Platelet-rich plasma in the management of musculoskeletal disorders: a narrative review of clinical evidence and practical considerations.

Background: Platelet-rich plasma (PRP) has emerged as a widely applied autologous biologic therapy in musculoskeletal medicine. Its concentrated growth factor content is postulated to promote tissue regeneration, modulate the inflammatory cascade, and provide clinically meaningful and durable symptom relief in both degenerative joint disease and chronic tendinopathy. Despite its widespread clinical adoption, the evidence base remains heterogeneous, and its rational application requires a critical synthesis of current findings. Objective: This narrative review aimed to critically examine the existing clinical evidence for PRP in the management of degenerative joint disorders and soft tissue conditions, to evaluate indication-specific efficacy, and to provide evidence-based clinical recommendations for its use in musculoskeletal practice. Methods: A narrative review of the literature was undertaken, with searches of Medline (via PubMed), Embase, and the Cochrane Database of Systematic Reviews for relevant publications up to July 2025. Randomized controlled trials (RCTs), systematic reviews, and meta-analyses comparing PRP with active comparators or placebo in osteoarthritis or tendinopathy were selected based on clinical relevance, sample size, and follow-up duration. No formal protocol registration, dual independent screening, or risk-of-bias scoring was applied; the synthesis is therefore interpretive rather than systematic. Results: PRP may provide clinically meaningful symptom improvement in selected patients with mild-to-moderate knee and hip osteoarthritis, where modest advantages over hyaluronic acid are reported in some studies and medium-term outcomes may be more durable than with corticosteroid, particularly with leukocyte-poor PRP (LP-PRP) delivered as a series of two to three injections. Among soft tissue conditions, PRP appears most useful relative to corticosteroid in plantar fasciitis, degenerative rotator cuff disease, and trochanteric tendinopathy. Evidence in lateral epicondylitis is mixed: PRP outperforms corticosteroid in the medium term, but placebo-controlled data do not demonstrate a clinically important effect. Current evidence does not support PRP for Achilles tendinopathy, and placebo-controlled data also challenge its use in ankle osteoarthritis. The therapeutic effect of PRP is characteristically delayed, emerging at eight to sixteen weeks and persisting up to eighteen to twenty-four months in selected indications; however, the certainty of evidence varies substantially by indication, comparator, PRP formulation, and follow-up duration. Conclusion: PRP may represent a reasonable second-line treatment option for selected musculoskeletal conditions, particularly after insufficient response to structured conservative management. The strength of evidence is highly indication-dependent and is weakest precisely where placebo-controlled data exist. Standardization of PRP preparation and reporting, and rigorous placebo-controlled trials in indications where these are lacking, are essential to advance the evidence base.