PRP Complications in Foot/Ankle: Systematic Review of 16 RCTs
(Arthroscopy 2025) · Arthroscopy (2025)
This 2025 systematic review uniquely focused on the safety profile of PRP in the foot and ankle, analyzing complication data from 16 RCTs (674 PRP patients vs 749 controls). PRP injections had statistically higher complication rates than comparators, driven almost entirely by post-injection pain. Only one patient across all studies required surgical intervention.
Clinical Relevance
Essential for informed consent: PRP in the foot and ankle causes more post-injection pain than alternatives. Patients should be warned about 1-3 days of increased discomfort after injection. However, the complications are overwhelmingly minor and transient.
Key Takeaways
- PRP had higher complication rates than comparators (p<0.01)
- Complications were almost exclusively post-injection pain
- Only 1 patient out of 674 required surgical intervention
- NNH = 13 (minor but meaningful for informed consent)
- 16 RCTs across Achilles, plantar fasciitis, ankle OA, and OLT
- 75% of PRP complications were post-treatment pain
- PRP is safe but patients should expect more post-injection discomfort
Key Findings
16 RCTs, 674 PRP vs 749 control. PRP had significantly HIGHER complication rates than comparators (p<0.01), primarily driven by POST-INJECTION PAIN. Only 1 patient required surgery. NNH = 13.
Clinical Context
Study Design
Systematic Review
Condition
Achilles Injury, Plantar Fasciitis, Ankle OA, OLT (Complication Focus)
Sample Size
1423 patients
Control Group
CS, Saline, Dry Needling, HA, Prolotherapy, SVF
Primary Outcome
Complication Rates, Number Needed to Harm
PRP Protocol & Intervention
Preparation System
Various across 16 RCTs
Guidance Method
Various