Outcomes of Acute Achilles Tendon Repair with Platelet-Rich Plasma Augmentation: A Comprehensive Review of Comparative Studies

Background/Objectives: Platelet-rich plasma (PRP) has been proposed as a biological augmentation strategy in the surgical repair of acute Achilles tendon rupture (ATR). However, clinical evidence remains heterogeneous, and its impact on structural and functional recovery is unclear. This review synthesizes comparative clinical evidence on PRP augmentation in surgical acute ATR repair. Methods: A comprehensive review of comparative clinical studies was conducted using PubMed, MEDLINE, Scopus, and Cochrane Central databases. Seven studies, including three randomized controlled trials, met the inclusion criteria, totaling 207 patients. Methodological quality was assessed using the Modified Newcastle-Ottawa Scale and Cochrane Risk of Bias tool. Results: Several studies reported early functional improvements with PRP. Zou et al. found better range of motion at 24 months (p < 0.001). Sánchez et al. reported faster recovery of range of motion (7 vs. 11 weeks) and earlier return to running (11 vs. 18 weeks). Hung et al. observed improved range of motion at 6 months, without differences at 24 months (ATRS 92.9 vs. 92.7). Conversely, randomized trials by Yasui, Schepull, and De Carli showed no significant long-term differences in functional outcomes. Conclusions: PRP may enhance early recovery after surgical acute ATR repair, but consistent long-term superiority has not been demonstrated. Heterogeneity in PRP preparation and administration likely contributes to conflicting findings. Further standardized trials are required to define its clinical role.