Table I.
Characteristics and main results of the included studies on the use of US-guided injection of platelet-rich plasma for tendinopathies
| Study (year) ref | Study design | Condition | Patients & years (range) | Test group (N) | Control group (N) | Other interventions (N) | Outcomes | Follow-up (months) | Main results |
|---|---|---|---|---|---|---|---|---|---|
| Boesen28 (2017) | RCT, DB | AT | 60 (18–59) | PRP (20) | Placebo (20) | Steroid (20) | VAS-pain VISA-A score Tendon thickness DC activity HR test Pts satisfaction |
6 | Steroid may be more effective than PRP in the short term |
| De Jonge29 (2011) | RCT, DB | AT | 54 (18–70) | PRP (27) | Placebo (27) | - | VISA-A score UTC Pts satisfaction Return to sport |
12 | No clinical improvement after PRP injections |
| De Vos30 (2010) | RCT, DB | AT | 54 (18–70) | PRP (27) | Placebo (27) | - | VISA-A score Pts satisfaction Return to sport |
6 | No clinical improvement after PRP injections |
| Krogh31 (2016) | RCT, DB | AT | 24 (37–62) | PRP (12) | Placebo (12) | - | VISA-A score Pain scores at rest Pain score while walking Pain when tendon was squeezed DC activity Tendon thickness Adverse events |
3 | PRP injections only increase tendon thickness |
| Boesen32 (2020) | RCT, DB | ATR | 40 (18–60) | PRP (20) | Placebo (20) | - | ATRS HR test ROM-ankle dorsiflexion ATL Calf circumference Return to sport |
12 | PRP injections do not stimulate tendon healing or improve patients outcomes |
| Chen33 (2021) | RCT, DB | CTS | 26 (31–74) | PRP (13) | Placebo (13) | - | BCTQ-SSS/FSS CSA of the MN DML SNCV |
12 | PRP injections provide a therapeutic effect for 1 year postinjection |
| Malahias34 (2017) | RCT, DB | CTS | 50 (40–75) | PRP (26) | Placebo (24) | - | VAS-pain Q-DASH CSA of the MN |
3 | PRP injections may have positive effects |
| Senna35 (2019) | RCT | CTS | 98 (30–51) | PRP (49) | Steroid (49) | - | VAS-pain BCTQ-SSS/FSS Paresthesia Phalen’s test Tinel’s test DML CMAP SNAP CSA of the MN |
3 | PRP injections are superior to steroid for treatment of mild to moderate CTS |
| Shen36 (2019) | RCT | CTS | 52 (31–77) | PRP (26) | DP (26) | - | BCTQ-SSS/FSS CSA of the MN DML SNCV |
6 | PRP injections are beneficial for the treatment of moderate CTS |
| Wu37 (2017) | RCT | CTS | 60 | PRP (30) | Night splint (30) | - | VAS-pain BCTQ-SSS/FSS DML SNCV CSA of the MN Palmar force |
6 | PRP injections improve pain and disability in patients with CTS |
| Behera38 (2015) | RCT | LET | 25 (27–50) | PRP (15) | Bupivacaine (10) | - | VAS-pain MMCPIE Nirschl score (activity) |
12 | PRP injections enabled good improvement in pain and function |
| Creaney39 (2011) | RCT | LET | 150 | PRP (80) | WB (70) | - | PRTEE | 6 | PRP and WB injections are useful second-line therapies to improve clinical outcomes |
| Krogh40 (2013) | RCT, DB | LET | 60 (35–54) | PRP (20) | Placebo (20) | Steroid (20) | PRTEE-pain PRTEE-disability Tendon thickness Adverse events |
3 | Only steroid injections reduce pain after 1 month |
| Lim41 (2017) | RCT | LET | 120 | PRP (61) | Physiotherapy (59) | - | VAS-pain MMCPIE MRI |
6 | PRP injections improve pain and function |
| Martin42 (2019) | RCT, DB | LET | 71 (40–58) | PRP (36) | Lidocaine (35) | - | VAS-pain DASH-E Tendon thickness Calcification |
12 | PRP results in similar improvements to those obtained with lidocaine |
| Merolla43 (2017) | RCT | LET | 101 | PRP (51) | Arthroscopic Release (50) | - | VAS-pain PRTEE Grip strength Muscle tenderness Adverse events |
24 | PRP injections or arthroscopic release are both effective in the short and medium term |
| Montalvan44 (2016) | RCT, DB | LET | 50 (38–56) | PRP (25) | Placebo (25) | - | VAS-pain Roles Maudsley score ECRB contraction EDC contraction Adverse events |
12 | No clinical improvement after PRP injections |
| Thanasas45 (2011) | RCT | LET | 28 (29–55) | PRP (14) | WB (14) | - | VAS-pain Liverpool Elbow score |
6 | PRP injections seems to be superior to WB in the short term |
| Gogna46 (2016) | RCT | PF | 40 | PRP (20) | Low Dose Radiation (20) | - | VAS-pain AOFAS score Plantar fascia Thickness |
6 | PRP is as good as Low Dose Radiation in patients not responding to physical therapy |
| Kim47 (2013) | RCT | PF | 21 (19–57) | PRP (10) | DP (11) | - | FFI score FFI pain subscale scores FFI disability subscale scores |
6 | PRP and DP injections are both effective |
