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Efficacy and safety of platelet-rich plasma combined with hyaluronic acid versus platelet-rich plasma alone for knee osteoarthritis: a systematic review and meta-analysis
Zhang Q, Liu T, Gu Y, Gao Y, Ni J
Journal of orthopaedic surgery and research. 2022;17(1):499
Abstract
PURPOSE To systematically evaluate the curative efficacy and safety of platelet-rich plasma (PRP) combined with hyaluronic acid (HA) in the treatment of knee osteoarthritis (KOA), comparing with platelet-rich plasma alone. METHODS Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI) and Embase were searched for randomized controlled trials (RCTs) and cohort studies regarding the efficacy and safety of platelet-rich plasma (PRP) combined with hyaluronic acid (HA) in the treatment of knee osteoarthritis (KOA) comparing with platelet-rich plasma alone before January 15, 2022. The methodological quality of the ultimately included studies was assessed comprehensively, and meta-analysis was implemented using RevMan 5.3 software. RESULTS Thirteen articles (9 RCTs, 4 cohort studies), including 1118 patients, were covered. There was no significant difference between the PRP + HA therapy and PRP-alone therapy in VAS scores at 3 months, 6 months and 12 months, WOMAC total scores at 3 months and KOOS at 1 month and 6 months. Compared with PRP-alone therapy, PRP + HA therapy was associated with significantly better improvement in VAS scores at 1 month, WOMAC total scores at 6 months, KOOS at 3 months, IKDC scores at 6 months and Lequesne index scores at 3 and 6 months. However, the smallest treatment effect of VAS scores, WOMAC total scores, KOOS and IKDC scores did not exceed the minimum clinically important difference (MCID). However, PRP + HA therapy got a greater reduction in the rate of adverse events, compared with PRP-alone therapy. CONCLUSION The results of this meta-analysis indicated that PRP + HA therapy was not found to be superior to PRP-alone therapy in pain relief and function improvement for patients with KOA. However, combined PRP with HA injections was generally safer than PRP injections alone, by assessing the incidence of adverse events.
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Additive effectiveness of autologous platelet-rich fibrin in the treatment of intrabony defects: A PRISMA-compliant meta-analysis
Li A, Yang H, Zhang J, Chen S, Wang H, Gao Y
Medicine. 2019;98(11):e14759
Abstract
BACKGROUND This meta-analysis was performed to determine the additive effectiveness of autologous platelet-rich fibrin in the treatment of intrabony defects in chronic periodontitis patients. METHODS Pertinent studies were identified by a search in Medline, EMBASE, the Web of Science, and the Cochrane Library. The trials searched were evaluated for eligibility. Cochrane Collaboration's Review Manager software was used to perform the meta-analyses. RESULTS Twelve eligible clinical trials were included. Pooled data found that adjunctive platelet-rich fibrin exactly yielded a significantly superior probing depth reduction compared with open flap debridement alone (weighted mean difference, 1.01; 95% confidence interval 0.95-1.08; P < .00001). The clinical attachment level (CAL) gain after treatment for 9 months was higher in patients treated with platelet-rich fibrin plus open flap debridement group than in open flap debridement-treated patients (weighted mean difference, 1.29; 95% confidence interval 0.96- 1.61; P < .00001). Similarly, the meta-analysis demonstrated that platelet-rich fibrin was superior to single open flap debridement with respect to gingival marginal level change (weighted mean difference, 0.45; 95% confidence interval 0.31-0.58; P < .00001). Regarding the hard tissue radiographic parameters, including defect depth reduction and percentage of fill defects in bone, adjunctive platelet-rich fibrin yielded significantly superior results compared with open flap debridement alone. CONCLUSION Adjunctive use of platelet-rich fibrin with open flap debridement significantly improves fill defects when compared to open flap debridement alone. However, additional powered studies with much larger sample sizes are needed to obtain a more concrete conclusion.
