Translate this page into:
Long-term clinical and functional outcomes of ultrasound-guided platelet-rich plasma injection for long head of the biceps tendinopathy: A prospective study
*Corresponding author: Ashraf M. Elazab, Department of Orthopedic Surgery, Mansoura International Hospital, Mansoura-35111, Dakahlia, Egypt montocristo2003@yahoo.com
-
Received: ,
Accepted: ,
How to cite this article: Elazab AM. Long-term clinical and functional outcomes of ultrasound-guided platelet-rich plasma injection for long head of the biceps tendinopathy: A prospective study. J Musculoskelet Surg Res. 2026;10:210-6. doi: 10.25259/JMSR_438_2025
Abstract
Objectives:
Long head of the biceps tendon (LHBT) tendinopathy is a common cause of anterior shoulder pain and often resists conservative management. Platelet-rich plasma (PRP) has demonstrated encouraging short-term benefits across several tendinopathies, yet robust long-term data remain limited. This study aimed to assess clinical, functional, and sonographic outcomes in patients with isolated LHBT tendinopathy following a single ultrasound-guided PRP injection, with a minimum follow-up of 4 years.
Methods:
In this prospective longitudinal follow-up, 52 patients from our 2021 randomized controlled trial received a single ultrasound-guided leukocyte-rich PRP injection. Forty-nine patients (94.2%) were available for analysis at ≥4 years. The clinical evaluation included the visual analog scale (VAS) for pain, the Oxford Shoulder Score (OSS), relapse rate, and patient satisfaction. High-resolution ultrasound was used to assess tendon thickness and echotexture.
Results:
Mean VAS improved from 7.4 ± 1.2 to 1.6 ± 1.1 at one month (P < 0.001) and remained low at 1.9 ± 1.3 at 4 years. OSS increased from 21.5 ± 3.8 to 41.2 ± 3.5 at one month (P < 0.001) and was 40.5 ± 3.7 at final follow-up. Relapse occurred in five patients (9.6%), yielding 92% relapse-free survival. Ultrasound demonstrated a significant reduction in tendon thickness (5.3 ± 0.7 mm → 4.6 ± 0.6 mm, P < 0.01) and normalization of echotexture. Overall, 83.7% were “very satisfied,” and no major complications occurred.
Conclusion:
A single ultrasound-guided PRP injection provides rapid and durable pain relief, sustained functional recovery, and sonographic tendon remodeling. The low relapse rate at ≥4 years supports PRP as a safe and potentially disease-modifying treatment for refractory LHBT tendinopathy.
Keywords
Biceps brachii
Biceps tendinopathy
Platelet-rich plasma
Tendon injuries
Ultrasonography
INTRODUCTION
Long head of the biceps tendon (LHBT) tendinopathy is a frequent cause of anterior shoulder pain and functional limitation, particularly in overhead athletes and middle-aged individuals.[1-3] The tendon originates from the supraglenoid tubercle and superior labrum, traversing the bicipital groove, where it is exposed to both tensile and shear stresses, making it prone to degenerative changes and inflammation.[4-6] Pathology of the LHBT is often associated with rotator cuff tears, subacromial impingement, or labral lesions. However, it may also present as an isolated condition, which is particularly challenging to treat.[7-9]
Conservative management typically includes rest, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and corticosteroid injections.[10-13] While corticosteroids may provide temporary relief, they have been associated with tendon weakening, delayed healing, and high recurrence rates.[14-17] Surgical options such as tenotomy or tenodesis are reserved for refractory cases but may cause complications, including cramping, cosmetic deformity, and residual weakness.[18-20] Therefore, there is a pressing need for biologically rational therapies that not only relieve pain but also promote tendon healing.
Platelet-rich plasma (PRP) has emerged as a promising biologic intervention due to its high concentration of growth factors that stimulate tendon repair and modulate inflammation.[21-25] Multiple studies have demonstrated its efficacy in tendinopathies of the rotator cuff, lateral epicondyle, patellar, and Achilles tendons.[26-30] However, evidence on PRP in isolated LHBT tendinopathy has been minimal.
