Effects of percutaneous platelet-rich plasma injection on return-to-play after acute hamstring muscle injury: a systematic review and meta-analysis

OBJECTIVE: To evaluate the effectiveness and safety of platelet-rich plasma (PRP) for acute hamstring injuries, with attention to return-to-play (RTP) time, reinjury rates and adverse events. DESIGN: Systematic review and meta-analysis of randomised controlled trials (RCTs). Risk of bias was assessed using the Cochrane tool; certainty of evidence was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation). DATA SOURCES: Databases included Embase, MEDLINE, Web of Science, Elsevier and Cochrane Central searched through March 2025. ELIGIBILITY CRITERIA: RCTs comparing PRP to control treatments for acute hamstring injuries were included. Non-randomised and chronic tendinopathy studies were excluded. RESULTS: Six RCTs (n=277) were included. PRP reduced RTP time versus control (mean difference -8.6 days; 21.4 vs 30.0 days; 95% CI -3.04 to -0.03; p=0.045), though heterogeneity was high (I²=94.1%). Reinjury (15% vs 16%; p=0.722) and adverse event rates (1% vs 0%; p=0.687) did not differ. Certainty of evidence was rated as low to moderate due to risk of bias and imprecision. CONCLUSION: PRP may shorten RTP in acute hamstring injuries, especially when image-guided. Reinjury risk appears unchanged. Further trials are needed to confirm these findings and standardise biological use in muscle injuries. PROSPERO REGISTRATION NUMBER: CRD420251109346.