Table 3

Assigning a graded recommendation for the use of PRP to treat tendon problems

Source of evidenceQuality of SR evidenceGeneral consensusConsidered judgementGraded recommendation
Six SRs (three SRs of RCTs; three SRs of mixed study designs)1× high-quality SR, very low risk of bias
2× low-quality SR, high risk of bias
3× low-quality SR, very high risk of bias
Inconclusive—conflicting results
All SRs include the same RCT19 that reported no effect of PRP for treating Achilles tendinopathy—this is the only high-quality study in the area
  • Mostly poor-quality and high-risk bias studies.

  • Study populations not elite/professional athletes so uncertain effect in the target clinical population

  • No convincing proof that PRP has any effect on Achilles tendinopathy

  • Financial implications, cost:benefit ratio not justified

  • Potential harms unknown

  • Pressure to consider use from media, players, agents

Overall no proof that PRP accelerates healing and/or time to return to play and/or return to play outcomes
High monetary cost for a treatment with little high-quality evidence, and where harms are unknown
D—insufficient evidence (both research and practice-based) to recommend this treatment
  • PRP, platelet-rich plasma; RCT, randomised controlled trial; SR, systematic review.