| Malahias48 (2019) | RCT, DB | PF | 36 | PRP (18) | PPP (18) | - | VAS-pain VAS-function VAS-satisfaction Adverse events |
6 | PRP and PPP injections are both effective |
| Monto49 (2014) | RCT | PF | 40 (24–74) | PRP (20) | Steroid (20) | - | AOFAS score | 24 | PRP was more effective and durable than steroid injection |
| Ugurlar50 (2018) | RCT | PF | 158 (19–62) | PRP (39) | Steroid (40) | ESWT (39); DP (40) | VAS-pain FFI score |
36 | No differences were found among the 4 treatments after 36 months |
| Dragoo51 (2014) | RCT, DB | PT | 23 (20–54) | PRP (10) | Dry needling (13) | - | VISA score VAS-pain Tegner score (activity) Lysholm knee score SF-12 |
6 | PRP injections improve pain, function and stability |
| Rodas52 (2021) | RCT, DB | PT | 20 (18–48) | PRP (10) | BM-MSCs (10) | - | VISA score VAS-pain Tendon thickness DC activity UTC MRI |
6 | No significant differences were found in the 2 groups |
| Scott53 (2019) | RCT | PT | 57 (18–50) | PRP (19) | Placebo (19) | LP-PRP (19) | VISA score NPRS GROC Adverse events |
12 | No significant differences were found among the 3 treatments |
| Dadgostar54 (2021) | RCT, DB | RC | 58 | PRP (30) | Steroid (28) | - | VAS-pain WORC score ROM DASH Muscle thickness |
3 | PRP and steroid injections are both effective |
| Kesikburun55 (2013) | RCT, DB | RC | 40 (18–70) | PRP (20) | Placebo (20) | - | VAS-pain WORC score SPADI ROM |
12 | PRP injection was found to be no more effective than placebo |
| Kwong56 (2021) | RCT, DB | RC | 99 | PRP (47) | Steroid (52) | - | VAS-pain WORC score ASES |
12 | No sustained benefit of PRP over steroid at 12 months |
| Nejati57 (2017) | RCT | RC | 62 | PRP (22) | Physiotherapy (20) | - | VAS-pain ROM DASH Muscle strength WORC score MRI |
6 | Both PRP injection and exercise therapy were effective in reducing pain and disability |
| Rha58 (2013) | RCT, DB | RC | 39 (36–79) | PRP (20) | Dry needling (19) | - | SPADI ROM Adverse events |
6 | PRP injections reduce pain and disability when compared to dry needling |
| Sari59 (2020) | RCT | RC | 129 (27–75) | PRP (33) | Steroid (33) | DP (32); Lidocaine (31) | VAS-pain WORC score ASES |
6 | The 4 interventions are both effective |
| Schwitzguebel60 (2019) | RCT, DB | RC | 80 (18–70) | PRP (41) | Placebo (39) | - | MRI SANE Constant score ASES VAS-pain Adverse events |
12 | No significant differences were found in the 2 groups |
AOFAS: American Orthopaedic Foot and Ankle Society; ASES: American Shoulder and Elbow Surgeons; AT: achilles tendinopathy; ATL: achilles tendon length; ATR: achilles tendinopathy rupture; ATRS: achilles tendon total rupture score; BCTQ: Boston Carpal Tunnel Syndrome Questionnaire; BM-MSCs: bone marrow mesenchymal stem cells; CMAP: compound muscle action potential; CSA: cross-sectional area; CTS: carpal tunnel syndrome; DASH-E: Spanish version of the Disabilities of the Arm, Shoulder and Hand questionnaires; DB: double blind; DC: Dopper Colour (vascolarity); DP: dextrose prolotherapy; DML: distal motor latency; ECRB: extensor carpi radialis brevis; EDC: extensor digitorum communis; ESWT: extracorporeal shock wave therapy; FFI: foot function index; FSS: functional status scale; GROC: global rating of change; HR test: Heel-Rise Test (muscle functional evaluation); LET: lateral epicondyle tendinopathy; LP-PRP: leukocyte-poor PRP; MMCPIE: modified Mayo clinic performance index for elbow; MN: median nerve; MRI: magnetic resonance imaging; NPRS: numeric pain rating scale; OSS: Oxford Shoulder Score; PF: plantar fasciitis; PPP: platelet poor plasma; PRP: platelet rich plasma; PRTEE: Patient-Rated Tennis Elbow Evaluation; Pts: patients; PT: patellar tendinopathy; Q-DASH: disabilities of the Arm, Shoulder and Hand questionnaire; RC: rotator cuff; RCT: randomized controlled trial; ROM: range of motion; SAIS: subacromial impingement syndrome; SANE: single assessment numeric evaluation; SF-12: Short Form 12-Item Health Survey; SNAP: sensory nerve action potential; SNCV: sensory nerve conduction velocity; SPADI: Shoulder Pain and Disability Index;SSS: symptom severity scale; US: ultrasound; UTC: ultrasound tissue characterization; VAS: visual analog scale; VISA: Victorian Institute of Sport Assessment; VISA-A: Victorian Institute of Sports Assessment-Achilles; WB: whole blood; WORC: Western Ontario Rotator Cuff.