Long-term clinical and functional outcomes of ultrasound-guided platelet-rich plasma injection for long head of the biceps tendinopathy: A prospective study

Objectives: Long head of the biceps tendon (LHBT) tendinopathy is a common cause of anterior shoulder pain and often resists conservative management. Platelet-rich plasma (PRP) has demonstrated encouraging short-term benefits across several tendinopathies, yet robust long-term data remain limited. This study aimed to assess clinical, functional, and sonographic outcomes in patients with isolated LHBT tendinopathy following a single ultrasound-guided PRP injection, with a minimum follow-up of 4 years. Methods: In this prospective longitudinal follow-up, 52 patients from our 2021 randomized controlled trial received a single ultrasound-guided leukocyte-rich PRP injection. Forty-nine patients (94.2%) were available for analysis at ≥4 years. The clinical evaluation included the visual analog scale (VAS) for pain, the Oxford Shoulder Score (OSS), relapse rate, and patient satisfaction. High-resolution ultrasound was used to assess tendon thickness and echotexture. Results: Mean VAS improved from 7.4 ± 1.2 to 1.6 ± 1.1 at one month ( P < 0.001) and remained low at 1.9 ± 1.3 at 4 years. OSS increased from 21.5 ± 3.8 to 41.2 ± 3.5 at one month ( P < 0.001) and was 40.5 ± 3.7 at final follow-up. Relapse occurred in five patients (9.6%), yielding 92% relapse-free survival. Ultrasound demonstrated a significant reduction in tendon thickness (5.3 ± 0.7 mm → 4.6 ± 0.6 mm, P < 0.01) and normalization of echotexture. Overall, 83.7% were “very satisfied,” and no major complications occurred. Conclusion: A single ultrasound-guided PRP injection provides rapid and durable pain relief, sustained functional recovery, and sonographic tendon remodeling. The low relapse rate at ≥4 years supports PRP as a safe and potentially disease-modifying treatment for refractory LHBT tendinopathy.