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Platelet-Rich Plasma (PRP) and Injection Therapies

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.

Overview

Platelet-rich plasma (PRP) therapy involves the injection of autologous platelet concentrates to modulate healing and reduce symptoms in various orthopaedic conditions. For knee osteoarthritis, at least two PRP injections are recommended, with clinical effects lasting for at least 24 weeks [1]. Both leukocyte-rich PRP (L-PRP) and leukocyte-poor PRP (LP-PRP) are effective treatment options for knee osteoarthritis, demonstrating comparable efficacy based on current evidence [2]. Additionally, PRP therapy is recommended for competition sports practitioners with large joint osteoarthritis [5].

In the management of lateral epicondylitis, a direct, linear relationship exists between the concentration factor of PRP used and the magnitude of patient-reported symptom relief [3]. High-dose PRP shows significant efficacy over alternative treatment strategies for this condition [3]. However, evidence does not support PRP as a recommended treatment for lateral epicondylitis compared with placebo [6]. Routine use of PRP is not supported for the treatment of greater trochanteric pain syndrome [7].

PRP is also utilized in soft tissue repair and acute injury management. Leukocyte-poor PRP reduces retear risk after arthroscopic rotator cuff repair [19]. Patients undergoing rotator cuff repair with PRP may experience lower retear rates when compared with patients undergoing rotator cuff repair with patch augmentation [28]. Current evidence supports the selective use of PRP in sports settings for acute muscle injuries, though standardization in protocols and outcomes is needed [8].

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 [4]. Studies evaluating the outcomes and procedures of PRP use in lateral epicondylitis have poor adherence to Minimum Information for Studies Evaluating Biologics in Orthopedics (MIBO) guidelines [10]. 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 [22]. Future studies on PRP should prioritize long-term outcomes to guide clinical decision-making more effectively [4].

Background & Causes

Knee Osteoarthritis: At least two PRP injections are recommended for treating knee osteoarthritis, with effects lasting for at least 24 weeks [1]. Both leukocyte-rich PRP (L-PRP) and leukocyte-poor PRP (LP-PRP) are effective treatment options with comparable efficacy for knee osteoarthritis [2]. 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 [13]. High platelet, low leukocyte PRP is preferred for advanced osteoarthritis to promote tissue repair and regeneration [13].

Lateral Epicondylitis: A direct, linear relationship exists between the concentration factor of PRP used and the magnitude of patient-reported symptom relief after PRP injection for lateral epicondylitis [3]. High-dose PRP shows significant efficacy over alternative treatment strategies for lateral epicondylitis [3]. PRP injections are associated with lower average VAS scores over time compared to corticosteroids for the treatment of lateral elbow tendinopathy [9]. PRP injections are a safe and effective conservative treatment method for reducing pain symptoms and increasing functionality in patients with lateral epicondylitis in the early follow-up period [12]. Findings refute claims of PRP equivalence to placebo and support its efficacy over placebo for the treatment of chronic tenosynovitis [11]. Conversely, findings do not support PRP as a recommended treatment for lateral epicondylitis [6].

Other Musculoskeletal Conditions: 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 [16]. Routine use of PRP is not supported for the treatment of greater trochanteric pain syndrome [7]. Intradiscal PRP injection can significantly alleviate long-term pain and dysfunction in lumbar disc herniation patients, with efficacy greater than that of control treatment [26].

Sports Medicine: Current evidence supports the selective use of PRP in sports settings for acute muscle injuries, though standardization in protocols and outcomes is needed [8]. The authors recommend systematically offering PRP therapy for competition sports practitioners [5]. PRF was associated with greater tensile strength when compared with PRP and control in medial collateral ligament recovery in an animal study [27].