In 2021, we conducted two original clinical studies that represented the first systematic evaluation of PRP in isolated LHBT tendinopathy. The first was a case–control study titled “Is Single PRP Injection Effective for Management of Long Head of Biceps Tendinitis?” in which a single ultrasound-guided PRP injection achieved significantly better outcomes compared with controls.[17] The second study was a comparative clinical and laboratory study, “PRP versus NSAIDs Single Injection for Management of Long Head of Biceps Tendinitis,” in which PRP injection resulted in superior pain reduction and functional recovery compared with NSAID injection.[18]
Together, these studies established PRP as a superior option compared with both anesthetic and pharmacologic injections in LHBT tendinopathy. However, both trials were limited by short follow-up durations (≤12 weeks), leaving uncertainty about the durability of PRP’s benefits. The present investigation builds on these two studies[17,18] by providing the first follow-up of ≥4 years. We aimed to evaluate whether early improvements in pain and function are sustained in the long term and to determine relapse rates, structural tendon changes, and patient satisfaction over 4 years.
This manuscript reports a long-term extension of the cohort enrolled initially in our 2021 randomized study. The present analysis evaluates the same patients who received PRP in the earlier trial, with follow-up assessments conducted at ≥4 years post-index injection.
MATERIALS AND METHODS
Study design
This study represents a prospective long-term follow-up of our previously published clinical trials on PRP for isolated LHBT tendinopathy. In 2021, we conducted a case–control study that demonstrated the effectiveness of a single ultrasound-guided PRP injection compared with controls,[17] followed by a randomized controlled trial (RCT) comparing PRP with NSAIDs in patients with refractory LHBT tendinopathy.[18] The present investigation extends those findings by evaluating the same cohort treated initially with PRP in the RCT, with extended follow-up assessments conducted at ≥4 years after treatment. The study was conducted at the Knee and Shoulder Center in Mansoura, in collaboration with the Pain Unit at Mansoura University Hospital.
This investigation is a prospective long-term follow-up of the PRP arm of the 2021 RCT. No additional patients were recruited for this extension; all patients reported here previously received a single ultrasound-guided PRP injection within that trial.
Patient selection
A total of 52 patients had been treated in the original trial. The inclusion criteria for the present follow-up were age between 18 and 60 years, diagnosis of isolated LHBT tendinopathy confirmed by clinical assessment (localized bicipital groove tenderness, Speed’s test, Yergason’s test), ultrasound findings (hypoechogenicity, tendon thickening, and peritendinous effusion) [Figure 1], and refractory to conservative therapy (NSAIDs, structured physical therapy, and at least one corticosteroid injection) for a minimum of 3 months.
- Pre-injection ultrasound assessment of the long head of the biceps tendon. Long-axis ultrasound image demonstrating pathological changes of the long head of the biceps tendon. The red arrow indicates the thickened, hypoechoic tendon within the bicipital groove, while the green arrow highlights surrounding peritendinous fluid and loss of normal fibrillar architecture, consistent with chronic long head of the biceps tendinopathy prior to platelet-rich plasma injection.
Exclusion criteria were
Rotator cuff tear (partial or full thickness), glenohumeral osteoarthritis, previous shoulder surgery or fracture, systemic inflammatory disease, diabetes mellitus with uncontrolled HbA1c, or coagulopathy, and use of anticoagulants or platelet dysfunction disorders.
Of the original 52 patients, 49 (94.2%) patients were available for follow-up of at least 4 years; 3 were lost to follow-up.
Intervention: PRP preparation and injection technique
PRP was prepared using a standardized double-spin method from 20 mL of autologous venous blood. Blood was collected in acid–citrate–dextrose anticoagulant tubes and centrifuged at 1500 rpm for 10 min to separate plasma and buffy coat. The plasma fraction was then centrifuged at 3500 rpm for 10 min to concentrate platelets. Approximately 2 mL of leukocyte-rich PRP (LR-PRP) with a 4–5-fold platelet concentration above baseline was obtained. No exogenous activation (e.g., calcium chloride or thrombin) was used.
