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Platelet-Rich Plasma (PRP) and Injection Therapies

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What the evidence shows for platelet-rich plasma and related injection therapies in tendinopathy, osteoarthritis and rotator cuff disease — where they help and where the data is weak.

Updated Jul 2026
A centrifuge tube of separated blood plasma.
PRP concentrates platelets from your own blood and is used for some tendon and joint conditions, with mixed evidence. Kieran Hirpara 4.0

What you're feeling

You may notice pain in your knee, elbow, or shoulder. This discomfort often flares up after you have been active. It can also wake you up at night if you sleep on the affected side. Simple tasks like reaching behind your back to fasten a bra or tucking in a shirt might become difficult.

For knee wear-and-tear arthritis, you might feel stiffness or ache that limits your movement. Your surgeon may recommend at least two Platelet-Rich Plasma (PRP) injections to help. These are shots using your own blood plasma to reduce inflammation. The relief from these injections typically lasts for at least 24 weeks.

If you have tennis elbow (lateral epicondylitis), the pain is usually on the outside of your elbow. You might feel weakness when gripping objects. The amount of symptom relief you get often depends on the concentration of the PRP used. Higher doses tend to provide more significant relief compared to other treatments.

Shoulder pain from rotator cuff issues can make lifting your arm painful. If you have had surgery, your surgeon might use a specific type of PRP called leukocyte-poor PRP. This type helps lower the risk of the tendon tearing again after repair.

For Achilles tendon pain or greater trochanteric pain syndrome (hip pain), current evidence does not support using PRP. It is no more effective than a placebo for these conditions. You should avoid these treatments until new, high-quality studies provide better answers.

Your surgeon will decide if PRP is right for you based on your specific injury. It is often considered for athletes with large joint arthritis or acute muscle injuries. However, results vary. Some people find great relief, while others may remain dissatisfied. Always discuss the potential benefits and limitations with your care team before starting treatment.

What's actually happening

Your body uses platelets to heal injuries. These cells gather at the site of damage and release proteins that help repair tissue. Platelet-rich plasma (PRP) therapy takes your own blood, spins it to concentrate these healing cells, and injects them back into the problem area. This gives your body a stronger signal to fix the damage.

In knee osteoarthritis, the smooth coating on your bone ends wears down. This is wear-and-tear arthritis. The joint loses its shock absorber. Your surgeon may recommend at least two PRP injections for this condition. The goal is to reduce pain and improve function. For many patients, these effects last for at least 24 weeks. However, the science is still evolving. Some studies have methodological issues, so we interpret the results with caution. We need more long-term data to be sure how well this works for everyone.

For tendon issues like lateral epicondylitis (tennis elbow), the rope-like tendon fibers become damaged. Research shows a direct link between the concentration of PRP used and how much symptom relief you get. Higher doses often provide better results than lower ones. This treatment can be more effective than other strategies for this specific condition. It also helps refute the idea that PRP is just a placebo for chronic tenosynovitis.

In shoulder injuries, the rotator cuff tendons act like ropes holding your arm in place. After surgery, these tendons can tear again. Using leukocyte-poor PRP during repair can lower this retear risk. Leukocytes are white blood cells. Removing some of them may create a better healing environment.

For other conditions, the evidence is mixed or negative. PRP is not recommended for Achilles tendinopathy. It is no more effective than a placebo for this issue. Routine use for greater trochanteric pain syndrome is also not supported. In sports settings, PRP may help with acute muscle injuries, but protocols need standardization. For large joint osteoarthritis in athletes, it should be systematically offered.

Ultimately, your surgeon will decide if PRP is right for you based on your specific injury and the latest evidence.

What to expect

Your outlook depends heavily on the specific condition you are treating. For knee wear-and-tear arthritis, your surgeon will likely recommend at least two PRP injections. These treatments can help manage symptoms for at least 24 weeks. This means you may experience relief for about six months before considering further care.

If you are an athlete with large joint arthritis, PRP therapy may be a useful part of your management plan. It can help you stay active during competition seasons. However, for acute muscle injuries, the evidence is less clear. While PRP might help in some sports settings, protocols are not yet standardized. You should discuss whether this is the right choice for your specific injury type.

