PRP as Second-Line Treatment for Chronic Tendinopathy: Systematic Review
(Pain Medicine review) · Pain Medicine (2025)
This meta-analysis specifically targeted patients with chronic tendinopathy who had failed first-line conservative treatment (a second-line population). Across 9 RCTs with 488 patients, PRP showed a statistically significant moderate effect on chronic pain reduction (SMD=0.47, p<0.001). This is a critical distinction from studies testing PRP as a first-line treatment, as refractory patients may represent the population most likely to benefit from PRP.
Clinical Relevance
Provides evidence-based support for the common clinical pathway of reserving PRP for patients who have failed conservative management. Clinicians can use this to justify PRP as a second-line intervention before considering surgery, rather than as a first-line treatment.
Key Takeaways
- Moderate effect size (SMD=0.47) for chronic pain reduction in treatment-refractory patients
- 9 RCTs, 488 patients who had FAILED conservative treatment
- First meta-analysis to specifically examine PRP as second-line therapy
- Suggests PRP is most valuable when standard treatments have failed
- Supports the clinical pathway of conservative care first, then PRP for non-responders
Key Findings
9 RCTs, 488 patients who FAILED conservative treatment. PRP significantly reduced chronic pain (SMD=0.47, p<0.001). PRP most beneficial as second-line treatment for refractory tendinopathy.
Clinical Context
Study Design
Systematic Review and Meta-Analysis
Condition
Chronic Tendinopathy Resistant to Conservative Treatment
Sample Size
488 patients
Control Group
Various non-surgical treatments
Primary Outcome
Pain Score, Functional Outcomes
PRP Protocol & Intervention
Preparation System
Various across 9 RCTs