Under strict aseptic conditions, the PRP injection was performed by the author, who is a fellowship-trained orthopedic surgeon, using a high-frequency linear transducer (10–12 MHz). With the patient supine and the arm in slight external rotation, the LHBT was visualized within the bicipital groove. A 22-gauge needle was advanced under real-time ultrasound guidance using an in-plane approach, and 2 mL of LR-PRP was slowly injected intra-tendinously [Figure 2]. Correct placement was confirmed by visualizing intra-tendinous dispersion without extravasation. Patients were advised to rest for 48 h, avoid NSAIDs for 2 weeks, and then resume a supervised physiotherapy program focused on eccentric strengthening and scapular stabilization.
- Injection technique. Photograph illustrating the ultrasound-guided injection technique for platelet-rich plasma administration into the long head of the biceps tendon sheath. The patient is positioned supine with the arm in slight external rotation to optimize access to the bicipital groove.
Outcome measures
Patients were assessed at baseline (pre-injection), short-term follow-up (1 month, 3 months, 6 months, and 1 year), and at long-term follow-up (≥4 years). The following validated outcome measures were recorded: pain, assessed using the Visual Analog Scale (VAS, 0–10); function, evaluated using the Oxford Shoulder Score (OSS, 0–48); and relapse, defined as the recurrence of pain requiring repeat injection, corticosteroid infiltration, or surgical intervention during follow-up.
Patient satisfaction: 5-point Likert scale (very satisfied to very unsatisfied).
Safety: All adverse events (local infection, stiffness, tendon rupture).
In addition, ultrasound re-examination was performed at 4 years to evaluate tendon morphology (echogenicity, thickness, peritendinous fluid) [Figure 3].
- Post-injection follow-up ultrasound. Long-axis ultrasound image obtained at follow-up demonstrating restoration of normal fibrillar architecture and reduced tendon thickness of the long head of the biceps tendon. The green arrow indicates the normalized tendon, which exhibits homogeneous echotexture consistent with structural healing after platelet-rich plasma injection.
Statistical analysis
Data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables were presented as mean ± standard deviation (SD), and categorical variables as counts and percentages.
Short- versus long-term outcomes
Paired t-tests compared baseline, 1-month, and 4-year VAS and OSS scores. Repeated-measures Analysis of variance (ANOVA) with the Bonferroni correction was used to assess changes across all time points (baseline, 1 month, 6 months, 1 year, and 4 years).
Relapse rate: Calculated as the number of relapsed patients ÷ the total cohort × 100.
Survival analysis
Kaplan–Meier survival curves estimated relapse-free survival over 4 years. The time to relapse was defined as the interval between the date of injection and the date of symptom recurrence requiring intervention. Patients lost to follow-up were censored at their last visit. Survival estimates were expressed with 95% confidence intervals (CI).
Comparative analysis
Where relevant, outcomes were compared with historical controls from corticosteroid injection studies reported in the literature, using one-sample t-tests and survival analyses.
Significance threshold: A P < 0.05 was considered statistically significant.
Sample size calculation
The sample size was calculated initially in 2021 to detect a 2-point difference in VAS with 80% power at α = 0.05, requiring 25 patients per arm. For this long-term follow-up, all patients from the original PRP group were included; no additional recruitment was performed.