For other common issues, results vary. In cases of chronic tenosynovitis (inflammation of the tendon sheath), PRP has been shown to work better than a placebo. However, for lateral epicondylitis (tennis elbow), the evidence is conflicting. Some studies show that higher doses provide better symptom relief, while others do not support its use at all. Similarly, routine use for greater trochanteric pain syndrome (hip pain) is not supported by current data.

Be cautious with expectations for Achilles tendinopathy. Current evidence shows PRP is no more effective than a placebo for this condition. It is generally not recommended until new, high-quality studies provide different answers. If you are undergoing rotator cuff repair, your surgeon might use leukocyte-poor PRP to help reduce the risk of the tendon tearing again.

Overall, PRP is not a guaranteed cure. It is a treatment option that works well for some people and conditions, but not all. Your surgeon will help you decide if the potential benefits outweigh the costs and effort for your specific situation.

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Overview

  • At least two PRP injections are recommended for treating knee osteoarthritis, with effects lasting for at least 24 weeks [1].
  • Conclusions regarding the clinical utility of PRP should be interpreted with caution due to major methodological concerns, including lack of PRP characterization and short-term follow-up [2].
  • Future studies should prioritize long-term outcomes to guide clinical decision-making more effectively [2].
  • Both leukocyte-rich (L-PRP) and leukocyte-poor (LP-PRP) platelet-rich plasma are effective treatment options with comparable efficacy based on current evidence [3].
  • Findings refute claims of PRP equivalence to placebo and support its efficacy over placebo in chronic tenosynovitis [4].
  • PRP therapy should be systematically offered for competition sports practitioners [5].
  • The authors argue that they fulfilled the reporting requirements for the injected PRP product as defined by MIBO [6].
  • Findings do not support PRP as a recommended treatment for lateral epicondylitis [7].
  • PRP is no more effective than placebo for treating Achilles tendinopathy and should not be used for this indication until new, large, high-quality RCTs upend current knowledge [8].
  • Rigorous basic, translational, and clinical research remains fundamental to realize the promise of PRP treatment for musculoskeletal disease [9].
  • Current evidence supports the selective use of PRP in sports settings, though standardization in protocols and outcomes is needed [11].
  • Routine use of PRP for the treatment of greater trochanteric pain syndrome is not supported [13].
  • Studies evaluating the outcomes and procedures of the use of PRP in the setting of lateral epicondylitis have poor adherence to MIBO guidelines [14].

How It Works

  • At least two PRP injections are recommended for treating knee osteoarthritis, with effects lasting for at least 24 weeks [1].
  • The clinical utility of PRP should be interpreted with caution due to major methodological concerns in some studies, including lack of PRP characterization and short-term follow-up [2].
  • Both leukocyte-rich PRP (L-PRP) and leukocyte-poor PRP (LP-PRP) are effective treatment options with comparable efficacy based on current evidence [3].
  • Findings refute claims of PRP equivalence to placebo and support its efficacy over placebo in chronic tenosynovitis [4].
  • PRP therapy is recommended for competition sports practitioners [5].
  • Authors argue that they fulfilled the reporting requirements for the injected PRP product as defined by MIBO [6].
  • Findings do not support PRP as a recommended treatment for lateral epicondylitis [7].
  • PRP is no more effective than placebo for treating Achilles tendinopathy and should not be used for this indication until new, large, high-quality RCTs upend current knowledge [8].
  • Rigorous basic, translational, and clinical research remains fundamental to realize the promise of PRP treatment for musculoskeletal disease [9].
  • A direct, linear relationship was observed between the concentration factor of PRP used and the magnitude of patient-reported symptom relief after PRP injection, with high-dose PRP showing significant efficacy over alternative treatment strategies [10].
  • Corticosteroids resulted in greater short-term improvement, while PRP demonstrated superior longer-term outcomes at 6 and 12 months for lateral elbow tendinopathy [12].
  • Routine use of PRP for the treatment of greater trochanteric pain syndrome is not supported [13].
  • The application of PRP following small-diameter core decompression results in significant pain relief, improved short-term functional outcomes, and enhanced quality of life compared to core decompression alone in early osteonecrosis of the femoral head [15].
  • The goal of characterization studies is to discern key molecular mediators between leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP) derived from the same patient with equivalent platelet concentrations [16].
  • Optimizing osteoarthritis treatment involves tailoring PRP protocols to disease stage, with low platelet, high leukocyte PRP recommended for early OA due to its anti-inflammatory effects and high platelet, low leukocyte PRP preferred for advanced OA to promote tissue repair and regeneration [17].

