Does PRP Work for Achilles Tendon Tears? What the Research Shows
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By Dr. Jeffrey Peng, MD · Published March 6, 2025 · 7 min read
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Achilles tendon ruptures are among the most devastating injuries an active person can experience, leading to significant pain, disability, and time away from work and sport. While surgical repair was once considered the default treatment, a growing body of evidence now supports nonsurgical management for many patients. This raises an important question: if we can treat Achilles tendon tears without surgery, can we use platelet-rich plasma (PRP) to further improve healing and accelerate recovery?
PRP has demonstrated meaningful benefits in overuse tendon conditions such as tennis elbow, golfer's elbow, gluteal tendinopathy, and plantar fasciitis. However, less is known about its effectiveness in acute injuries like Achilles tendon ruptures. A recently published randomized controlled trial — the PATH-2 trial — provides some of the strongest evidence to date on this question. Below, I review the trial's two-year follow-up results and discuss what they mean for patients considering PRP treatment.
What Is an Achilles Tendon Rupture?
The Achilles tendon is the largest and strongest tendon in the body, connecting the calf muscles to the heel bone. A rupture occurs when this tendon partially or completely tears, typically during sudden forceful movements such as sprinting, jumping, or pivoting. Patients often describe hearing a pop followed by immediate pain and difficulty walking. Achilles tendon ruptures lead to significant limitations in both work and sporting activities, which is why clinicians are always searching for treatments that can facilitate healing and improve recovery times.
Can PRP Improve Healing After an Achilles Tendon Tear?
The PATH-2 trial was a randomized, placebo-controlled, multicenter superiority trial conducted across 19 hospitals in the United Kingdom. The study enrolled 230 adults with acute Achilles tendon ruptures managed nonsurgically — 114 received a PRP injection and 116 received a placebo injection. The primary goal was to determine whether adding PRP to standard nonsurgical treatment would improve patient-reported function and quality of life.
The study used Magellan PRP kits, which involved a 50 cc blood draw to produce a final volume of 8 cc of PRP. However, the authors allocated 4 cc for laboratory analysis and injected only the remaining 4 cc into the tendon rupture site. The PRP had a 4.1-fold greater platelet concentration than baseline, resulting in an estimated total of 4 to 5 billion platelets. No activating agents were used.
What Did the PATH-2 Trial Find at Two Years?
At two years of follow-up, the investigators found no evidence of a difference in the Achilles Tendon Rupture Score (ATRS) or any secondary outcome between the PRP and placebo groups. There were also no re-ruptures between 24 weeks and two years in either group. The authors concluded that PRP injection did not improve patient-reported function or quality of life two years after acute Achilles tendon rupture compared with placebo. This represents some of the strongest evidence to date that PRP does not offer meaningful benefit for acute Achilles tendon tears.
Does Platelet Dose Matter in PRP Treatments?
One important critique of the PATH-2 trial involves platelet dosing. The PRP preparation initially yielded an estimated 8 to 10 billion platelets — a range that many experts consider the target for effective PRP treatment. However, because the authors reserved half of the preparation for laboratory analysis, only 4 to 5 billion platelets were actually injected into the tendon.
This matters because emerging research suggests that absolute platelet count is critically important to the success of PRP injections. A study by Bansal et al. demonstrated that an absolute count of 10 billion platelets was crucial for achieving sustained chondroprotective effects in knee osteoarthritis. If the therapeutic threshold for PRP effectiveness requires a higher platelet count, then the PATH-2 results may reflect an underdosed treatment rather than a true lack of efficacy. Insufficient platelet dosing was also a recognized limitation of the RESTORE trial for knee osteoarthritis.
Why Ultrasound-Guided Injections Matter for PRP
Another significant critique of the PATH-2 trial is the method of injection delivery. The authors report that ultrasound guidance was not used. Instead, the treating clinician palpated for the tendon defect and injected PRP without imaging. Additionally, physicians in training delivered the injections in 25% of cases.