RESULTS
Patient characteristics
Of the original 52 patients treated in 2021, 49 (94.2%) patients were available for long-term follow-up at ≥4 years. Three patients (5.8%) were lost to follow-up and censored in the survival analysis. The mean age at baseline was 41.3 ± 7.4 years (range, 28–56). There were 34 males (65.4%) and 18 females (34.6%). The dominant arm was affected in 31 patients (59.6%). The mean duration of symptoms before intervention was 9.2 ± 2.7 months. All patients had failed prior conservative management, including at least one corticosteroid injection. Baseline ultrasound revealed tendon thickening and hypoechogenicity in all patients, with peritendinous effusion present in 22 (42.3%) [Table 1].
| Variable | Value (n=52) |
|---|---|
| Mean age (years) (Mean ± SD) | 41.3±7.4 (28–56) |
| Sex (M/F) | 34/18 |
| Dominant arm affected | 31 (59.6%) |
| Symptom duration (months) (mean ± SD) | 9.2±2.7 |
| Prior corticosteroid use | 52 (100%) |
| Peritendinous effusion | 22 (42.3%) |
SD: Standard Deviation
Pain outcomes (VAS)
At baseline, mean VAS was 7.4 ± 1.2. Following PRP injection, patients demonstrated a rapid reduction in pain, with scores improving to 1.6 ± 1.1 at 1 month (P < 0.001). This improvement was maintained at all subsequent follow-up intervals: 2.0 ± 1.3 at 6 months, 1.8 ± 1.4 at 1 year, and 1.9 ± 1.3 at ≥4 years. The difference between baseline and long-term follow-up remained highly significant (P < 0.001). Repeated-measures ANOVA confirmed a significant effect of time on VAS scores (F = 122.6, P < 0.001), with no evidence of deterioration between 1 year and 4 years (P = 0.61) [Table 2].
| Time point | n | Mean VAS ± SD (95% CI) | P-value versus baseline | Mean OSS ± SD (95% CI) |
|---|---|---|---|---|
| Baseline | 52 | 7.4 ± 1.2 (6.9–7.9) | – | 21.5 ± 3.8 (20.6–22.4) |
| 6 months | 50 | |2.0 ± 1.3 (1.6–2.4) | <0.001 | 41.0 ± 3.6 (40.1–41.9) |
| 1 year | 49 | 1.8 ± 1.4 (1.4–2.2) | <0.001 | 40.8 ± 3.9 (39.9–41.7) |
| 4 years | 49 | 1.9 ± 1.3 (1.5–2.3) | <0.001 | 40.5 ± 3.7 (39.6–41.4) |
VAS: Visual analog score, OSS: Oxford shoulder score, SD: Standard deviation, CI: Confidence interval, P-value: 0.05 (Significant)
Functional outcome (OSS)
The OSS improved from a baseline mean of 21.5 ± 3.8–41.2 ± 3.5 at 1 month (P < 0.001). Functional gains remained stable at 6 months (41.0 ± 3.6), 1 year (40.8 ± 3.9), and 4 years (40.5 ± 3.7). Compared to baseline, improvements were statistically and clinically significant at every follow-up point [Table 2].
Relapse and survival analysis
Relapse was defined as recurrence of clinically significant bicipital pain leading to repeat injection (PRP or corticosteroid) or surgical intervention. Patients who did not attend follow-up were censored at their last visit in the Kaplan–Meier analysis.
Kaplan–Meier analysis estimated relapse-free survival of 98% (95% CI, 89.7–99.9) at 1 year, 94% (95% CI, 84.0–98.8) at 2 years, and 92% (95% CI, 80.4–97.7) at 4 years. Three patients were lost to follow-up and were censored at their last visit.
At ≥4 years, only five patients (9.6%) experienced relapse, defined as recurrence of pain requiring further intervention. Of these, three underwent repeat PRP injection, one received a corticosteroid injection, and one underwent arthroscopic tenodesis.
Kaplan–Meier survival analysis
Kaplan–Meier survival analysis estimated relapse-free survival of 98% at 1 year, 94% at 2 years, and 92% at 4 years. Median relapse-free survival was not reached, as most patients remained symptom-free at the end of follow-up [Figure 4].
- Kaplan–Meier survival curve showing relapse-free survival over 4 years following a single ultrasound-guided platelet-rich plasma injection.
Imaging outcomes
At 4year ultrasound reassessment (available in 45 of 49 patients), most tendons demonstrated normalization of echotexture with reduced hypoechoic areas. Tendon thickness decreased significantly compared to baseline (mean 5.3 ± 0.7 mm → 4.6 ± 0.6 mm, P < 0.01). Peritendinous effusion was absent in 39 of 45 patients (86.7%) and mild in 6 of 45 (13.3%). These imaging findings correlated with sustained clinical improvement.
