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The Efficacy of Platelet-Rich Plasma Injection Therapy in the Treatment of Patients with Achilles Tendinopathy: A Systematic Review and Meta-Analysis
Arthur Vithran DT, Xie W, Opoku M, Essien AE, He M, Li Y
Journal of clinical medicine. 2023;12(3)
Abstract
BACKGROUND Over the past few years, many studies have been conducted to evaluate the effectiveness of platelet-rich plasma (PRP) in treating musculoskeletal conditions. However, there is controversy about its benefits for patients with Achilles tendinopathy. OBJECTIVE This study aimed to investigate whether platelet-rich plasma injections can improve outcomes in patients with Achilles tendinopathy. METHODS A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, Web of Science, China Biomedical CD-ROM, and Chinese Science and Technology Journal databases to identify randomised controlled clinical trials that compared the efficacy of PRP injection in patients with Achilles tendinopathy (AT) versus placebo, published between 1 January 1966 and 1 December 2022. Review Manager 5.4.1 software was used for the statistical analysis, and the Jadad score was used to assess the included literature. Only 8 of the 288 articles found met the inclusion criteria. RESULTS Our work suggests that: The PRP treatment group had a slightly higher VISA-A score than the placebo group at 6 weeks [MD = 1.92, 95% CI (-0.54, 4.38), I(2) = 34%], at 12 weeks [MD = 0.20, 95% CI (-2.65 3.05), I(2) = 60%], and 24 weeks [MD = 2.75, 95% CI (-2.76, 8.26), I(2) = 87%]). However, the difference was not statistically significant. The Achilles tendon thickness was higher at 12 weeks of treatment in the PRP treatment group compared to the control group [MD = 0.34, 95% CI (-0.04, 0.71), p = 0.08], but the difference was not statistically significant. The VAS-improvement results showed no significant difference at 6 and 24 weeks between the two groups, respectively (MD = 6.75, 95% CI = (-6.12, 19.62), I(2) = 69%, p = 0.30), and (MD = 10.46, 95% CI = (-2.44 to 23.37), I(2) = 69%, p = 0.11). However, at 12 weeks of treatment, the PRP injection group showed a substantial VAS improvement compared to the control group (MD = 11.30, 95% CI = (7.33 to 15.27), I(2) = 0%, p < 0.00001). The difference was statistically significant. The return to exercise rate results showed a higher return to exercise rate in the PRP treatment group than the placebo group [RR = 1.11, 95% CI (0.87, 1.42), p = 0.40]; the difference was not statistically significant. CONCLUSION There is no proof that PRP injections can enhance patient functional and clinical outcomes for Achilles tendinopathy. Augmenting the frequency of PRP injections may boost the outcomes, and additionally, more rigorous designs and standardised clinical randomised controlled trials are needed to produce more reliable and accurate results.
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Platelet-rich Plasma Injection Can Be a Viable Alternative to Corticosteroid Injection for Conservative Treatment of Rotator Cuff Disease: A Meta-analysis of Randomized Controlled Trials
Bachelor LP, Bachelor YX, Li T, Li Y, Zhu J, Tang X
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2022
Abstract
PURPOSE The purpose of this study was to explore whether PRP injection can be a viable alternative to CS injection for conservative treatment of rotator cuff disease. METHODS The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, The Cochrane Library, and Web of Science were searched for English-written randomized controlled trials (RCTs) which compared PRP and CS injections for patients with rotator cuff disease from January 1, 1990, to March 20, 2022. Two evaluators independently screened the literature, extracted data, and assessed the level of evidence and methodological quality of the enrolled studies. The meta-analysis was conducted using RevMan 5.3.3 software. RESULTS Thirteen non-surgical RCTs with 725 patients were included. Compared with CS, PRP provided statistically worse short-term (<2 months) changes (Δ) of the American Shoulder and Elbow Surgeons (ASES) assessment, Δ the Simple Shoulder Test (SST), Δ the Disability of Arm, Shoulder and Hand (DASH) questionnaires but better medium-term (2 to 6 months) Δ DASH, long-term (≥ 6 months) Δ Constant-Murley Score (CMS), Δ ASES and Δ SST. No statistical differences regarding pain reduction were found between the two groups. PRP injections led to worse short-term Δ forward flexion, Δ internal rotation but better medium-term Δ forward flexion and Δ external rotation. PRP had significantly lower rates of postinjection failure (requests for a subsequent injection or surgical intervention prior to 12 months) than CS. No outcome reached the minimal clinically important difference (MCID). After sensitivity analyses by excluding studies with substantial clinical and/or methodological heterogeneity, PRP showed better medium-term Δ ASES, Δ VAS, and long-term Δ VAS which reached the MCID. CONCLUSIONS Without the drawbacks of CS injection, PRP injection is not worse than CS injection in pain relief and function recovery at any time point of the follow-up. PRP injection may reduce rates of subsequent injection or surgery, and might provide better improvement in pain and function in the medium- to long-term. PRP injection can be a viable alternative to CS injection for conservative treatment of rotator cuff disease. LEVEL OF EVIDENCE Systematic review of Level I and II studies.