This is a meaningful limitation. A comprehensive review by Daniels et al. aggregated existing evidence comparing ultrasound-guided to landmark-based injections across multiple anatomic sites. The results were striking: ultrasound-guided injections achieved 90 to 100% accuracy for virtually every body region, while landmark-based accuracy ranged from the mid-teens to the mid-seventies for most indications.
When injections are performed without imaging guidance, there is no way to confirm that the PRP was delivered to the correct location within the injured tendon. If the injection misses the target, outcomes will naturally be poor — not because PRP is ineffective, but because it was never properly administered. In my practice, I believe all orthobiologic injections should be performed under ultrasound guidance, and this is especially important in clinical trials where conclusions can shape how physicians practice.
Does PRP Help Chronic Achilles Tendinopathy?
The PATH-2 trial examined acute Achilles ruptures, but what about chronic Achilles tendinopathy? A systematic review and meta-analysis by Nauwelaers et al. looked specifically at PRP for chronic midsubstance Achilles tendinopathy. Their pooled analysis of four randomized controlled trials found no difference in VISA-A functional scores between PRP and placebo groups at 3 months, 6 months, or 12 months. The authors concluded that PRP has no clear additional value in managing chronic midsubstance Achilles tendinopathy and should not be used as a first-line treatment option.
Taken together, the evidence from both acute and chronic Achilles tendon conditions suggests that PRP does not offer clear benefit for this particular tendon.
Should You Get PRP for an Achilles Tendon Injury?
Based on the current evidence, the medical literature is fairly clear that PRP does not meaningfully improve healing in Achilles tendon injuries — whether acute tears or chronic tendinopathy. In my practice, I have largely stopped recommending PRP injections for Achilles tendon problems unless a patient is truly adamant about exhausting every possible nonsurgical option before considering surgery. Even then, I counsel patients that PRP may not help.
It is worth noting that PRP continues to show strong evidence of benefit in many other conditions, including lateral epicondylitis (tennis elbow), gluteal tendinopathy, and knee osteoarthritis. The Achilles tendon appears to be an exception rather than the rule when it comes to PRP effectiveness.
What to Ask Your Doctor Before Getting a PRP Injection
If you are considering a PRP injection for any condition, there are several important questions worth asking your healthcare provider. What type of PRP system is being used, and how many platelets will be injected? How will the injection be delivered — is it performed under ultrasound guidance or by landmark palpation? These factors can significantly influence outcomes and are important details that every patient should understand. If you are interested in learning more about whether PRP or other orthobiologic treatments may be right for your condition, I encourage you to schedule a consultation to discuss your options.
References
1. Keene DJ, Alsousou J, Harrison P, et al. Platelet-rich plasma injection for acute Achilles tendon rupture: two-year follow-up of the PATH-2 randomized, placebo-controlled, superiority trial. Bone Joint J. 2022;104-B(11):1256-1265. doi:10.1302/0301-620X.104B11.BJJ-2022-0653.R1
2. Bansal H, Leon J, Pont JL, et al. Platelet-rich plasma (PRP) in osteoarthritis (OA) knee: Correct dose critical for long term clinical efficacy. Sci Rep. 2021;11(1):3971. doi:10.1038/s41598-021-83025-2
3. Daniels EW, Cole D, Jacobs B, Phillips SF. Existing Evidence on Ultrasound-Guided Injections in Sports Medicine. Orthop J Sports Med. 2018;6(2):2325967118756576. doi:10.1177/2325967118756576
4. Nauwelaers AK, Van Oost L, Peers K. Evidence for the use of PRP in chronic midsubstance Achilles tendinopathy: A systematic review with meta-analysis. Foot Ankle Surg. 2020;27(5):486-495. doi:10.1016/j.fas.2020.07.009
Medical Disclaimer: This content is for educational purposes only and does not substitute for the medical advice of a physician. Always consult your healthcare provider before beginning any new treatment program. The information presented reflects the opinion of Dr. Jeffrey Peng and does not represent the views of his employers or affiliated hospital systems.
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