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Platelet-rich plasma vs corticosteroids for elbow epicondylitis: A systematic review and meta-analysis
Li A, Wang H, Yu Z, Zhang G, Feng S, Liu L, Gao Y
Medicine. 2019;98(51):e18358
Abstract
OBJECTIVE The aim of this meta-analysis was to compare the effectiveness of platelet-rich plasma (PRP) vs corticosteroids for treatment of patients with lateral elbow epicondylitis. METHODS A literature search was performed in EMBASE, Medline, the Cochrane Library and PubMed. Randomized controlled studies comparing PRP with corticosteroids for the treatment of epicondylitis were included. The Cochrane Collaboration's tool for assessing the risk of bias was used to evaluate the methodological quality of the included trials. The Cochrane Collaboration's Review Manager software was used to perform the meta-analyses. The overall effect size of each anesthetic was calculated as the weighted average of the inverse variance of the study-specific estimates. RESULTS Seven randomized controlled trials were included in this review. The data from 2 studies were unavailable for meta-analysis, and the systematic review criteria were just achieved. Local corticosteroid injection yielded a significantly superior Disabilities of the Arm, Shoulder and Hand (DASH) score at 4 weeks (WMD, 11.90; 95% CI: 7.72 to 16.08; P < .00001; heterogeneity, chi = 0, I = 0%, P = 1.00) and 8 weeks (WMD, 6.29; 95% CI: 2.98 to 9.60; P = .0002, chi = 0, I = 0%, P = 1.00). Otherwise, it was noteworthy that a significantly lower VAS score (WMD, -2.61; 95% CI: -5.18 to -0.04; P = .05; heterogeneity, chi = 29.85, I = 97%, P < .00001) and DASH score (WMD, -7.73; 95% CI: -9.99 to -5.46; P < .00001, chi = 0.20, I = 0%, P = .66) existed in the PRP regimen than in the steroid regimen at the 24-week follow-up. More effective treatments were achieved in the PRP-treated patients than in the patients treated with corticosteroids (WMD, 3.33; 95% CI: 1.81 to 6.14; P = .000; heterogeneity, chi = 0.43, I = 0%, P = .51). CONCLUSIONS Local corticosteroid injections demonstrated favorable outcomes compared with those of local PRP treatments for lateral elbow epicondylitis during the short-term follow-up period (4 weeks and 8 weeks post-treatment). Otherwise, at the long-term follow-up (24 weeks post-treatment), PRP injections had improved pain and function more effectively than corticosteroid injections.
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Autologous platelet-rich gel treatment for diabetic chronic cutaneous ulcers: a meta-analysis of randomized controlled trials
Li Y, Gao Y, Gao Y, Chen D, Wang C, Liu G, Yang X, Ran X
Journal of Diabetes. 2018
Abstract
BACKGROUND Recent years, many studies have reported that autologous platelet-rich gel (APG) is an effective adjunctive method to promote chronic cutaneous ulcers in diabetics. The aim of the present study was to explore the efficacy and safety of APG for the topical treatment of diabetic chronic cutaneous ulcers. METHODS The Chinese CBM, CNKI, VIP, Wanfang databases, Cochrane Library databases, EBSCOhost, Embase and PubMed on October 18, 2017 were systematically searched. The fixed/random-effect models were used to calculate the risk ratio (RR)/odds ratio (OR)/mean difference (MD) with the 95% confidence interval (95%CI) as the effect analysis statistics. Subgroup analyses were conducted according to the Diabetic Foot Wagner Classification. RESULTS Fifteen RCTs with 829 patients were eligible for the present analysis. Compared with standard care/conventional treatment, APG significantly improved the healing rate (RR=1.39, 95% CI 1.29 to 1.50, P < 0.00001), shortened the healing time (MD= -9.18, 95% CI -11.32 to -7.05, P < 0.00001), reduced the incidence of infection (OR= 0.34, 95% CI 0.15 to 0.77, P = 0.009). CONCLUSIONS Current evidence suggests that APG is effective and safe, and it's probable to be used as an adjuvant treatment for diabetic ulcers, especially for the chronic refractory ulcers. But more RCTs with good design and high quality are needed before it can be implemented widely.