Efficacy of Platelet-Rich Plasma Augmentation in Anterior Cruciate Ligament Reconstruction: An Updated Systematic Review and Meta-Analysis of Clinical Trials

This updated systematic review and meta-analysis evaluated the efficacy and safety of platelet-rich plasma (PRP) augmentation in anterior cruciate ligament reconstruction (ACLR). A comprehensive search of PubMed, the Cochrane Central Register of Controlled Trials, trial registries, and grey literature up to August 13, 2025, identified 16 randomized controlled trials comprising 1,085 participants (545 PRP; 540 control) with follow-up durations ranging from 3 to 24 months. Compared with standard ACLR, PRP significantly reduced pain at three months (mean difference (MD) -0.76; 95% confidence interval (CI) -1.90 to -0.39) and six months (MD -0.67; 95% CI -1.24 to -0.11), but no difference remained at 12 months (MD -0.16; 95% CI -0.51 to 0.18). Functional outcomes demonstrated small, non-significant gains in Lysholm Knee Scoring Scale and International Knee Documentation Committee (IKDC) scores at three and six months and no effect at 12 months, while the Tegner Activity Scale showed a modest but significant improvement at six months (MD 0.46; 95% CI 0.06 to 0.85) that disappeared thereafter. Tunnel widening at 12 months was non-significant for both tibial (MD 0.16; 95% CI -0.46 to 0.78) and femoral tunnels (MD 0.27; 95% CI -0.07 to 0.62). KT-1000 arthrometer (KT-1000) outcomes slightly favored control (MD 0.48; 95% CI 0.12 to 0.83), indicating minimally greater anterior-posterior stability without PRP. The certainty of evidence was moderate to high for pain outcomes and low to very low for functional and structural outcomes due to heterogeneity and small sample sizes. In summary, PRP augmentation provides modest short-term benefits in pain reduction and functional recovery but does not improve long-term stability, graft maturation, or tunnel integrity, and therefore should currently be considered an adjunct rather than a routine practice in ACLR.