Symptoms & Presentation

Knee Osteoarthritis: At least two PRP injections are recommended for treating knee osteoarthritis, with effects lasting for at least 24 weeks [1]. Both leukocyte-rich PRP (L-PRP) and leukocyte-poor PRP (LP-PRP) are effective treatment options with comparable efficacy for knee osteoarthritis [2]. Optimizing osteoarthritis treatment involves tailoring PRP protocols to disease stage: low platelet, high leukocyte PRP is recommended for early OA due to anti-inflammatory effects, while high platelet, low leukocyte PRP is preferred for advanced OA to promote tissue repair [13]. Intra-articular PRP injection is an effective treatment for improving overall function in patients with primary osteoarthritis, particularly in younger individuals [15]. For knee osteoarthritis, PRP combined with hyaluronic acid (PRP + HA) yields better outcomes in pain relief and functional improvement compared to PRP monotherapy [17]. Hydrolyzed collagen demonstrated a more sustained therapeutic effect in pain relief and functional improvement over a one-year period compared to hyaluronic acid and platelet-rich plasma in symptomatic knee osteoarthritis [18].

Lateral Epicondylitis: A direct, linear relationship exists between the platelet concentration factor of PRP used and the magnitude of patient-reported symptom relief in lateral epicondylitis, with high-dose PRP showing significant efficacy [3]. PRP injections are considered a safe and effective conservative treatment for reducing pain symptoms and increasing functionality in patients with lateral epicondylitis in the early follow-up period [12]. PRP was associated with lower average Visual Analog Scale (VAS) pain scores over time compared to corticosteroids in the treatment of lateral elbow tendinopathy [9]. Both minimally invasive needle tenotomy (MINT) and PRP resulted in significant improvements in pain (VAS) for chronic elbow epicondylitis, with no significant differences in function (qDASH) [23]. Evidence does not support PRP as a recommended treatment for lateral epicondylitis compared with placebo [6]. Studies evaluating PRP outcomes for lateral epicondylitis demonstrate poor adherence to Minimum Information for Studies Evaluating Biologics in Orthopedics (MIBO) guidelines [10].

Other Musculoskeletal Conditions: PRP therapy is recommended for competition sports practitioners [5]. PRP can effectively improve pain and functional impairment in patients with tendinopathy, with midterm efficacy superior to that of corticosteroids [25]. Routine use of PRP is not supported for the treatment of greater trochanteric pain syndrome [7]. Application of PRP following small-diameter core decompression results in significant pain relief and improved short-term functional outcomes in patients with early osteonecrosis of the femoral head [14]. Intervention with aspiration combined with a 2-injection series of leukocyte-poor PRP in acute ACL-injured knees resulted in a significant reduction in effusion inflammatory markers [24].

Methodological Considerations: The clinical utility of PRP should be interpreted with caution due to methodological concerns such as lack of PRP characterization and short-term follow-up in some studies [4].

Management

Knee Osteoarthritis: At least two PRP injections are recommended, with effects lasting for at least 24 weeks [1]. Intra-articular PRP injection is an effective treatment for improving overall function in patients with primary knee, hip, and traumatic osteoarthritis, particularly in younger individuals [15]. Leukocyte-rich PRP (L-PRP) and leukocyte-poor PRP (LP-PRP) are effective treatment options for knee osteoarthritis with comparable efficacy [2]. Optimizing osteoarthritis treatment involves tailoring PRP protocols to disease stage: low platelet, high leukocyte PRP is recommended for early OA due to anti-inflammatory effects, while high platelet, low leukocyte PRP is preferred for advanced OA to promote tissue repair and regeneration [13]. For patients with knee osteoarthritis, PRP combined with hyaluronic acid (PRP + HA) is safe and yields better outcomes in pain relief and functional improvement compared to PRP monotherapy [17]. The combination of PRP with non-crosslinked hyaluronic acid in a mono-injection is non-inferior to crosslinked hyaluronic acid regarding the percentage of responders over 6 months for knee osteoarthritis [21].

