Hyaluronic Acid Versus Platelet-Rich Plasma for Chronic Tendinopathy and Enthesopathy

Comparative Analysis of the Efficacy of Hyaluronic Acid and Platelet-Rich Plasma Injections in the Treatment of Chronic Tendinopathies and Enthesopathies: A Prospective, Randomized Comparative Study

Chronic tendinopathies and enthesopathies are common musculoskeletal conditions in orthopedics and sports medicine, frequently leading to pain, impaired function, and significantly reduced quality of life. Their pathogenesis involves tissue degeneration and ineffective repair response, often without an active inflammatory process.

Standard conservative management based on physiotherapy and activity modification is often prolonged and not always satisfactory. Minimally invasive injectable interventions supporting tendon and enthesis regeneration represent a promising alternative due to their favorable safety profile and outpatient feasibility.

Hyaluronic acid (HA) is a glycosaminoglycan naturally present in connective tissues. In the context of tendinopathy, it is thought to modulate inflammatory processes, provide mechanical protection by reducing friction and adhesion within the tendon sheath, and support the proper organization of collagen fibers in the tendon matrix.

Platelet-rich plasma (PRP) is an autologous concentrate of platelets providing high local concentrations of growth factors, including platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-β), and vascular endothelial growth factor (VEGF), which initiate and support repair processes, cellular proliferation, and angiogenesis.

This prospective, randomized, open-label, two-arm study aims to compare the clinical efficacy of hyaluronic acid (HA) and platelet-rich plasma (PRP) injections in 80 participants with chronic Achilles tendinopathy or medial epicondylopathy of the elbow. Participants will be randomly assigned in a 1:1 ratio to receive either two HA injections or two PRP injections administered two weeks apart under ultrasonographic guidance. Follow-up will continue for 12 months after the second injection. The primary outcomes are the changes from baseline to 6 months in pain intensity measured using a 100-millimeter (mm) Visual Analog Scale (VAS), upper-limb function measured using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire in participants with medial epicondylopathy, and Achilles tendon symptoms and function measured using the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire in participants with Achilles tendinopathy. The results will provide evidence to support the selection of injectable treatment for chronic tendinopathies and enthesopathies.

Study Overview

• Status: Recruiting
• Conditions: Tendinopathy; Enthesopathy; Achilles Tendinopathy; Medial Epicondylitis; Golfer's Elbow
• Intervention / Treatment: Device: Hyaluronic acid injection; Device: Autologous Platelet-Rich Plasma Injection

• Study Type: Interventional
• Enrollment (Estimated): 80
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Tomasz Wnuk, MD, PhD; Phone Number: +48 538 360 332; Email: tomashorto@gmail.com

Study Locations

• Poland
  • Lublin Voivodeship
    • Lublin, Lublin Voivodeship, Poland, 20-841
      • Recruiting
      • Ortonika Orthopedic Medical Clinic in Lublin
      • Contact: Tomasz Wnuk, MD, PhD; Phone Number: +48 538 360 332; Email: tomashorto@gmail.com
      • Principal Investigator: Tomasz Wnuk, MD, PhD
      • Sub-Investigator: Piotr Przybylski, MD, PhD
      • Sub-Investigator: Mateusz Matyjaszczyk, MD
      • Sub-Investigator: Przemysław Golonka, MD
      • Sub-Investigator: Damian Borys, MD
      • Sub-Investigator: Beata Krupska, MSc
      • Sub-Investigator: Emilia Antoniewska, MSc

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Chronic tendinopathy or enthesopathy of the Achilles tendon or tendon insertion in the elbow region (medial epicondylopathy, so-called golfer's elbow)
• Symptom duration exceeding 3 months
• Pain intensity of at least 40 millimeters (mm) on a 100-mm Visual Analog Scale (VAS)
• Age 18-65 years
• Signed written informed consent

Exclusion Criteria:

• Previous surgical treatment of the studied tendon or tendon insertion
• Prior injection of corticosteroids, platelet-rich plasma (PRP), or hyaluronic acid into the area being studied within 3 months before enrollment
• Active systemic or local infection at the planned injection site
• Systemic inflammatory or autoimmune disease involving the joints, including rheumatoid arthritis, spondyloarthritis, or systemic lupus erythematosus
• Pregnancy or breastfeeding
• Body mass index (BMI) of 40 kilograms per square meter (kg/m²) or greater

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Arm 1 - Hyaluronic Acid (HA); Two peritendinous or intratendinous injections of hyaluronic acid (HA), containing 32 milligrams (mg) of sodium hyaluronate in 2 milliliters (mL) per injection, administered two weeks apart under ultrasonographic guidance.	Device: Hyaluronic acid injection; Assigned to: Arm 1
Experimental: Arm 2 - Platelet-Rich Plasma (PRP); Two peritendinous or intratendinous injections of autologous platelet-rich plasma (PRP), administered two weeks apart under ultrasonographic guidance.	Device: Autologous Platelet-Rich Plasma Injection; Assigned to: Arm 2

