Quick answer
Injection evidence for Achilles tendinopathy is mixed. PRP has not outperformed sham in major mid-substance trials. Prolotherapy has encouraging but limited small-trial evidence. Injection choice should therefore be cautious, diagnosis-specific and secondary to a structured rehabilitation plan.
Article
PRP: stronger trials, disappointing results
Two placebo/sham-controlled randomised trials, including a 240-participant multicentre trial, did not show clinically important benefit for single-injection PRP in chronic mid-substance Achilles tendinopathy.
Prolotherapy: smaller evidence base
A small randomised trial suggested faster improvement when dextrose prolotherapy was combined with eccentric loading, but long-term differences were less clear. Larger confirmatory trials are needed.
Avoid the “regenerative” shortcut
The term regenerative medicine can imply that a treatment has been proven to regrow normal tendon. For Achilles tendinopathy, that is too strong. It is more accurate to describe PRP and prolotherapy as injection approaches with different and incomplete evidence bases.
Key points
- Evidence quality matters more than treatment novelty.
- Treatment location matters: mid-substance evidence should not be assumed to apply to insertional disease.
- Shared decision-making should include uncertainty, cost, alternatives and rehabilitation requirements.
Frequently Asked Questions
Which injection is best for Achilles tendinopathy?
Current evidence does not support a universal “best” injection. Progressive loading remains the most consistent foundation.
Why do some patients report improvement after injections?
Symptoms can improve for many reasons, including natural history, concurrent rehabilitation, contextual effects and a true treatment effect. Controlled trials help separate these influences.