Lateral Epicondylitis: There is a direct, linear relationship between the platelet concentration factor of PRP and the magnitude of patient-reported symptom relief in lateral epicondylitis, with high-dose PRP showing significant efficacy over alternative treatments [3]. PRP injections are a safe and effective conservative treatment for reducing pain symptoms and increasing functionality in patients with lateral epicondylitis in the early follow-up period [12]. PRP was associated with lower average VAS scores over time compared to corticosteroids in a 1-year trial for lateral elbow tendinopathy [9]. Findings refute claims of PRP equivalence to placebo and support its efficacy over placebo in chronic tenosynovitis [11]. However, evidence does not support PRP as a recommended treatment for lateral epicondylitis when compared with placebo [6]. Studies evaluating PRP outcomes and procedures for lateral epicondylitis demonstrate poor adherence to MIBO guidelines [10].

Other Musculoskeletal Conditions: Routine use of PRP is not supported for the treatment of greater trochanteric pain syndrome [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 [16]. 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 [14]. Current evidence supports the selective use of PRP in sports settings for acute muscle injuries, though standardization in protocols and outcomes is needed [8]. PRP therapy should be systematically offered to competition sports practitioners [5].

Methodological Considerations: Conclusions regarding the clinical utility of PRP should be interpreted with caution due to methodological concerns such as lack of PRP characterization and short-term follow-up in some studies [4].

Key Considerations

Knee Osteoarthritis: At least two PRP injections are recommended for treating knee osteoarthritis, with effects lasting for at least 24 weeks [1]. Leukocyte-rich PRP (L-PRP) and leukocyte-poor PRP (LP-PRP) are effective treatment options for knee osteoarthritis with comparable efficacy [2]. Hydrolyzed collagen demonstrated a more sustained therapeutic effect in terms of pain relief and functional improvement compared to hyaluronic acid and platelet-rich plasma over a one-year period in patients with symptomatic knee osteoarthritis [18]. PRP therapy is recommended for competition sports practitioners with large joint osteoarthritis [5].

Lateral Epicondylitis: A direct, linear relationship exists between the concentration factor of PRP used and the magnitude of patient-reported symptom relief after PRP injection for lateral epicondylitis [3]. High-dose PRP shows significant efficacy over alternative treatment strategies for lateral epicondylitis [3]. PRP was associated with lower average VAS scores over time compared to corticosteroid for the treatment of lateral elbow tendinopathy in a 1-year randomized controlled trial [9]. However, findings from a meta-analysis of randomized clinical trials do not support PRP as a recommended treatment for lateral epicondylitis when compared with placebo [6]. 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 [10].

Other Tendinopathies and Soft Tissue: PRP refutes claims of equivalence to placebo and supports efficacy over placebo for the treatment of chronic tenosynovitis [11]. Current evidence supports the selective use of PRP in sports settings for acute muscle injuries, though standardization in protocols and outcomes is needed [8]. Routine use of PRP is not supported for the treatment of greater trochanteric pain syndrome [7].

Osteonecrosis: 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 [14].

Rotator Cuff Repair: LP-PRP reduces retear risk after arthroscopic rotator cuff repair [19]. The economic value of LP-PRP after arthroscopic rotator cuff repair is conditional rather than uniform and depends on revision probability and preparation cost [19].

Anterior Cruciate Ligament Reconstruction: 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 [20].

Methodological Caveats: The conclusions regarding the clinical utility of PRP from a prospective, double-blinded, randomized controlled trial comparing PRP to corticosteroid injections for short-term pain relief should be interpreted with caution due to major methodological concerns, including lack of PRP characterization and short-term follow-up [4].