What the Evidence Shows

Efficacy by Condition

  • At least two PRP injections are recommended for knee osteoarthritis, with effects lasting for at least 24 weeks [1].
  • PRP is no more effective than placebo for treating Achilles tendinopathy and should not be used for this indication until new, large, high-quality RCTs upend current knowledge [8].
  • Findings do not support PRP as a recommended treatment for lateral epicondylitis [7].
  • Routine use of PRP for the treatment of greater trochanteric pain syndrome is not supported [13].
  • Intra-articular PRP injection is an effective treatment for improving overall function in patients with primary osteoarthritis, particularly in younger individuals [23].
  • PRP injections are a safe and effective conservative treatment method for reducing pain symptoms and increasing functionality in patients with lateral epicondylitis [22].
  • The application of PRP following small-diameter core decompression results in significant pain relief, improved short-term functional outcomes, and enhanced quality of life compared to core decompression alone in early osteonecrosis of the femoral head [15].
  • Current evidence supports the selective use of PRP in sports settings for acute muscle injuries, though standardization in protocols and outcomes is needed [11].
  • PRP can effectively improve pain and functional impairment in patients with tendinopathy, and its midterm efficacy is superior to that of corticosteroids [20].
  • Corticosteroids resulted in greater short-term improvement than PRP, while PRP demonstrated superior longer-term outcomes at 6 and 12 months for lateral elbow tendinopathy [12].
  • Current evidence is of insufficient quality to determine if anterior cruciate ligament reconstruction (ACLR) augmented with PRP provides a clinically meaningful improvement in postoperative outcomes over ACLR without PRP [26].

Product Composition and Preparation

  • Both leukocyte-rich (L-PRP) and leukocyte-poor (LP-PRP) are effective treatment options with comparable efficacy for knee osteoarthritis based on current evidence [3].
  • Leukocytes did not affect the safety and efficacy of intra-articular PRP injections for the treatment of patients with knee osteoarthritis in a double-blind randomized controlled trial [19].
  • A direct, linear relationship was observed between the concentration factor of PRP used and the magnitude of patient-reported symptom relief after PRP injection for lateral epicondylitis, with high-dose PRP showing significant efficacy over alternative treatment strategies [10].
  • The findings refute claims of PRP equivalence to placebo and support its efficacy over placebo for chronic tenosynovitis [4].

Combination Therapies

  • For patients with knee osteoarthritis, PRP combined with hyaluronic acid (PRP + HA) therapy is safe and yields better outcomes in pain relief and functional improvement compared to PRP monotherapy [21].
  • The combination of PRP with non-crosslinked hyaluronic acid in mono-injection was found to be non-inferior to crosslinked hyaluronic acid regarding the percentage of responders over 6 months for knee osteoarthritis [25].

Reporting Quality and Methodological Concerns

  • The authors' conclusions regarding the clinical utility of PRP should be interpreted with caution due to major methodological concerns, including lack of PRP characterization and short-term follow-up; future studies should prioritize long-term outcomes to guide clinical decision-making more effectively [2].
  • Spin bias is highly prevalent in the abstracts of systematic reviews and meta-analyses of intra-articular PRP to treat knee osteoarthritis, with identified spin tending to favor the use of PRP [24].
  • Studies evaluating the outcomes and procedures of the use of PRP in the setting of lateral epicondylitis have poor adherence to Minimum Information for Studies Evaluating Biologics in Orthopedics (MIBO) guidelines [14].
  • The authors argue that they fulfilled the reporting requirements for the injected PRP product as defined by MIBO [6].

