Platelet-Rich Plasma in Acute Muscle Injuries: An Umbrella Review and Meta-analysis of Return to Sport and Reinjury...

Platelet-rich plasma (PRP) is frequently used in sports medicine to treat muscle injuries; however, the clinical evidence remains inconsistent and fragmented.

To assess whether PRP therapy improves clinical outcomes, particularly return to sport (RTS) and reinjury rate, compared with conventional treatments for acute muscle injuries.

Systematic review and meta-analysis; Level of evidence, 2.

Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic search of PubMed, Embase, BVS, and Scopus was conducted through April 2025 for systematic reviews, with or without meta-analysis, to evaluate PRP for acute muscle injuries in athletes. A total of 1464 manuscripts were identified through the initial search. Main outcomes included RTS, reinjury rate, pain, and complications. Methodological quality was assessed using the Risk of Bias in Systematic Reviews (ROBIS) tool, and the certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Meta-analyses were performed using random-effects models with Hartung-Knapp-Sidik-Jonkman adjustments.

Eight systematic reviews were included. PRP significantly reduced reinjury risk compared with controls (risk ratio, 0.84 [95% CI, 0.76 to 0.92]; I² = 0%), with high-certainty evidence. A reduction in RTS time favored PRP (mean difference, -4.43 days [95% CI, -9.28 to 0.42); however, it did not reach statistical significance (low-certainty evidence). Narrative synthesis suggested inconsistent short-term pain relief and low complication rates, but evidence certainty was rated very low to low due to methodological and reporting limitations.

Our review study demonstrated that PRP may reduce muscular reinjury rates and potentially accelerate RTS, although benefits on pain and safety remain uncertain. Current evidence supports the selective use of PRP in sports settings; however, standardization in protocols and outcomes is needed. These findings may assist clinicians in individualizing treatment strategies involving PRP for acute muscle injuries, particularly in high-performance athletes at risk of recurrence.Registration: CRD42021279300.