Platelet-Rich Plasma for Diabetic Foot Ulcers: A Cross-Sectional Appraisal of Overlapping Meta-Analyses.

Abstract

Purpose: The treatment of diabetic foot ulcers (DFUs) remains challenging, and the benefits and safety of platelet-rich plasma (PRP) therapy are still debated. This study analyzed existing meta-analyses on PRP therapy for DFUs to identify the most reliable evidence source.

Methods: This cross-sectional appraisal was conducted according to PRISMA 2020 guidance. PubMed, Embase, and the Cochrane Library were searched from inception to May 20, 2026, for meta-analyses comparing PRP therapy with standard or conventional care for DFUs. Only meta-analyses based exclusively on randomized controlled trials (RCTs) were included. Methodological quality was assessed using AMSTAR, evidence level was classified according to the Oxford Levels of Evidence, and discordant findings were examined using the Jadad decision algorithm.

Results: Eleven meta-analyses were included in this study, all of which were categorized as Level II evidence. The AMSTAR scores ranged from 6 to 10 (median 8). The meta-analysis identified by the Jadad algorithm as the most robust source showed that autologous PRP improved complete ulcer healing rates (OR: 2.11; 95% CI: 1.55-2.86) and shortened complete healing time (MD: -19.04 days; 95% CI: -20.46 to -17.61) compared with standard care. Furthermore, the incidence of adverse events in PRP groups was not significantly different from that in standard care groups, and the results were robust in sensitivity analyses.

Conclusion: PRP is an effective adjunctive therapy for DFUs, with no statistically significant increase in reported adverse events. However, further large-scale, high-quality trials are needed to standardize PRP preparation and administration, and to establish optimal treatment protocols.