Improved Outcomes With Platelet-Rich Plasma for Treating Extra-articular Hip Pathology Especially Greater Trochanteric Pain Syndrome and Hamstring Injury: A Systematic Review of Randomized Controlled Trials
Author(s):Kuhns BD, Becker N, Reyes-Cordova A, Strok MJ, Quesada-Jimenez R, Kahana-Rojkind AH, Domb BG.
DOI Link: 10.1002/arj.70024
Background
Platelet-rich plasma (PRP) has been increasingly used for extra-articular hip pathology, including greater trochanteric pain syndrome (GTPS) and hamstring injuries. However, variability in indications, preparation methods, and reported outcomes has limited clear clinical conclusions.
Methods
A systematic review of randomized controlled trials (RCTs) was conducted using PubMed-MEDLINE, Embase, and Cochrane databases. Only RCTs evaluating PRP injections for extra-articular hip conditions were included. Studies were analyzed for PRP preparation (PAW classification), patient and pathology characteristics, outcomes, and risk of bias (RoB2 tool). Meta-analyses were performed when appropriate.
Key Findings
Eleven RCTs (581 hips) were included:
- GTPS/abductor tendinopathy: 5 studies (263 patients)
- Hamstring injuries: 5 studies (225 patients total; acute and chronic)
- Piriformis syndrome: 1 study (60 patients)
PRP demonstrated superior outcomes compared with control groups in:
- 60% of GTPS trials (at ≥1 time point)
- 50% of hamstring RCTs for return-to-sport outcomes
Meta-analysis findings:
- GTPS: High heterogeneity (I² = 0.92), but significant improvement in mHHS favoring PRP (P = .005)
- Hamstring injuries: Lower heterogeneity (I² = 0.65), with significant benefit for PRP and ~8-day faster return to sport (P = .005)
All RCTs reported improvements in pain and function, with comparable or superior outcomes in PRP groups versus controls.
Conclusion
PRP injections for GTPS and hamstring pathology demonstrate consistent clinical improvement, with meta-analytic evidence suggesting potential superiority over control treatments despite significant heterogeneity in study design and protocols.
What Does This Mean for Providers?
PRP appears to be a promising biologic adjunct for extra-articular hip pathology, particularly GTPS and hamstring injuries, with evidence supporting improved pain, function, and earlier return to sport in some settings. However, variability in PRP preparation, injection protocols, and study design limits definitive clinical standardization. Providers should consider PRP as a reasonable treatment option while recognizing that outcomes may depend heavily on formulation and patient selection.