The Use of Platelet-Rich Plasma (PRP) in the Treatment of Achilles Tendinopathy in Athletes: a Review of Current Guidelines

Abstract

Objective: To systematically evaluate platelet-rich plasma (PRP) injections for Achilles tendinopathy in athletes based on literature published between 2017 and 2026.

Methods: A systematic PubMed search identified 20 high-quality studies, including RCTs, meta-analyses, and systematic reviews. The analysis focused on clinical outcomes (primarily VISA-A scores) and technical factors, such as cellular composition, injection frequency, and anatomical injury location.

Results: Evaluating data from 697 patients, PRP showed no significant benefit over placebo for midportion tendinopathy (p = 0.085). However, multiple injections (e.g., four) yielded superior tendon remodeling compared to a single dose. PRP demonstrated greater efficacy for insertional tendinopathy and cases unresponsive to standard care. Still, the supporting evidence is statistically fragile (median Fragility Index = 5) and prone to publication bias. Clinically, PRP should not be a first-line treatment for midportion lesions but may be considered for insertional injuries or patients failing to improve after at least six months of conservative management. Repeated, carefully structured injections may be necessary for positive results.

Conclusions: PRP is not recommended as a primary treatment but serves as an auxiliary option for chronic, recalcitrant cases. Due to the lack of uniform protocols and the statistical instability of current evidence, clinicians must exercise considerable caution before routinely adopting PRP in sports medicine.