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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.

34 citationsUpdated Sep 2026

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Overview

Platelet-rich plasma (PRP) and related biological injections serve as therapeutic options for various musculoskeletal conditions, including knee osteoarthritis, lateral epicondylitis, and acute muscle injuries. For knee osteoarthritis, at least two PRP injections are recommended to achieve effects lasting for at least 24 weeks [1]. Current evidence indicates that leukocyte-rich PRP (L-PRP) and leukocyte-poor PRP (LP-PRP) are effective treatment options with comparable efficacy for this indication [5]. In the context of lateral epicondylitis, a direct, linear relationship exists between the concentration factor of PRP used and the magnitude of patient-reported symptom relief [8], with high-dose PRP showing significant efficacy over alternative treatment strategies [8]. However, findings from a meta-analysis of randomized clinical trials do not support PRP as a recommended treatment for lateral epicondylitis [14]. For chronic tenosynovitis, findings from a randomized controlled trial refute claims of PRP equivalence to placebo and support its efficacy over placebo [10].

The clinical utility of PRP varies significantly across different pathologies and patient populations. PRP therapy is recommended to be systematically offered for competition sports practitioners with large joint osteoarthritis [11]. In sports settings, current evidence supports the selective use of PRP for acute muscle injuries, though standardization in protocols and outcomes is needed [12]. The application of Plasma Rich in Growth Factors (PRGF) in intramuscular infiltrations represents an innovative biological approach to the treatment of muscle injuries [7]. Conversely, 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 routine use of PRP for the treatment of greater trochanteric pain syndrome is not supported [17]. Furthermore, further studies are needed to evaluate PRP’s long-term efficacy and cost-effectiveness for practical patient use in the treatment of hypertrophic facet joints [3].

Methodological rigor remains a critical consideration when interpreting PRP outcomes. Conclusions regarding the clinical utility of PRP from a specific prospective, double-blinded, randomized controlled trial should be interpreted with caution due to major methodological concerns, including lack of PRP characterization and short-term follow-up [4]. Studies evaluating the outcomes and procedures of the use of PRP in the setting of lateral epicondylitis have poor adherence to MIBO guidelines [18], although the authors of a specific study argue that they fulfilled the reporting requirements for the injected PRP product as defined by MIBO [13]. Rigorous basic, translational, and clinical research remains fundamental to realize the promise of PRP treatment for musculoskeletal disease [2]. Extensive clinical studies are required regarding the routine use of PRP in fracture healing for delayed union or non-union [6]. Interventions employing PRP, MSCs, and exosomes are considered in the context of degenerative osteoarthritis as a reversible chronic disease [9]. Current orthobiologics can be categorised into three tiers of recommendations based on the level of clinical evidence [28].

How It Works

Osteoarthritis

Current evidence supports the use of at least two PRP injections for knee osteoarthritis, with therapeutic effects persisting for a minimum of 24 weeks [1]. Both leukocyte-rich PRP (L-PRP) and leukocyte-poor PRP (LP-PRP) demonstrate comparable efficacy for knee osteoarthritis [5]. Specifically, leukocytes do not influence the safety or efficacy of PRP injections, as both LR-PRP and LP-PRP yield comparable clinical outcomes at all follow-up time points [23]. Treatment protocols should be tailored to disease stage: low platelet, high leukocyte PRP is recommended for early osteoarthritis due to its anti-inflammatory effects [19], while high platelet, low leukocyte PRP is preferred for advanced osteoarthritis to promote tissue repair and regeneration [19]. Intra-articular PRP injection effectively improves overall function in patients with primary osteoarthritis, particularly younger individuals [27]. Additionally, 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 six months for knee osteoarthritis [24]. Further studies are needed to evaluate PRP’s long-term efficacy and cost-effectiveness for practical patient use [3].