Specific Recommendations

  • The authors recommend systematically offering PRP therapy for competition sports practitioners [5].

Practical Considerations

  • At least two PRP injections are recommended for treating knee osteoarthritis, with effects lasting for at least 24 weeks [1].
  • Conclusions regarding the clinical utility of PRP should be interpreted with caution due to major methodological concerns, including lack of PRP characterization and short-term follow-up [2].
  • Future studies should prioritize long-term outcomes to guide clinical decision-making more effectively [2].
  • Both leukocyte-rich (L-PRP) and leukocyte-poor (LP-PRP) are effective treatment options with comparable efficacy based on current evidence [3].
  • Findings refute claims of PRP equivalence to placebo and support its efficacy over placebo in chronic tenosynovitis [4].
  • PRP therapy should be systematically offered for competition sports practitioners [5].
  • The authors argue that they fulfilled the reporting requirements for the injected PRP product as defined by MIBO [6].
  • Findings do not support PRP as a recommended treatment for lateral epicondylitis [7].
  • PRP is no more effective than placebo for treating Achilles tendinopathy and should not be used for this indication until new, large, high-quality RCTs upend current knowledge [8].
  • Rigorous basic, translational, and clinical research remains fundamental to realize the promise of PRP treatment for musculoskeletal disease [9].
  • A direct, linear relationship was observed between the concentration factor of PRP used and the magnitude of patient-reported symptom relief after PRP injection [10].
  • High-dose PRP shows significant efficacy over alternative treatment strategies [10].
  • Current evidence supports the selective use of PRP in sports settings, though standardization in protocols and outcomes is needed [11].
  • Corticosteroids resulted in greater short-term improvement compared to PRP for lateral elbow tendinopathy [12].
  • PRP demonstrated superior longer-term outcomes at 6 and 12 months compared to corticosteroids for lateral elbow tendinopathy [12].
  • Studies evaluating the outcomes and procedures of the use of PRP in the setting of lateral epicondylitis have poor adherence to MIBO guidelines [14].
  • Leukocyte-poor platelet-rich plasma reduces retear risk after arthroscopic rotator cuff repair [18].
  • The economic value of LP-PRP is conditional rather than uniform and depends on revision probability and preparation cost [18].