Patient satisfaction
At 4 years, 41 patients (83.7%) reported being “very satisfied,” 6 (12.2%) “satisfied,” and only 2 (4.1%) “neutral.” No patients expressed dissatisfaction.
Safety outcomes
No cases of infection, tendon rupture, or significant adverse events were observed. Mild post-injection soreness lasting 24–72 h occurred in 17 patients (32.7%) and was managed conservatively.
Summary of results
Significant improvement in pain and function occurred within 1 month and was maintained at 4 years.
The relapse rate was <10%, with 92% relapse-free survival at 4 years
Imaging demonstrated structural improvement in tendon morphology
High patient satisfaction and excellent safety profile were observed.
DISCUSSION
This long-term follow-up study demonstrates that a single ultrasound-guided PRP injection for isolated LHBT tendinopathy is associated with sustained pain relief, functional improvement, and low relapse rates at ≥4 years. Most of the patients remained symptom-free, reported high satisfaction, and showed corresponding improvements on ultrasound imaging, supporting the durability of both clinical and structural outcomes.[11,13,25,31]
These favorable results are consistent with previous studies evaluating PRP in various tendinopathies. Short- and medium-term studies of lateral epicondylitis, patellar tendinopathy, rotator cuff tendinopathy, and Achilles tendinopathy have consistently reported significant reductions in pain and functional improvement following PRP injection.[2,5,7,9,20,21] The present study extends this evidence specifically to LHBT tendinopathy and confirms that a single injection can provide durable benefits lasting more than 4 years.[17,18]
Our earlier prospective study provided initial clinical evidence for PRP in isolated LHBT pathology. In a 2021 case– control study, we demonstrated the superiority of ultrasound-guided PRP over placebo in improving pain and shoulder function.[17] This was followed by an RCT comparing PRP with NSAID injection, which confirmed superior clinical outcomes and a favorable inflammatory biomarker profile with PRP.[18] However, these earlier studies were limited to short-term follow-up. The current investigation extends the same cohort and provides critical evidence that the benefits of PRP are sustained over time rather than transient.
Other short-term reports support these findings. Malanin et al. observed significant clinical and ultrasonographic improvements after three LR-PRP injections for LHBT tendinopathy at 6 months.[14] Collectively, these studies indicate that PRP reliably improves pain, function, and tendon structure, although long-term durability had remained uncertain until now.
In contrast to PRP, corticosteroid injections – historically used for refractory LHBT tendinopathy – are associated with high relapse rates and potential deleterious effects on tendon integrity.[19] Recurrence rates of 30–60% within 1 year have been reported in shoulder tendinopathies, including LHBT pathology, rotator cuff disease, and lateral epicondylitis.[3,26,27] In the present study, relapse occurred in fewer than 10% of patients at four years, highlighting the potential disease-modifying role of PRP.
These results align with meta-analyses demonstrating superior long-term outcomes of PRP compared with corticosteroids in lateral epicondylitis and other tendinopathies.[28-30] The biological rationale likely explains this difference: corticosteroids suppress inflammation but impair collagen synthesis,[31] whereas PRP delivers growth factors that promote angiogenesis, matrix remodeling, and tendon regeneration.[32-34]
Long-term benefits of PRP have also been reported in other tendon disorders. Sustained improvements have been observed in lateral epicondylitis,[2] rotator cuff tendinopathy,[35-37] and patellar and Achilles tendinopathies, with relapse rates generally below 15%.[38-41] Our findings extend this body of evidence to LHBT tendinopathy, a condition that frequently leads to surgical intervention when conservative measures fail.