Tendinopathy

For lateral epicondylitis, a direct, linear relationship exists between the concentration factor of PRP used and the magnitude of patient-reported symptom relief [8]. High-dose PRP demonstrates significant efficacy over alternative treatment strategies for this condition [8]. PRP injections serve as a safe and effective conservative treatment method for reducing pain symptoms and increasing functionality in patients with lateral epicondylitis [21]. When compared to corticosteroids for lateral elbow tendinopathy, corticosteroids result in greater short-term improvement, whereas PRP demonstrates superior longer-term outcomes at six and 12 months [15]. In chronic tenosynovitis, time-dependent growth factor kinetics and platelet concentration following PRP versus saline refute claims of PRP equivalence to placebo and support its efficacy over placebo [10]. Conversely, PRP is not supported for routine use in the treatment of greater trochanteric pain syndrome [17].

Musculoskeletal Injuries and Fractures

Regarding fracture healing, extensive clinical studies are required on the subject of the routine use of PRP for delayed union or non-union [6]. In early osteonecrosis of the femoral head, the application of PRP following core decompression results in significant pain relief, improved short-term functional outcomes, and enhanced quality of life compared to core decompression alone [22].

General Principles and Research Needs

Interventions employing PRP, mesenchymal stem cells (MSCs), and exosomes are considered in the context of degenerative osteoarthritis as a reversible chronic disease [9]. A study hypothesized that PRP and hyperbaric oxygen therapy will enhance muscle regeneration after contusion injury, with a synergistic effect when combined [30]. Methodological rigor remains a concern; conclusions regarding the clinical utility of PRP from a specific RCT should be interpreted with caution due to major methodological concerns, including lack of PRP characterization and short-term follow-up [4]. Future studies should prioritize long-term outcomes to guide clinical decision-making more effectively regarding PRP [4]. Regarding product characterization, the authors of a study on PRP characterization argue that they fulfilled the reporting requirements for the injected PRP product as defined by MIBO [13]. The goal of that 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 [25].

What the Evidence Shows

Knee Osteoarthritis

Current evidence indicates that both leukocyte-rich (L-PRP) and leukocyte-poor (LP-PRP) formulations are effective treatment options for knee osteoarthritis with comparable efficacy [5]. Leukocytes do not influence the safety or efficacy of PRP injections, as LR-PRP and LP-PRP demonstrated comparable clinical outcomes at all follow-up time points [23]. Regarding combination therapies, PRP combined with hyaluronic acid therapy is safe and yields better outcomes in pain relief and functional improvement compared to PRP monotherapy [32]. Additionally, 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 WOMAC pain [24]. Intra-articular injections of PRP and microfragmented adipose tissue (MFAT) both provided significant clinical benefits and were safe for treating knee osteoarthritis over a 12-month period [29].

The authors recommend systematically offering PRP therapy for competition sports practitioners with large joint osteoarthritis [11]. However, 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 [33]. Further studies are needed to evaluate the long-term efficacy and cost-effectiveness of PRP for practical patient use in the future [3].

Lateral Epicondylitis

Current findings do not support PRP as a recommended treatment for lateral epicondylitis as compared with placebo based on a meta-analysis of randomized clinical trials [14]. In contrast, corticosteroids resulted in greater short-term improvement, while PRP demonstrated superior longer-term outcomes at 6 and 12 months for lateral elbow tendinopathy [15]. PRP injections are a safe and effective conservative treatment method for reducing pain symptoms and increasing functionality in patients with lateral epicondylitis during the early follow-up period [21]. For chronic elbow epicondylitis, both minimally invasive needle tenotomy (MINT) and PRP resulted in significant improvements in pain (VAS) with no significant differences in function (qDASH) [34].

Other Tendinopathies and Musculoskeletal Conditions

PRP does not support the routine use for the treatment of greater trochanteric pain syndrome [17]. Conversely, PRP can effectively improve pain and functional impairment in patients with tendinopathy, and its midterm efficacy is superior to that of corticosteroids [31]. Time-dependent growth factor kinetics and platelet concentration findings refute claims of PRP equivalence to placebo and support its efficacy over placebo in chronic tenosynovitis [10].

