Abstract
OBJECTIVE: This study aims to assess the therapeutic effectiveness and safety of platelet-rich plasma (PRP) in the management of primary and posttraumatic osteoarthritis (OA) patients. METHODS: A comprehensive literature search was conducted in the following databases: PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP database, Wanfang Database, and China Biology Medicine Disc for all double-blind randomized controlled trials (RCTs) on the use of PRP in TOA until November 2025. The data extraction and quality assessment were carried out independently by two researchers. The RevMan5.4 statistical software was used to perform a meta-analysis of the data that met the inclusion criteria. RESULTS: Eleven RCTs involving 851 participants were included. PRP injection resulted in a significant improvement in the WOMAC Total score compared to control treatments in primary OA (SMD: -8.53; 95% CI: -14.52 to -2.55; p = 0.005). Subgroup analyses revealed that this benefit was significant in patients younger than 60 years and with both single and double-dose regimens. However, no significant overall effects were observed for the WOMAC Pain, WOMAC Stiffness, VAS, or KOOS subscales. PRP was associated with more transient adverse events, primarily injection-site reactions. CONCLUSIONS: Intra-articular PRP injection is an effective treatment for improving overall function in patients with primary OA, particularly in younger individuals. While it demonstrates a acceptable safety profile, its effects on specific pain and quality-of-life measures require further investigation. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12891-026-09486-6.