Platelet‐Rich Plasma Injections for Foot and Ankle Pathologies Have Significantly More Complications Compared With Hyaluronic Acid Injections, Saline Solution Injections, and Dry Needling: A Systematic Review

Purpose To investigate complications of platelet‐rich plasma (PRP) injections for foot and ankle pathologies to better inform clinical decision making. Methods A systematic review of the PubMed, Embase, Web of Science, and Cochrane databases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines to identify randomized controlled trials documenting complications after PRP injections for foot and ankle pathologies. Condition studied, demographic characteristics, and complications were extracted. Complication rates and the number needed to harm were calculated, and random‐effects models were generated to compare complications using odds ratios, with P < .05 indicating significance. Results Sixteen studies assessing Achilles tendon injuries, plantar fasciitis, ankle osteoarthritis, and osteochondral lesions of the talus were identified, with 674 patients receiving PRP and 749 patients received alternative treatments (corticosteroid injection, saline solution injection, dry needling, hyaluronic acid injection, prolotherapy, and stromal vascular fraction injection). Twelve studies reported no complications. Four studies reported 277 complications in the PRP group (complication rate, 41.1%) and 249 complications in the comparison group (complication rate, 33.7%) ( P < .01). Treatment‐site pain was the most common complication, occurring at a significantly higher rate in the PRP group (15.1% vs 10.2%, P < .01), and metadata showing higher odds of pain after PRP injection (odds ratio = 2.23, I 2 = 0.0%, P < .01). The number needed to harm for PRP treatment was 13. One patient receiving PRP injections for Achilles tendinopathy experienced severe pain that resolved with surgical debridement. No other serious complications or infections occurred. Conclusions PRP injections in the foot and ankle have significantly higher rates of post‐injection pain versus comparison treatments, and an estimated 13 patients need to receive PRP injections to experience any complication over an alternative injection. Only 1 patient experienced an event that necessitated surgical intervention. Level of Evidence Level II, systematic review of Level I and II studies.