Arthroscopy. 2025 Apr 8:S0749-8063(25)00262-2. doi: 10.1016/j.arthro.2025.03.065. Online ahead of print.

ABSTRACT

PURPOSE: To investigate complications of platelet rich plasma (PRP) injections for foot and ankle pathologies to better inform clinical decision-making.

METHODS: A systematic review following PRISMA guidelines of PubMed, Embase, Web of Science, and Cochrane databases was conducted to identify randomized controlled trials (RCTs) documenting complications following PRP injections for foot and ankle pathologies. Condition studied, demographics, and complications were extracted. Complication rates and number needed to harm (NNH) were calculated, and random-effects models were generated to compare complications using odds ratios, with a p-value < 0.05 indicating significance.

RESULTS: Sixteen studies assessing Achilles tendon injuries, plantar fasciitis, ankle osteoarthritis, and osteochondral lesions of the talus were identified, with 674 patients receiving PRP, and 749 patients received alternatives (corticosteroids, saline, dry needling, hyaluronic acid, prolotherapy, and stromal vascular fraction). Twelve studies reported no complications. Four studies reported 277 (rate of 41.1%) complications in the PRP group and 249 (rate of 33.7%) in the comparison group (p < 0.01). Treatment site pain was the most common complication, occurring at a significantly higher rate in the PRP group (14.5% vs. 10.1%, respectively, p < 0.01), and meta-data showing higher odds of pain following PRP (OR 2.23 I² = 0.0%, p <0.01). The NNH for PRP was 13. One patient receiving PRP injections for Achilles tendinopathy experienced severe pain that resolved with surgical debridement. No other serious complications or infections occurred.

CONCLUSION: PRP injections of the foot and ankle have significantly higher rates of post-injection pain versus comparison treatments, and an estimated 13 patients need to receive PRP injections to experience any complication over an alternative injection. Only one patient experienced an event that necessitated surgical intervention. Future studies investigating PRP should aim to report complications to allow clinicians to appropriately counsel patients.

LEVEL OF EVIDENCE: Level II, Systematic Review of RCTs.

PMID:40209826 | DOI:10.1016/j.arthro.2025.03.065