Quick answer
Platelet-rich plasma (PRP) is prepared from a patient’s blood and contains concentrated platelets. Despite a plausible biological rationale, high-quality trials have not shown a clinically important benefit of a single PRP injection for chronic mid-substance Achilles tendinopathy compared with placebo or sham treatment.
Article
Why PRP attracted interest
Platelets release growth factors involved in tissue repair, which led to the hypothesis that concentrated platelets might improve tendinopathy. Biological plausibility, however, is not the same as proven clinical effectiveness.
What randomised trials found
A 2010 placebo-controlled trial found no added benefit from PRP when both groups performed eccentric exercise. A larger 2021 multicentre trial of 240 adults likewise found that a single intratendinous PRP injection did not improve Achilles dysfunction at six months compared with sham.
How to discuss PRP responsibly
PRP protocols vary, and unanswered questions remain about preparation, dosing and different tendon locations. Nevertheless, current high-quality evidence does not justify presenting PRP as a proven treatment for chronic mid-substance Achilles tendinopathy. Patients considering it should understand the uncertainty, cost and alternatives.
Key points
- Separate biological theory from patient-outcome evidence.
- Do not extrapolate mid-substance PRP evidence automatically to insertional disease.
- Exercise-based rehabilitation remains the foundation of care.
Frequently Asked Questions
Does PRP regenerate the Achilles tendon?
That has not been demonstrated convincingly in clinical trials.
Could PRP still be considered?
Individual clinicians and patients may discuss it in selected circumstances, but the evidence limitations should be explicit and it should not replace rehabilitation.