Is Platelet-Rich Plasma (PRP) Effective in the Treatment of Acute Muscle Injuries? A Systematic Review and Meta-Analysis
Two articles on PainSci cite Grassi 2018: 1. The Complete Guide to Muscle Strains 2. Does Platelet-Rich Plasma Injection Work?
PainSci notes on Grassi 2018:
A negative review of six trials of platelet-rich plasma injections for muscle strain, concluding that some hopeful early evidence is (predictably) “not confirmed by the recent high-level RCTs.” Although the quality of four of the trials reviewed was poor and they had positive results, two of them were better quality and had negative results.
The results of trials of PRP for other conditions is also generally disappointing, so this review’s conclusion is no surprise.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
BACKGROUND: Muscle lesions account for one-third of sport-related injuries, thus representing a substantial problem for both players and their teams. The use of platelet-rich plasma (PRP) injections is rapidly growing in clinical practice, prompted by an unmet clinical need with a large commercial market. However, after early reports of positive preliminary experience, higher quality studies recently questioned the real benefit provided by PRP injections to promote muscle healing and return to sport.
OBJECTIVE: To evaluate the effect of platelet-rich plasma (PRP) injections on outcomes following acute muscle injuries.
DESIGN: Meta-analysis of randomized, controlled trials (RCTs), Level I.
DATA SOURCES: PubMed (MEDLINE), Cochrane (CENTRAL), Web of Science, clinicaltrials.gov, who.int, isrctn.com, greylit.org, opengrey.eu.
ELIGIBILITY CRITERIA: RCTs investigating the effect of PRP for the treatment of acute muscle injuries against at least one control group including patients treated with placebo injection or physical therapy. The outcomes evaluated were time to return to sport, re-injuries, complications, pain, muscle strength, range of motion (ROM)/flexibility, muscle function, and imaging.
RESULTS: Six studies, involving 374 patients, were included in the meta-analysis. The time to return to sport evaluated in all six studies was significantly shorter in patients treated with PRP (mean difference = - 7.17 days). However, if only the double-blind studies (n = 2) or studies including only hamstring injuries (n = 3) were considered, non-significant differences were found. Re-injuries (relative risk = - 0.03) and complications (relative risk = 0.01) were also similar between the two groups (p> 0.05), nor were any substantial differences found regarding pain, muscle strength, ROM/flexibility, muscle function, and imaging. The performance bias was high risk due to the lack of patient blinding in four studies. The quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was therefore low or very low.
CONCLUSIONS: The promising biological rationale, the positive preclinical findings, and the successful early clinical experience of PRP injections are not confirmed by the recent high-level RCTs. Therefore any benefit in terms of pain, function, return to sport, and recurrence using PRP injections for the treatment of acute muscle injuries is not supported. Due to the bias in the studies, the heterogeneity of the findings, and the limited sample size, the evidence should be considered to be of low or very low quality.
related content
- “Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review,” de Vos et al, British Journal of Sports Medicine, 2014.
- “Impact of autologous blood injections in treatment of mid-portion Achilles tendinopathy: double blind randomised controlled trial,” Bell et al, British Medical Journal, 2013.
- “Platelet-rich therapies for musculoskeletal soft tissue injuries,” Moraes et al, Cochrane Database of Systematic Reviews, 2014.
- “Autologous growth factor injections in chronic tendinopathy,” Sandrey, Journal of Athletic Training, 2014.
- “Popular Blood Therapy May Not Work,” Gina Kolata, New York Times.
- “Meta-analysis Comparing Platelet-Rich Plasma vs Hyaluronic Acid Injection in Patients with Knee Osteoarthritis,” Han et al, Pain Med, 2019.
- “The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment,” Chen et al, American Journal of Sports Medicine, 2018.
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