Platelet-Rich Plasma, Visual Analog Scale

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