Muscle Strain Injuries: Comparative Evaluation of Platelet-Rich Plasma, Platelet-Rich Fibrin, and Prolotherapy

Abstract

Context: Muscle injuries are among the most common sports-related traumas, accounting for 30%–55% of all athletic injuries. This review evaluates the therapeutic efficacy of three regenerative approaches—platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and prolotherapy—in the treatment of muscle strains. Evidence Acquisition: This narrative review synthesized current clinical and mechanistic evidence on PRP, PRF, and prolotherapy in the management of muscle strain injuries. A targeted search of the relevant literature was performed to identify influential and representative studies. The aim was to summarize key patterns, physiological mechanisms, and clinical implications rather than to conduct a systematic or exhaustive analysis. Results: Platelet-rich plasma demonstrated promising regenerative effects through growth factor-mediated modulation of inflammation and tissue repair; however, clinical outcomes varied because of differences in preparation protocols. Platelet-rich fibrin may provide a fibrin-based scaffold with sustained release of bioactive molecules, making it a potential option for chronic or severe injuries; however, high-quality clinical trials remain limited. Prolotherapy, by inducing controlled inflammation, may provide symptomatic improvement, but its regenerative impact appears less consistent than that of platelet-based therapies. Across all modalities, methodological variability and limited comparative studies remain major challenges. Conclusions: Current evidence suggests that PRP and PRF may be beneficial treatment options for muscle injuries. However, owing to heterogeneity in study design and preparation protocols, as well as the limited number of high-quality comparative trials, definitive conclusions regarding their superiority or routine clinical use cannot yet be established. Protocol standardization remains crucial. Future research should prioritize direct comparative studies and the evaluation of combination therapies with novel regenerative approaches.