Comparative Effectiveness of Platelet Rich Plasma PRP Stem Cells and Exosomes in the Treatment of Sports Injuries A Narrative Review

Background Sports related musculoskeletal injuries are among the most common conditions in orthopedics and sports medicine and affect tendons, ligaments, muscles and articular cartilage. Impaired healing driven by mechanical overload, repetitive microtrauma and insufficient recovery may lead to sustained pro inflammatory cytokine activity including IL 1β and TNF α, progressive tissue degeneration and chronic pain. The limited vascularization and cellularity of cartilage and tendons further restrict intrinsic regenerative capacity. Conventional treatments such as nonsteroidal anti inflammatory drugs, rest, ice, compression and elevation, and physical therapy primarily provide symptomatic relief and may interfere with biological processes involved in tissue repair. These limitations have stimulated increasing interest in biologic regenerative approaches, including platelet rich plasma, mesenchymal stem cells and exosome based therapies. Aim To comparatively evaluate platelet rich plasma, mesenchymal stem cells and mesenchymal stem cell derived exosomes as biologic regenerative therapies in sports related musculoskeletal injuries, with focus on mechanisms of action, clinical effectiveness across tissue types, safety and clinical applicability. Methods A qualitative narrative review of experimental and clinical studies published between 2000 and 2024 was conducted using PubMed, Scopus and Google Scholar. Included publications addressed biological mechanisms, regenerative effects, safety aspects and clinical outcomes of platelet rich plasma, mesenchymal stem cells and exosomes in injuries of tendons, cartilage, muscles and ligaments. Results Platelet rich plasma, mesenchymal stem cells and exosome based therapies were associated with regenerative and anti inflammatory effects across a range of musculoskeletal conditions. Platelet rich plasma was most consistently linked to angiogenesis enhancement, collagen synthesis and symptomatic improvement, although reported outcomes varied substantially due to heterogeneity in preparation and application protocols. Mesenchymal stem cell based therapies demonstrated pronounced immunomodulatory and regenerative effects, particularly in tendon and cartilage related conditions, with some studies suggesting improved outcomes under specific dosing and administration strategies. Exosome based approaches showed promising effects on tissue repair and inflammation modulation in preclinical models, representing a potential cell free alternative, but clinical evidence remains limited. Overall safety profiles were acceptable, while methodological heterogeneity and limited direct comparative data contributed to variability in reported outcomes. Conclusions Biologic regenerative therapies provide complementary mechanisms that may support tissue repair in sports related musculoskeletal injuries. Platelet rich plasma, mesenchymal stem cells and exosome based approaches demonstrate clinical potential and acceptable safety, but heterogeneity of protocols and the lack of long term comparative clinical data limit definitive conclusions regarding relative effectiveness. Further standardized and well designed clinical studies are required to define optimal indications and to support integration of these therapies into personalized and mechanism oriented regenerative treatment strategies.