Key Evidence

  • [L3] At least two PRP injections are recommended, with effects lasting for at least 24 weeks. [1] (10.1186/s13018-025-05756-6)
  • [L5] The authors' conclusions regarding the clinical utility of PRP should be interpreted with caution due to major methodological concerns, including lack of PRP characterization and short-term follow-up; future studies should prioritize long-term outcomes to guide clinical decision-making more effectively. [2] (10.1016/j.arth.2025.05.007)
  • [L1] Both L-PRP and LP-PRP are effective treatment options with comparable efficacy based on current evidence. [3] (10.1186/s13018-026-06689-4)
  • [L1] These findings refute claims of PRP equivalence to placebo and support its efficacy over placebo. [4] (10.1186/s12891-025-09339-8)
  • [L4] The authors recommend systematically offering PRP therapy for competition sports practitioners. [5] (10.1186/s12891-025-08663-3)
  • [Paper] The authors argue that they fulfilled the reporting requirements for the injected PRP product as defined by MIBO. [6] (10.1177/03635465231203202)
  • [L1] These findings do not support PRP as a recommended treatment for this condition. [7] (10.1177/03635465251383039)
  • [L1] PRP is no more effective than placebo for treating Achilles tendinopathy and should not be used for this indication until new, large, high-quality RCTs upend current knowledge. [8] (10.1097/corr.0000000000003478)
  • [Paper] Rigorous basic, translational, and clinical research remains fundamental to realize the promise of PRP treatment for musculoskeletal disease. [9] (10.1177/03635465251395284)
  • [L1] A direct, linear relationship was observed between the concentration factor of PRP used and the magnitude of patient-reported symptom relief after PRP injection, with high-dose PRP showing significant efficacy over alternative treatment strategies. [10] (10.1016/j.jisako.2025.100442)
  • [L2] Current evidence supports the selective use of PRP in sports settings, though standardization in protocols and outcomes is needed. [11] (10.1177/23259671251399907)
  • [L1] Corticosteroids resulted in greater short-term improvement, while PRP demonstrated superior longer-term outcomes at 6 and 12 months. [12] (10.1177/23259671251386862)
  • [L1] As a result, we do not support the routine use of PRP for the treatment of this condition. [13] (10.2106/jbjs.24.00763)
  • [L2] This review demonstrated that studies evaluating the outcomes and procedures of the use of PRP in the setting of LE have poor adherence to MIBO guidelines. [14] (10.5397/cise.2024.01060)
  • [L3] The application of PRP following CD results in significant pain relief, improved short-term functional outcomes, and enhanced quality of life compared to CD alone. [15] (10.1186/s12891-024-08243-x)
  • [L5] The goal of the study was to discern key molecular mediators between leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP) derived from the same patient with equivalent platelet concentrations. [16] (10.1177/03635465231206930)
  • [L1] Optimizing OA treatment involves tailoring PRP protocols to disease stage, with low platelet, high leukocyte PRP recommended for early OA due to its anti-inflammatory effects and high platelet, low leukocyte PRP preferred for advanced OA to promote tissue repair and regeneration. [17] (10.1186/s13018-025-06026-1)
  • [L1] The economic value of LP-PRP is conditional rather than uniform and depends on revision probability and preparation cost. [18] (10.1016/j.jse.2026.02.018)
  • [L1] This double-blind randomized controlled trial demonstrated that leukocytes did not affect the safety and efficacy of intra-articular PRP injections for the treatment of patients with knee OA. [19] (10.1177/03635465241283500)
  • [L1] PRP can effectively improve pain and functional impairment in patients with tendinopathy, and its midterm efficacy is superior to that of corticosteroids. [20] (10.1186/s12891-025-08566-3)
  • [L1] This meta-analysis reveals that, for patients with KOA, PRP + HA therapy is safe and yields better outcomes in pain relief and functional improvement compared to PRP monotherapy. [21] (10.1186/s13018-024-05429-w)
  • [L4] PRP injections are a safe and effective conservative treatment method for reducing pain symptoms and increasing functionality in patients with lateral epicondylitis. [22] (10.1177/2325967125s00169)
  • [L1] Intra-articular PRP injection is an effective treatment for improving overall function in patients with primary OA, particularly in younger individuals. [23] (10.1186/s12891-026-09486-6)
  • [L1] Spin bias is highly prevalent in the abstracts of systematic reviews and meta-analyses of intra-articular PRP to treat knee osteoarthritis, with identified spin tending to favor the use of PRP. [24] (10.1002/arj.70027)
  • [L1] The combination of PRP with non-crosslinked HA in mono-injection was found to be non-inferior to crosslinked HA, with regards to the percentage of responders over 6 months (WOMAC pain). [25] (10.1186/s12891-026-09625-z)
  • [L1] Current evidence is of insufficient quality to determine if ACLR augmented with PRP application provides a clinically meaningful improvement in postoperative outcomes over ACLR without PRP. [26] (10.1186/s13018-026-06714-6)