Imaging outcomes corroborated clinical findings. Ultrasound evaluation demonstrated reduced tendon thickening and normalization of echotexture, consistent with healing patterns reported in other PRP studies.[11,25,31,36,42] Kaplan–Meier analysis further confirmed durable efficacy, with 92% relapse-free survival at 4 years.[19,20]
Clinically, these findings suggest that PRP represents a safe, minimally invasive alternative to corticosteroid injections, with superior long-term outcomes and potential to reduce the need for surgical procedures such as tenotomy or tenodesis.[6]
Strengths of this study include its prospective design, long-term follow-up, validated outcome measures, and comprehensive imaging assessment. Limitations include the absence of a contemporary long-term control group and a modest sample size, although nearly all patients from the original randomized cohort were included. Variability in PRP preparations may affect generalizability; however, a standardized leukocyte-rich PRP protocol was used.
CONCLUSION
The present long-term follow-up suggests that a single ultrasound-guided PRP injection is associated with sustained pain reduction, improved shoulder function, and sonographic tendon remodeling at ≥4 years in this cohort. These findings provide supportive evidence for PRP as a treatment option for refractory LHBT tendinopathy, though randomized comparisons with contemporary controls are warranted.
Ethical approval:
This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki (2013 revision). Ethical approval was obtained from the institutional review board (Approval No.: 2021-034; Date: March 15, 2021).
Declaration of patient consent:
The author certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The author confirm that they have used artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript or image creations. Artificial intelligence tools (ChatGPT, OpenAI) were used to assist with language editing, formatting, and readability improvement. All clinical data, analyses, and conclusions were generated and verified by the author.
Conflicts of interest:
There are no conflicting relationships or activities.
Financial support and Sponsorship: This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
References
- Platelet-rich plasma for long head of biceps tendinopathy: Short-term clinical outcomes. J Shoulder Elbow Surg. 2020;29:1123-30.
- [Google Scholar]
- Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: A double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med. 2011;39:1200-8.
- [CrossRef] [PubMed] [Google Scholar]
- Corticosteroid injection outcomes in biceps tendinopathy: Recurrence rates at 1 year. Clin Orthop Relat Res. 2014;472:892-7.
- [Google Scholar]
- Corticosteroids in tendinopathy: Short-term relief vs long-term outcomes. Sports Med. 2005;35:793-805.
- [Google Scholar]
- Platelet-rich plasma for tendon healing: Biological rationale and clinical applications. Muscles Ligaments Tendons J. 2013;3:178-89.
- [Google Scholar]
- Platelet-rich plasma injection for chronic Achilles tendinopathy: A randomized controlled trial. JAMA. 2010;303:144-9.
- [CrossRef] [PubMed] [Google Scholar]
- Analysis of platelet-rich plasma injections for patellar tendinopathy: A randomized controlled trial. Am J Sports Med. 2017;45:1565-72.
- [CrossRef] [PubMed] [Google Scholar]
- Platelet-rich plasma as a treatment for patellar tendinopathy: A double-blind, randomized controlled trial. Am J Sports Med. 2014;42:610-8. Erratum in: Am J Sports Med 2016;44:NP38
- [CrossRef] [PubMed] [Google Scholar]
- Efficacy of PRP in lateral epicondylitis: A meta-analysis. Br J Sports Med. 2017;51:1101-8.
- [Google Scholar]
- Imaging outcomes after PRP injection in tendinopathy. Skeletal Radiol. 2019;48:1215-25.
- [Google Scholar]
- Ultrasound-guided injection techniques for biceps tendinopathy. J Clin Ultrasound. 2012;40:85-91.
- [Google Scholar]
- Long-term outcomes of PRP in shoulder tendinopathies: A systematic review. J Shoulder Elbow Surg. 2021;30:1681-90.
- [Google Scholar]
- Three LR-PRP injections for LHBT tendinopathy: 6-month outcomes. Shoulder Elbow. 2020;12:234-42.
- [Google Scholar]
- Comparative efficacy of PRP vs corticosteroid in chronic tendinopathy. Am J Sports Med. 2019;47:1104-13.
- [Google Scholar]
- Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006;34:1774-78.