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Effectiveness of platelet-rich plasma injections for the treatment of acute Achilles tendon rupture: A systematic review and meta-analysis
Wang C, Fan H, Li Y, Yun Z, Zhang Z, Zhu Q
Medicine. 2021;100(41):e27526
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Abstract
BACKGROUND The effect of platelet-rich plasma (PRP) on patients with acute Achilles tendon rupture is still controversial. The purpose of this systematic review is to assess the efficacy of PRP injections treating acute Achilles tendon rupture. METHODS A comprehensive electronic literature search was performed in the PubMed, Embase, Cochrane Library, and Web of Science databases to identify relevant studies that were published prior to April 29, 2021. Randomized controlled trials evaluating the efficacy of PRP injections in treating patients with acute Achilles tendon rupture were included. Statistical analyses were conducted using RevMan software. RESULTS Five randomized controlled trials were included in this systematic review. The results of the meta-analysis showed that PRP has positive effects on ankle dorsiflexion angle, dorsal extension strength of the ankle, and calf circumference compared with that in controls. However, the current evidence failed to show that PRP effectively improves ankle plantar flexion angle, plantar flexion strength of the ankle, and pain. CONCLUSIONS PRP injections for the treatment of acute Achilles tendon rupture significantly improved ankle dorsiflexion angle, dorsal extension strength of the ankle, and calf circumference compared with that in controls. Additional studies with larger sample sizes, more rigorous designs and standardized protocols are needed to draw more reliable and accurate conclusions.
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The Use of Platelet-Rich Plasma for the Treatment of Osteonecrosis of the Femoral Head: A Systematic Review
Han J, Gao F, Li Y, Ma J, Sun W, Shi L, Wu X, Li T
Biomed Res Int. 2020;2020:2642439
Abstract
Background: As a pathological process, osteonecrosis of the femoral head (ONFH) is characterized by the avascularity of the femoral head, cellular necrosis, microfracture, and the collapse of the articular surface. Currently, critical treatment for early-stage ONFH is limited to core decompression. However, the efficacy of core decompression remains controversial. To improve the core decompression efficacy, regenerative techniques such as the use of platelet-rich plasma (PRP) were proposed for early-stage ONFH. As a type of autologous plasma containing concentrations of platelets greater than the baseline, PRP plays an important role in tissue repair, regeneration, and the differentiation of mesenchymal stem cells (MSCs). In this review, we present a comprehensive overview of the operation modes, mechanism, and efficacy of PRP for early-stage ONFH treatment. Methods: We searched for relevant studies in the PubMed, Web of Science, and Embase databases. By searching these electronic databases, the identification of either clinical or experimental studies evaluating PRP, MSC, core decompression, and ONFH was our goal. Results: Seventeen studies of PRP and avascular necrosis of the femoral head were evaluated in our review. Ten studies related to the possible mechanism of PRP for treating ONFH were reviewed. Seven studies of the operation modes of PRP in treating ONFH were identified. We reviewed the efficacy of PRP in treating ONFH systematically and made an attempt to compare the PRP operation modes in 7 studies and other operation modes in past studies for early-stage ONFH treatment. Conclusion: PRP treats ONFH mainly through three mechanisms: inducing angiogenesis and osteogenesis to accelerate bone healing, inhibiting inflammatory reactions in necrotic lesions, and preventing apoptosis induced by glucocorticoids. In addition, as an adjunctive therapy for core decompression, the use of PRP is recommended to improve the treatment of early-stage ONFH patients, especially when combined with stem cells and bone grafts, by inducing osteogenic activity and stimulating the differentiation of stem cells in necrotic lesions.
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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.