Platelet-Rich Plasma Vs Placebo in Achilles Tendinopathy

Key Takeaways

• Across four randomized trials, single autologous PRP was not associated with a significant difference from placebo on VISA-A scores at 3 and 6 months.
• Pain outcomes from three studies and radiologic outcomes from two studies also did not show significant between-group differences.
• The authors concluded that single autologous PRP injections did not show clinical or radiologic benefit over placebo, stated that they do not recommend PRP injections to manage Achilles tendinopathy, and noted that multiple PRP injections may warrant further study alongside larger, higher-quality trials with standardized protocols.

A systematic review and meta-analysis found that single autologous platelet-rich plasma injections did not outperform placebo for Achilles tendinopathy on pooled VISA-A scores. Across four randomized controlled trials, 337 patients contributed pooled VISA-A data at 3 and 6 months, with no statistically significant difference between groups at either follow-up point. The pooled data came from placebo-controlled randomized trials, keeping the central comparison direct. On the VISA-A functional outcome, the pooled analysis did not favor PRP.

The review examined whether platelet-rich plasma injections improved outcomes over placebo in patients with clinically diagnosed Achilles tendinopathy. The search covered PubMed, Embase, the Cochrane Library, and Google Scholar through January 2025, and it was limited to English-language randomized controlled trials. A total of 301 records were initially identified, and five studies met inclusion criteria after title, abstract, and full-text screening. Two reports came from the same trial, which explains why four placebo-controlled studies contributed the pooled VISA-A dataset in this randomized trial set. Data were synthesized with Review Manager 5.4, and heterogeneity was assessed with I² statistics.

Secondary outcomes followed the same overall pattern as the functional results. Three studies reporting VAS pain scores showed no significant difference between PRP and placebo, with 283 patients at 3 months and 270 at 6 months. Two studies also found no significant between-group changes in tendon thickness or vascularity on radiologic assessment. These imaging measures did not suggest separation between groups during the reported 3- and 6-month follow-up periods. Across pain and imaging outcomes, the pooled evidence did not identify a measurable advantage for single-injection PRP.

The authors concluded that single autologous PRP injections did not provide clinical or radiologic benefit over placebo for Achilles tendinopathy. They also stated that they do not recommend using PRP injections to manage Achilles tendinopathy, while noting that multiple PRP injections may offer significant improvements over placebo and should be studied in adequately powered trials with more standardized treatment protocols. Overall, the reported synthesis remained centered on a lack of pooled clinical and radiologic benefit for single-injection autologous PRP versus placebo.