In the context of rotator cuff repair, leukocyte-poor platelet-rich plasma reduces retear risk after arthroscopic rotator cuff repair [20]. The economic value of leukocyte-poor platelet-rich plasma is conditional rather than uniform and depends on revision probability and preparation cost [20]. Regarding anterior cruciate ligament reconstruction, current evidence is of insufficient quality to determine if anterior cruciate ligament reconstruction augmented with PRP application provides a clinically meaningful improvement in postoperative outcomes over reconstruction without PRP [26].

Methodology and Research Quality

Conclusions regarding the clinical utility of PRP from certain trials should be interpreted with caution due to major methodological concerns, including lack of PRP characterization and short-term follow-up [4]. Authors of specific studies argue that they fulfilled the reporting requirements for the injected PRP product as defined by MIBO [13].

Practical Considerations

Dosing and Protocol Optimization

Protocol selection for osteoarthritis requires tailoring the PRP formulation to the specific disease stage [19]. For early-stage osteoarthritis, low platelet, high leukocyte PRP is recommended due to its anti-inflammatory effects [19].

Formulation and Preparation

Characterizing PRP aims 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 [25]. In the treatment of knee osteoarthritis, both LR-PRP and LP-PRP demonstrated comparable clinical outcomes at all follow-up time points [23]. No differences were observed in subjective and objective outcomes, adverse events, or treatment failures between the two formulations [23].

Indication-Specific Efficacy

Lateral epicondylitis: PRP injections serve as a safe and effective conservative treatment method for reducing pain symptoms and increasing functionality in the early follow-up period [21]. Knee osteoarthritis: Intra-articular injections of PRP provided significant clinical benefits and were safe for treating knee osteoarthritis over a 12-month period [29]. ACL reconstruction: Current evidence is of insufficient quality to determine if ACL reconstruction augmented with PRP application provides a clinically meaningful improvement in postoperative outcomes over ACL reconstruction without PRP [26].

Comparative and Economic Considerations

The economic value of LP-PRP is conditional rather than uniform, depending on revision probability and preparation cost [20]. Intra-articular injections of Microfragmented Adipose Tissue (MFAT) provided significant clinical benefits and were safe for treating knee osteoarthritis over a 12-month period [29].

Research Gaps and Methodological Concerns

Further studies are needed to evaluate PRP’s long-term efficacy and cost-effectiveness for practical patient use in the future for hypertrophic facet joints [3]. Extensive clinical studies are required on the subject of the routine use of PRP in fracture healing [6].

