Platelet-Rich Plasma Accelerates the Return to Sport in Athletes with Acute Muscle Injuries: A Systematic Review and Statistical Fragility Index-Based Meta-Analysis of Randomized Controlled Trials.

backgroundMuscle lesions are common sport injuries resulting in prolonged absence from sport activity and long rehabilitation periods. The aim of this systematic review and meta-analysis was to quantify the clinical benefits of platelet-rich plasma (PRP) injections in treating acute muscle injuries.

methodsThe search was conducted on PubMed, Cochrane Library, and Web of Science in January 2026. The PRISMA guidelines were used. Inclusion criteria were: randomized controlled trials (RCTs) published in English comparing PRP injections with control (rehabilitation or placebo) for the treatment of acute muscle injuries. The outcomes analysed were: time to return to sport (RTS), Visual Analogue Scale (VAS) for pain, re-injury and complication rates. Two sub-analyses were performed, one on the double-blind RCTs and one on the RCTs focusing on hamstrings. A fragility analysis was performed using the fragility index (FI) and the continuous FI (CFI). The quality of each article was assessed using the Cochrane RoB 2 and the GRADE tools.

resultsAmong the 4969 articles retrieved, nine RCTs (474 patients) were included. PRP provided faster RTS both in the overall analysis (p < 0.001, mean difference (MD) = 7.5, CFI = 188) and in the two sub-analyses (p < 0.001, MD = 8.8, CFI = 67 and p = 0.001, MD = 7.5, CFI = 97 respectively), as well as superior VAS improvement in the hamstring sub-analysis (p = 0.006, MD = 0.4, CFI = 22). No difference was found in terms of re-injury and complication rates between the two groups (FI = 5 and FI = 7, respectively). The evaluation using the RoB 2 tool showed that four studies had a "low risk" of bias and five had a "high risk" of bias. The GRADE evaluation showed a limited quality of evidence of the analysed outcomes.

conclusionPRP produced a faster RTS compared to controls in acute muscle injury patients, both in the overall analysis and in the sub-analyses. PRP was able to produce a statistically higher pain relief only in the hamstring subgroup, while no difference was found in terms of re-injury and complication rates, suggesting a similar safety profile when compared to rehabilitation alone and placebo. The fragility analysis supported the benefits in terms of RTS, although the high-quality literature addressing this topic remains limited, warranting caution in the interpretation of the current results.