Key Evidence

  • [L3] At least two PRP injections are recommended, with effects lasting for at least 24 weeks. (10.1186/s13018-025-05756-6)
  • [L1] Both L-PRP and LP-PRP are effective treatment options with comparable efficacy based on current evidence. (10.1186/s13018-026-06689-4)
  • [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. (10.1016/j.jisako.2025.100442)
  • [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. (10.1016/j.arth.2025.05.007)
  • [L4] The authors recommend systematically offering PRP therapy for competition sports practitioners. (10.1186/s12891-025-08663-3)
  • [L1] These findings do not support PRP as a recommended treatment for this condition. (10.1177/03635465251383039)
  • [L1] As a result, we do not support the routine use of PRP for the treatment of this condition. (10.2106/jbjs.24.00763)
  • [L2] Current evidence supports the selective use of PRP in sports settings, though standardization in protocols and outcomes is needed. (10.1177/23259671251399907)
  • [L1] PRP was associated with lower average VAS scores over time. (10.1177/23259671251386862)
  • [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. (10.5397/cise.2024.01060)
  • [L1] These findings refute claims of PRP equivalence to placebo and support its efficacy over placebo. (10.1186/s12891-025-09339-8)
  • [L4] PRP injections are a safe and effective conservative treatment method for reducing pain symptoms and increasing functionality in patients with lateral epicondylitis. (10.1177/2325967125s00169)
  • [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. (10.1186/s13018-025-06026-1)
  • [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. (10.1186/s12891-024-08243-x)
  • [L1] Intra-articular PRP injection is an effective treatment for improving overall function in patients with primary OA, particularly in younger individuals. (10.1186/s12891-026-09486-6)
  • [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. (10.1097/corr.0000000000003478)
  • [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. (10.1186/s13018-024-05429-w)
  • [L3] In this retrospective study, hydrolyzed collagen demonstrated a more sustained therapeutic effect in terms of pain relief and functional improvement compared to hyaluronic acid and platelet-rich plasma over a one-year period. (10.1186/s12891-025-08811-9)
  • [L1] The economic value of LP-PRP is conditional rather than uniform and depends on revision probability and preparation cost. (10.1016/j.jse.2026.02.018)
  • [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. (10.1186/s13018-026-06714-6)
  • [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). (10.1186/s12891-026-09625-z)
  • [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. (10.1002/arj.70027)
  • [L3] Both MINT and PRP resulted in significant improvements in pain (VAS) with no significant differences in function (qDASH). (10.1016/j.jseint.2024.08.183)
  • [L1] Intervention with aspiration combined with a 2-injection series of leukocyte-poor PRP in the acute ACL-injured knee resulted in a significant reduction in effusion inflammatory markers, whereas the control aspiration (without PRP injections) did not show such marker reduction. (10.1177/23259671241312754)
  • [L1] PRP can effectively improve pain and functional impairment in patients with tendinopathy, and its midterm efficacy is superior to that of corticosteroids. (10.1186/s12891-025-08566-3)
  • [L1] Intradiscal PRP injection can significantly alleviate long-term pain and dysfunction in LDH patients, and its efficacy is greater than that of the control treatment; however, further studies are needed to verify the long-term mechanism involved. (10.1186/s13018-025-06025-2)
  • [L5] PRF was associated with greater tensile strength when compared with PRP and control. (10.1177/23259671251324472)
  • [L2] Patients undergoing RCR with PRP may experience lower retear rates when compared with patients undergoing RCR with PA. (10.1177/23259671251358398)

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] 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

[3] 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

[4] 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

[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] 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

[7] 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

[8] 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

[9] 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

[10] 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

[11] 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

[12] 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

[13] 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

[14] 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

[15] 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

[16] 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

[17] 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

[18] Efficacy of hydrolyzed collagen injections compared to platelet-rich plasma and hyaluronic acid in the treatment of patients with symptomatic knee osteoarthritis: a retrospective clinical study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08811-9

[19] 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

[20] 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

[21] 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

[22] 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

[23] Minimally invasive needle tenotomy vs. platelet rich plasma injection in the treatment of chronic elbow epicondylitis. JSES International. 2025. DOI: 10.1016/j.jseint.2024.08.183

[24] Preoperative Platelet-Rich Plasma Injections Decrease Inflammatory and Chondrodegenerative Biomarkers in Patients With Acute Anterior Cruciate Ligament Tears: A Pilot Randomized Controlled Trial. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671241312754

[25] 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

[26] Application and mechanism of percutaneous puncture disc platelet-rich plasma injection for lumbar disc herniation: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06025-2

[27] Comparison of Outcomes in Application of Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF) in Medial Collateral Ligament Recovery: An Animal Study. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251324472

[28] Rotator Cuff Repair With Platelet-Rich Plasma Is Associated With Lower Retear Rates When Compared With Rotator Cuff Repair With Patch Augmentation: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251358398

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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.