Double-row rotator cuff repair enhanced with platelet-rich therapy reduces re-tear rate: a systematic review and meta-analysis of randomized controlled trials
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2020
PURPOSE To assess re-tear rate in arthroscopic double-row rotator cuff repair (double-row RCR) with and without platelet rich therapy (PRT) METHODS Systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, Embase, and Scopus databases were searched for RCTs involving use of PRT exclusively in arthroscopic double-row RCR. A random-effects model and the generic inverse variance method were used for quantitative data synthesis. Heterogeneity was tested with the I(2) statistic index. RESULTS The nine RCT´s included within the meta-analysis demonstrated a risk reduction of 49% for re-tears in patients receiving PRT (risk ratio [RR] 0.51; 95% confidence interval [CI] 0.35 to 0.76; p = 0.0008; I(2) = 0%). Divided by tears sizes, re-tear risk reduction of 47% (RR, 0.53; 95% CI, 0.30 to 0.95; p = 0.03; I(2) = 0%) was found in small-medium tears and of 51% (RR, 0.49; 95% CI, 0.29 to 0.84; p = 0.009; I(2) = 0%) in large/massive tears. Linked double-row RCR resulted in risk reduction of 51% for re-tears in comparison with non-linked repairs. CONCLUSION Double-row RCR plus PRT significantly reduced re-tear rates in all sizes of rotator cuff tears. Linked double-row RCR and applying the PRT during the surgical procedure and in the tendon-bone interface reproduced the best outcomes. Clinically, all patients improved and no statistically significant difference was seen on the clinical and functional scores between both intervention groups. All patients achieved optimal values for PROMs. LEVEL OF EVIDENCE Level I Systematic reviews and meta-analysis of level 1 studies.
Comparison of the Clinical Effectiveness of Single Versus Multiple Injections of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-analysis
Orthopaedic journal of sports medicine. 2019;7(12):2325967119887116
Background: Reports have concluded that platelet-rich plasma (PRP) is an effective and safe biological approach in the treatment of knee osteoarthritis (OA). However, no consensus has been established regarding the number of injections required to observe a therapeutic effect. Purpose: To compare the clinical effectiveness reported in randomized controlled trials (RCTs) of single versus multiple PRP injections in the treatment of knee OA. Study Design: Systematic review; Level of evidence, 1. Methods: A comprehensive search was conducted for RCTs published between 1970 and 2019 that compared the effect of single versus multiple PRP injections on pain and functionality in patients with knee OA. Searched databases included MEDLINE, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. A data extraction form was designed to obtain bibliographic information of the study as well as patient, intervention, comparison, and outcomes of interest data. A random-effects model was used to pool quantitative data from the primary outcomes. Results: We included 5 clinical trials with a low-moderate risk of bias that reported data for 301 patients. Meta-analysis showed that, at 6 months after the intervention, single and multiple (double or triple) injections had similar pain improvement, with no significant differences (standardized mean difference [SMD], 0.61 [95% CI, -1.09 to 2.31]; I (2) = 97%; P = .48). A significant improvement in knee functionality was observed in favor of multiple injections (SMD, 2.29 [95% CI, 0.45-4.12]; I (2) = 97%; P = .01). Subanalysis showed that the significant improvement was only evident for the results of single versus triple injections (SMD, 3.12 [95% CI, 0.64-5.60]; I (2) = 97%; P = .01). Conclusion: According to our results, a single injection was as effective as multiple PRP injections in pain improvement; however, multiple injections seemed more effective in joint functionality than a single injection at 6 months. We consider that the available evidence is still insufficient, and future research on this specific topic is needed to confirm our results.
Intraarticular injection of platelet-rich plasma in knee osteoarthritis: single versus triple application approach. Pilot study
Acta reumatologica portuguesa. 2019
OBJECTIVE To compare the clinical effectiveness of the triple intra-articular injection of platelet-rich plasma (PRP) with respect to the single injection in patients with mild osteoarthritis of the knee. METHODS A total of 35 patients with a clinical and radiographic diagnosis of osteoarthritis grade I and II were analyzed. They were randomized into two groups: single application (18 patients) and triple application (17 patients). Both groups were evaluated using the Visual Analogue Scale (VAS), the Western Ontario and McMaster Universities (WOMAC) index, and the Health Survey 12v2 (SF-12) at baseline and at 6, 12, 24, 36 and 48 weeks post-treatment. RESULTS Both treatments significantly decreased the level of pain (VAS) (single, from 7.3+/-2.1 to 4.6+/-2.7 and triple, from 6.6+/-2.4 to 0.9+/-1.4; p lt 0.05) and the total WOMAC (single, from 44.2+/-19.7 to 26.7+/-24.9 and triple, from 41.4+/-15.5 to 7.2+/-7.3; p lt 0.05) at the end of the study. The triple application showed better improvement in the VAS (p= 0.0007) and the total WOMAC (p= 0.0209) scores when comparing the final results between groups. CONCLUSION The triple infiltration of PRP in patients with mild knee osteoarthritis is clinically more effective than the single application at 48 weeks of follow-up.