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Change From Baseline in Pain Intensity Measured Using the 100-Millimeter Visual Analog Scale at 6 Months	Pain intensity will be measured using a 100-millimeter (mm) Visual Analog Scale (VAS), ranging from 0 mm, indicating no pain, to 100 mm, indicating the worst imaginable pain. The outcome will be the mean change in VAS score from baseline to 6 months after the second injection. A decrease in score indicates improvement.	Baseline and 6 months after the second injection
Mean Change From Baseline in the Quick Disabilities of the Arm, Shoulder and Hand Score at 6 Months	Upper-limb symptoms and function will be assessed using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire in participants with medial epicondylopathy. The total score ranges from 0 to 100 points, with higher scores indicating greater disability. The outcome will be the mean change from baseline to 6 months after the second injection. A decrease in score indicates improvement.	Baseline and 6 months after the second injection
Mean Change From Baseline in the Victorian Institute of Sport Assessment-Achilles Score at 6 Months	Symptoms and function associated with Achilles tendinopathy will be assessed using the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire in participants with Achilles tendinopathy. The total score ranges from 0 to 100 points, with higher scores indicating better function and fewer symptoms. The outcome will be the mean change from baseline to 6 months after the second injection. An increase in score indicates improvement.	Baseline and 6 months after the second injection

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Change From Baseline in Pain Intensity Measured Using the 100-Millimeter Visual Analog Scale at 1, 3, and 12 Months	Pain intensity will be measured using a 100-millimeter (mm) Visual Analog Scale (VAS), ranging from 0 mm, indicating no pain, to 100 mm, indicating the worst imaginable pain. Mean changes from baseline will be assessed separately at 1, 3, and 12 months after the second injection. A decrease in score indicates improvement.	Baseline and 1, 3, and 12 months after the second injection
Mean Change From Baseline in the Quick Disabilities of the Arm, Shoulder and Hand Score at 1, 3, and 12 Months	Upper-limb symptoms and function will be assessed using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire in participants with medial epicondylopathy. The total score ranges from 0 to 100 points, with higher scores indicating greater disability. Mean changes from baseline will be assessed separately at 1, 3, and 12 months after the second injection. A decrease in score indicates improvement.	Baseline and 1, 3, and 12 months after the second injection
Mean Change From Baseline in the Victorian Institute of Sport Assessment-Achilles Score at 1, 3, and 12 Months	Symptoms and function associated with Achilles tendinopathy will be assessed using the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire in participants with Achilles tendinopathy. The total score ranges from 0 to 100 points, with higher scores indicating better function and fewer symptoms. Mean changes from baseline will be assessed separately at 1, 3, and 12 months after the second injection. An increase in score indicates improvement.	Baseline and 1, 3, and 12 months after the second injection
Time From the Second Injection to Return to the Pre-Injury Level of Physical Activity	The number of days from the second injection to the first documented return to the participant's pre-injury level of physical activity without activity restrictions will be recorded. Participants who do not return to their pre-injury activity level during follow-up will be considered not to have experienced the event by the end of the 12-month follow-up period.	From the second injection through 12 months of follow-up
Number of Participants With Adverse Events, Serious Adverse Events, or Adverse Device Effects	The number and percentage of participants experiencing one or more adverse events (AEs), serious adverse events (SAEs), or adverse device effects (ADEs) will be reported. Events will be assessed according to their type, severity, seriousness, and relationship to the administered intervention.	From the first injection through 12 months after the second injection

Collaborators and Investigators

• Sponsor: Ortonika Orthopedic Medical Clinic in Lublin
• Investigators: Principal Investigator: Tomasz Wnuk, MD, PhD, Ortonika Orthopedic Medical Clinic

Study record dates

Study Major Dates

• Study Start (Actual): June 10, 2026
• Primary Completion (Estimated): June 1, 2028
• Study Completion (Estimated): June 1, 2028

Study Registration Dates

• First Submitted: July 3, 2026
• First Submitted That Met QC Criteria: July 14, 2026
• First Posted (Actual): July 20, 2026

Study Record Updates

• Last Update Posted (Actual): July 20, 2026
• Last Update Submitted That Met QC Criteria: July 14, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: hyaluronic acid; PRP; platelet-rich plasma; tendinopathy; Achilles tendon; enthesopathy; epicondylopathy; intratendinous injection
• Additional Relevant MeSH Terms: Elbow Injuries; Musculoskeletal Diseases; Muscular Diseases; Wounds and Injuries; Tendon Injuries; Arm Injuries; Enthesopathy; Elbow Tendinopathy; Tendinopathy
• Other Study ID Numbers: 1.0 13.04.2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No