1.
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.
2.
The effects of platelet-rich plasma injection in knee and hip osteoarthritis: a meta-analysis of randomized controlled trials
Dong Y, Zhang B, Yang Q, Zhu J, Sun X
Clin Rheumatol. 2020
Abstract
OBJECTIVE We conducted this updated meta-analysis to evaluate the effects of PRP in patients with knee or hip OA. METHOD PubMed, Embase, and Web of Science were searched to identify randomized controlled trials (RCTs) that compared the efficacy of PRP with other intra-articular injections. The outcomes of interest included Western Ontario and McMaster (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Visual Analog Scale (VAS), Harris Hip Score (HHS), and International Knee Documentation Committee (IKDC). RESULTS Twenty-four RCTs with 21 at knee OA and three at hip OA were included in this meta-analysis. The PRP injections significantly improved the WOMAC score, VAS score, IKDC score, and HHS score as compared with comparators. The WOMAC pain, stiffness, and physical function scores were also significantly better in the PRP group than in the control group. Most of the evaluated parameters that favored PRP were observed in knee OA but not in hip OA, at short-term (at 1, 2, 3, 6, 12 months) but not long-term follow-up (at 18 months), in RCTs with low risk of bias. CONCLUSIONS Intra-articular PRP injection provided better effects than other injections for OA patients, especially in knee OA patients, in terms of pain reduction and function improvement at short-term follow-up.Key Points* This updated meta-analysis, based on great sample size and high-quality studies, evaluates the effects of PRP in patients with knee or hip OA.* Intra-articular PRP injection provided better effects than other injections for OA patients.* Most of the evaluated parameters that favored PRP were observed in knee OA at short term (at 1, 2, 3, 6, 12 months).