The impact of platelet-rich plasma augmentation on postoperative clinical outcomes in patients undergoing anterior cruciate ligament reconstruction: a systematic review and meta-analysis.

backgroundAnterior cruciate ligament reconstruction (ACLR) is the standard surgical treatment for restoring knee function and stability in patients with ACL injuries, but long-term rehabilitation challenges recovery. Platelet-rich plasma (PRP), with its potential to enhance healing, has been introduced to accelerate this process, but its clinical efficacy remains controversial.

methodsThe PubMed, Embase, Cochrane Library, and Web of Science databases were used to identify studies published from January 2000 to June 2025. We systematically reviewed RCTs comparing ACLR with versus without PRP augmentation in patients with ACL injuries. Evaluated outcomes included the International Knee Documentation Committee (IKDC) scores, visual analogue scale (VAS), Lysholm scores, Tegner scores, KT-1000/2000 arthrometer side-to-side differences (SSD), pivot-shift tests, and bone tunnel enlargement. We applied the GRADE criteria to evaluate the overall quality of the evidence. The relative risk (RR) was used for dichotomous data, and the mean difference (MD) was used for continuous variable data. Data were pooled using the random-effects model due to the anticipated clinical heterogeneity. The minimal clinically important difference (MCID) was used to determine whether patients had improved enough clinically to notice a difference. Subgroup analyses were conducted to examine the potential effects of follow-up duration.

resultsA total of 13 studies were included in this systematic review and meta-analysis, enrolling 667 patients, with 332 undergoing ACLR augmented with PRP and 335 in the control group. Although there were statistically significant differences between the two groups in favor of the PRP technique in terms of VAS scores at 6 months postoperatively (MD − 1.01; 95% CI − 1.74 to − 0.28; I2 = 0%; P < 0.01) (GRADE: LOW), and SSD at 3 months postoperatively (MD − 1.12; 95% CI − 1.64 to − 0.60; I2 = 0%; P < 0.01) (GRADE: VERY LOW), these observed differences are so small that they are unlikely to be clinically relevant. No differences were found in other clinical outcomes between the two groups.

conclusionsCurrent 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.