Effectiveness of Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy: An Umbrella Systematic Review

Chronic Achilles tendinopathy (CAT) represents a prevalent overuse injury affecting athletes and active individuals, with conventional treatments showing variable success rates. Platelet-rich plasma (PRP) injection has emerged as a promising biologic therapy, theoretically promoting tendon regeneration through growth factor release. However, clinical evidence regarding PRP effectiveness remains controversial. This umbrella systematic review synthesized findings from systematic reviews and meta-analyses examining PRP injection effectiveness for CAT management. A comprehensive literature search was conducted across five major databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) from inception until June 2025. Eight systematic reviews and meta-analyses published between 2018 and 2025 were included, encompassing 170-697 participants across primary studies. Methodological quality was assessed using AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews) criteria. The predominant finding across reviews was the absence of statistically significant differences between PRP and control interventions for primary outcomes, including pain reduction (visual analog scale) and functional improvement (Victorian Institute of Sport Assessment-Achilles scores). While some reviews reported modest short-term improvements in pain scores at three to 12 weeks, these benefits were neither clinically meaningful nor sustained at longer follow-up periods. Tendon structural outcomes assessed via ultrasonography yielded inconsistent results, with substantial heterogeneity attributed to variability in PRP preparation methods, injection protocols, and outcome measurements. Safety profiles were generally favorable with minimal adverse events. The collective evidence fails to demonstrate PRP superiority over placebo or standard conservative treatments. Current evidence does not support routine PRP use as a first-line treatment for CAT, with established conservative interventions remaining the preferred therapeutic approach.