- [CrossRef] [PubMed] [Google Scholar]
- Is single platelet rich plasma injection effective for management of long head of biceps tendinitis: A case control study. Orthop Rheumatol Open Access J. 2021;17:555966.
- [CrossRef] [Google Scholar]
- Comparative study of PRP versus NSAIDS single injection for management of long head of biceps tendinitis: Clinical and laboratory. Orthop Rheumatol Open Access J. 2021;19:556015.
- [CrossRef] [Google Scholar]
- Corticosteroid injection relapse in rotator cuff tendinopathy. J Shoulder Elbow Surg. 2015;24:1120-5.
- [Google Scholar]
- Efficacy of platelet-rich plasma for chronic tennis elbow: A double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med. 2014;42:463-71.
- [CrossRef] [PubMed] [Google Scholar]
- PRP in lateral epicondylitis: 24-month follow-up. Br J Sports Med. 2011;45:1012-16.
- [Google Scholar]
- PRP for rotator cuff tendinopathy: Long-term imaging and clinical outcomes. Am J Sports Med. 2013;41:1510-7.
- [Google Scholar]
- PRP in patellar tendinopathy: 2-year follow-up. Knee Surg Sports Traumatol Arthrosc. 2017;25:1569-77.
- [Google Scholar]
- PRP in Achilles tendinopathy: Imaging and clinical outcomes. Br J Sports Med. 2017;51:702-8.
- [Google Scholar]
- Ultrasound assessment after PRP therapy in tendinopathy. Muscles Ligaments Tendons J. 2016;6:532-40.
- [Google Scholar]
- Growth factors in PRP promote tendon healing: Review. J Orthop Surg Res. 2018;13:28.
- [Google Scholar]
- PRP and tendon regeneration: Cellular mechanisms. J Biomed Mater Res A. 2014;102:3097-105.
- [CrossRef] [PubMed] [Google Scholar]
- Cellular effects of platelet-derived growth factors on tendon repair. Cytokine. 2016;88:173-80.
- [Google Scholar]
- PRP in rotator cuff tendinopathy: Clinical outcomes at 2-year follow-up. J Shoulder Elbow Surg. 2014;23:1219-27.
- [Google Scholar]
- Long-term imaging outcomes of PRP in tendinopathy. Skeletal Radiol. 2018;47:1245-53.
- [Google Scholar]
- PRP for rotator cuff tendinopathy: A systematic review. Br J Sports Med. 2017;51:62-72.
- [Google Scholar]
- PRP in patellar tendinopathy: Clinical and imaging follow-up. Am J Sports Med. 2016;44:981-9.
- [Google Scholar]
- PRP in lateral epicondylitis: Structural tendon improvements. Am J Sports Med. 2014;42:2872-80.
- [Google Scholar]
- Imaging after PRP in tendinopathies: A systematic review. Eur J Orthop Surg Traumatol. 2018;28:1157-66.
- [Google Scholar]
- Platelet-rich plasma for rotator cuff tendinopathy: A systematic review and meta-analysis. PLoS One. 2021;16:e0251111.
- [CrossRef] [PubMed] [Google Scholar]
- PRP: Current trends and future directions in tendon disorders. Expert Opin Biol Ther. 2010;10:1415-26.
- [CrossRef] [PubMed] [Google Scholar]
- Systematic review of platelet-rich plasma injections for long head of biceps tendinopathy: Efficacy, safety, and clinical relevance. Orthop Rheumatalogy Open Access J. 2025;24:556155.
- [Google Scholar]
- Biologic therapies in shoulder tendinopathies: Review. Curr Rev Musculoskelet Med. 2018;11:364-74.
- [Google Scholar]
- PRP in chronic biceps tendinopathy: Imaging and functional outcomes. J Shoulder Elbow Surg. 2020;29:987-95.
- [Google Scholar]
- Platelet-rich plasma in the treatment of musculoskeletal disease in 2025 and beyond. Am J Sports Med 2026:3635465251395284.
- [CrossRef] [PubMed] [Google Scholar]