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)
  • [Paper] Rigorous basic, translational, and clinical research remains fundamental to realize the promise of PRP treatment for musculoskeletal disease. [2] (10.1177/03635465251395284)
  • [L4] Further studies will be needed to evaluate PRP’s long-term efficacy and cost-effectiveness for practical patient use in the future. [3] (10.5435/jaaosglobal-d-24-00140)
  • [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. [4] (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. [5] (10.1186/s13018-026-06689-4)
  • [L4] Extensive clinical studies are required on the subject of the routine use of PRP in fracture healing. [6] (10.1016/s0020-1383(13)70158-x)
  • [L5] An innovative biological approach to the treatment of muscle injuries is the application of Plasma Rich in Growth Factors (PRGF) in intramuscular infiltrations. [7] (10.1016/s0020-1383(14)70004-x)
  • [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. [8] (10.1016/j.jisako.2025.100442)
  • [L5] Interventions employing PRP, MSCs and exosomes are considered in this article. [9] (10.1016/j.reth.2020.07.007)
  • [L1] These findings refute claims of PRP equivalence to placebo and support its efficacy over placebo. [10] (10.1186/s12891-025-09339-8)
  • [L4] The authors recommend systematically offering PRP therapy for competition sports practitioners. [11] (10.1186/s12891-025-08663-3)
  • [L2] Current evidence supports the selective use of PRP in sports settings, though standardization in protocols and outcomes is needed. [12] (10.1177/23259671251399907)
  • [Paper] The authors argue that they fulfilled the reporting requirements for the injected PRP product as defined by MIBO. [13] (10.1177/03635465231203202)
  • [L1] These findings do not support PRP as a recommended treatment for this condition. [14] (10.1177/03635465251383039)
  • [L1] Corticosteroids resulted in greater short-term improvement, while PRP demonstrated superior longer-term outcomes at 6 and 12 months. [15] (10.1177/23259671251386862)
  • [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. [16] (10.1097/corr.0000000000003478)
  • [L1] As a result, we do not support the routine use of PRP for the treatment of this condition. [17] (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. [18] (10.5397/cise.2024.01060)
  • [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. [19] (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. [20] (10.1016/j.jse.2026.02.018)
  • [L4] PRP injections are a safe and effective conservative treatment method for reducing pain symptoms and increasing functionality in patients with lateral epicondylitis. [21] (10.1177/2325967125s00169)
  • [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. [22] (10.1186/s12891-024-08243-x)
  • [L1] Both LR-PRP and LP-PRP demonstrated comparable clinical outcomes at all follow-up time points, without showing differences in subjective and objective outcomes or in adverse events and treatment failures. [23] (10.1177/03635465241283500)
  • [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). [24] (10.1186/s12891-026-09625-z)
  • [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. [25] (10.1177/03635465231206930)
  • [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)
  • [L1] Intra-articular PRP injection is an effective treatment for improving overall function in patients with primary OA, particularly in younger individuals. [27] (10.1186/s12891-026-09486-6)
  • [Paper] Current orthobiologics can be categorised into three tiers of recommendations based on the level of clinical evidence. [28] (10.1136/bjsports-2022-106494)
  • [L2] Intra-articular injections of PRP and MFAT both provided significant clinical benefits and were safe for treating knee OA over a 12-month period. [29] (10.1177/03635465251337759)
  • [Paper] The study hypothesized that PRP and HBO therapy will enhance muscle regeneration after contusion injury, with a synergistic effect when combined. [30] (10.1016/j.jseint.2025.101453)
  • [L1] PRP can effectively improve pain and functional impairment in patients with tendinopathy, and its midterm efficacy is superior to that of corticosteroids. [31] (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. [32] (10.1186/s13018-024-05429-w)
  • [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. [33] (10.1002/arj.70027)
  • [L3] Both MINT and PRP resulted in significant improvements in pain (VAS) with no significant differences in function (qDASH). [34] (10.1016/j.jseint.2024.08.183)

See Also

  • Osteoarthritis

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] Platelet-Rich Plasma in the Treatment of Musculoskeletal Disease in 2025 and Beyond. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465251395284

[3] Overview of Available Treatments and Their Limitations for Hypertrophic Facet Joints—A Systematic Review of the Literature. JAAOS: Global Research and Reviews. 2025. DOI: 10.5435/jaaosglobal-d-24-00140

[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] 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

[6] PS9 Is platelet-rich plasma injection an effective choice in cases of delayed union or non-union?. Injury. 2013. DOI: 10.1016/s0020-1383(13)70158-x

[7] Muscle repair: platelet-rich plasma derivates as a bridge from spontaneity to intervention. Injury. 2014. DOI: 10.1016/s0020-1383(14)70004-x

[8] 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

[9] Degenerative osteoarthritis a reversible chronic disease. Regenerative Therapy. 2020. DOI: 10.1016/j.reth.2020.07.007

[10] 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

[11] 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

[12] 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

[13] Improving Injectable Orthobiologics Reporting Guidelines Adherence: Response. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231203202

[14] 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

[15] 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

[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] 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

[18] 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

[19] 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

[20] 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

[21] 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

[22] 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

[23] 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

[24] 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

[25] The Accurate Characterization of Platelet-Rich Plasma Enables Its Classification and Comparison: Response. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231206930

[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

[27] 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

[28] Tiered approach to considering orthobiologics for patients with musculoskeletal conditions. British Journal of Sports Medicine. 2023. DOI: 10.1136/bjsports-2022-106494

[29] Microfragmented Adipose Tissue as an Alternative to Platelet-Rich Plasma for Intra-articular Injection in Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251337759

[30] Synergistic Effects of Platelet-Rich Plasma and Hyperbaric Oxygen Therapy on Muscle Contusion Recovery in Mice. JSES International. 2026. DOI: 10.1016/j.jseint.2025.101453

[31] 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

[32] 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

[33] 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

[34] 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

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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.