Leukoplatelet-derived products in acute muscle and myotendinous injuries: Evidence on prp, platelet lysates, and i-prf

Acute muscle and myotendinous injuries are frequent in sports and involve a complex regenerative process regulated by inflammatory, cellular, angiogenic, and extracellular matrix remodeling mechanisms. Leukoplatelet-derived products have emerged as biological strategies capable of modulating different stages of tissue repair; however, platelet-rich plasma (PRP), platelet lysates/releasates, and injectable platelet-rich fibrin (i-PRF) differ substantially in composition, structure, mediator-release kinetics, and maturity of supporting evidence. This review aimed to critically integrate clinical, experimental, and mechanistic evidence regarding these derivatives in the context of acute muscle and myotendinous repair. The literature was analyzed according to product characteristics, biological mechanisms, functional outcomes, return to sport, reinjury, and level of evidence. PRP showed the most developed clinical evidence, with several studies reporting favorable effects on functional recovery and return to sport, although effect magnitude varied across trials and quantitative syntheses. Recent aggregated evidence also identified a favorable association with reinjury outcomes. Experimental studies supported the biological plausibility of PRP by demonstrating effects on muscle repair and myogenic responses, while also highlighting transforming growth factor beta 1 (TGF-β1) as a relevant mediator linking platelet-derived signaling to fibrotic remodeling and as a potential target for product optimization. Platelet lysates and releasates demonstrated activity on myogenesis, cellular differentiation, inflammation, apoptosis, and muscle regeneration, supporting the biological relevance of the soluble platelet-derived fraction. i-PRF exhibited a distinct biological profile characterized by a three-dimensional fibrin matrix, cellular incorporation, mediator release, and immunomodulatory activity involving macrophages and dendritic cells. Current i-PRF evidence relevant to muscle repair remains predominantly mechanistic and translational rather than clinical. Overall, leukoplatelet-derived products represent biologically distinct and potentially complementary platforms. PRP currently has the strongest clinical foundation, whereas platelet lysates/releasates and i-PRF broaden the molecular, structural, and immunological possibilities for modulating muscle repair. These findings support the development of increasingly characterized and biologically targeted autologous therapies based on product composition, release kinetics, injury microenvironment, and therapeutic objective.