The study
A meta-analysis pooled four randomised placebo-controlled trials, 337 people with Achilles tendinopathy. It compared platelet-rich plasma injections, a concentrate of the patient's own platelets injected into the tendon, against placebo injections. Outcomes were the VISA-A score (a validated measure of Achilles pain and function, higher being better), VAS pain, and imaging measures of tendon thickness and vascularity. The search ran to January 2025.
What they found
No difference. PRP did not beat placebo on VISA-A at three or six months, showed no difference on VAS pain, and produced no change in tendon thickness or vascularity on imaging. The authors call for larger trials, but the current evidence is a null result.
What it means for your practice
This is the answer for the patient who asks about PRP for their Achilles. On the best placebo-controlled evidence, it does not outperform a placebo injection, and it is not a cheap thing to try. The treatment that holds up remains progressive tendon loading given enough time.
If a patient is set on injections, they deserve to hear that the controlled trials show no benefit over placebo before they spend the money. The trials are few, only four, and they vary, so the picture could shift with better data. For now the direction is clear enough to guide the conversation.
Bottom line
PRP injections did not beat placebo for Achilles tendinopathy on pain, function or imaging. Keep loading as the treatment and set expectations on injections honestly.