References

[1] Efficacy of multiple autologous apheresis platelet-rich plasma injections for treating knee osteoarthritis and its influencing factors: a retrospective cohort study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05756-6 [2] Letter Regarding “Platelet-Rich Plasma Injections are Inferior to Corticosteroid Injections for Short-Term Pain Relief: A Prospective, Double-Blinded, Randomized Controlled Trial”. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.05.007 [3] Leukocyte-rich versus leukocyte-poor platelet-rich plasma and hyaluronic acid for knee osteoarthritis: a systematic review and network meta-analysis. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-026-06689-4 [4] Time-dependent growth factor kinetics, platelet concentration, and clinical response following platelet-rich plasma versus saline in chronic tenosynovitis: a randomized controlled trial. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09339-8 [5] Platelet-rich plasma treatment for large joint osteoarthritis: retrospective study highlighting a possible treatment protocol with long-lasting stimulation of the joint with an adequate dose of platelets. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08663-3 [6] Improving Injectable Orthobiologics Reporting Guidelines Adherence: Response. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231203202 [7] Platelet-Rich Plasma Does Not Improve Pain or Function in Patients With Lateral Epicondylitis as Compared With Placebo: A Meta-analysis of Randomized Clinical Trials. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465251383039 [8] Editor’s Spotlight/Take 5: Is Platelet-rich Plasma Effective in Treating Achilles Tendinopathy? A Meta-analysis of Randomized Clinical Trials. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003478 [9] Platelet-Rich Plasma in the Treatment of Musculoskeletal Disease in 2025 and Beyond. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465251395284 [10] Platelet Concentration Factor Explains Variability in Outcomes of Platelet-rich Plasma for Lateral Epicondylitis: High Dose Critical for Positive Response. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100442 [11] Platelet-Rich Plasma in Acute Muscle Injuries: An Umbrella Review and Meta-analysis of Return to Sport and Reinjury Outcomes. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671251399907 [12] A Randomized Controlled Trial of 1-Year Clinical Outcomes of a Single Platelet-Rich Plasma Injection Versus Corticosteroid for the Treatment of Lateral Elbow Tendinopathy. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671251386862 [13] Efficacy of Platelet-Rich Plasma Versus Placebo for the Treatment of Greater Trochanteric Pain Syndrome. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.00763 [14] Adherence rates to the Minimum Information for Studies Evaluating Biologics in Orthopedics guidelines for clinical studies on platelet-rich plasma for the treatment of lateral epicondylitis: a systematic review. Clinics in Shoulder and Elbow. 2026. DOI: 10.5397/cise.2024.01060 [15] Efficacy of small-diameter core decompression with platelet-rich plasma in early osteonecrosis of the femoral head: a retrospective study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-024-08243-x [16] The Accurate Characterization of Platelet-Rich Plasma Enables Its Classification and Comparison: Response. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231206930 [17] The efficacy of platelet-rich plasma preparation protocols in the treatment of osteoarthritis: a network meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06026-1 [18] Leukocyte-poor platelet-rich plasma reduces retear risk after arthroscopic rotator cuff repair: a meta-analysis with mechanistic and economic evaluation. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.02.018 [19] Leukocytes Do Not Influence the Safety and Efficacy of Platelet-Rich Plasma Injections for the Treatment of Knee Osteoarthritis: A Double-Blind Randomized Controlled Trial. The American Journal of Sports Medicine. 2024. DOI: 10.1177/03635465241283500 [20] Platelet-rich plasma and corticosteroid injection for tendinopathy: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08566-3 [21] RETRACTED ARTICLE: A meta-analysis and systematic review of the clinical efficacy and safety of platelet-rich plasma combined with hyaluronic acid (PRP + HA) versus PRP monotherapy for knee osteoarthritis (KOA). Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-024-05429-w [22] Poster 58: Decreased Pain After Platelet-Rich Plasma Injection in Lateral Epicondylitis Patients in the Early Follow-up Period. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00169 [23] Investigating the therapeutic impact of platelet-rich plasma on knee, hip, and traumatic osteoarthritis: a meta-analysis and systematic review. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09486-6 [24] Statistically Significant Results Favored in Abstracts of Platelet Rich Plasma Treatment of Knee Osteoarthritis: A Systematic Review and Spin Analysis. Arthroscopy. 2026. DOI: 10.1002/arj.70027 [25] Efficacy and safety of a combination of platelet-rich plasma with non-crosslinked hyaluronic acid versus a crosslinked hyaluronic acid, in single-injection for knee osteoarthritis. Randomized, controlled, multicenter, non-inferiority trial. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09625-z [26] The impact of platelet-rich plasma augmentation on postoperative clinical outcomes in patients undergoing anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-026-06714-6

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k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.