A Feasibility Study Comparing Platelet-Rich Plasma Injection With Saline for the Treatment of Plantar Fasciitis Using a Prospective, Randomized Trial Design

Johnson-Lynn, Sarah; Cooney, Alan; Ferguson, Diarmaid; Bunn, Deborah; Gray, William K.; Coorsh, Jonathan; Kakwani, Rajesh; Townshend, David

doi:10.1177/1938640018776065

Cited by 11 publications

(14 citation statements)

References 35 publications

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“…21,24,29,32 However, recent studies have reported conflicting results when PRP injections were compared with steroid injection and other treatment methods, and in some instances they were unable to demonstrate superiority of the PRP treatment. [17][18][19]27,39,40,47,50 The purpose of this study was to perform a meta-analysis comparing injection of PRP with corticosteroid injections.…”

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confidence: 99%

Platelet-Rich Plasma Versus Corticosteroids for the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis

2020

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Background: Plantar fasciitis is a common cause of heel pain. Corticosteroid injections are commonly used and proven to be effective, and lately platelet-rich plasma (PRP) has been used with mixed results. Purpose: To perform a systematic review and meta-analysis comparing intralesional injections of PRP and steroid infiltration. Study Design: Systematic review and meta-analysis. Methods: A systematic review of Medline, Embase, Scopus, and Google Scholar including all level 1 and 2 studies from 2010 to 2019 was perfomed. American Orthopaedic Foot and Ankle Society and visual analog scale for pain scores were used as outcome variables. Publication bias and risk of bias was assessed with the Cochrane Collaboration tools. The Grading of Recommendations, Assessment, Development and Evaluations system was used to assess the quality of the body of evidence. Heterogeneity was assessed with χ2 and I2 statistics. Results: Fifteen studies were included in the analysis. Nine studies had a high risk of bias. There was 1 study with high quality, 9 with moderate, 2 studies with low, and 3 with very low quality. The pooled estimate for the American Orthopaedic Foot and Ankle Society score demonstrated nonsignificant differences at 1 month ( P = .4) and 3 months ( P = .076). At 6 months ( P = .009) and 12 months ( P = .009), it indicated significant differences in favor of PRP. The pooled estimate for visual analog scale demonstrated nonsignificant differences at 1 month ( P = .653). At 3 months ( P = .0001), 6 months ( P = .002), and 12 months ( P = .019), it yielded significant differences in favor of PRP. Conclusion: The results of this systematic review and meta-analysis suggest that PRP is superior to corticosteroid injections for pain control at 3 months and lasts up to 1 year. In the short term, there is no advantage of corticosteroid infiltration. However, the low study quality, high risk of bias, and different protocols for PRP preparation reduce the internal and external validity of these findings, and these results must be viewed with caution.

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confidence: 99%

Platelet-Rich Plasma Versus Corticosteroids for the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis

2020

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“…Two studies comparing PRP and placebo were included in this meta-analysis [ 42 , 43 ]. One article was judged to have an ambiguous bias risk; the other was found to be at a lower risk (Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Jain et al [ 37 ] and Sherpy et al [ 39 ] performed trials of different time in the patient, but the participants were not allowed to remain blind. Another experiment conducted by Johnson-Lynn et al [ 42 ] performed a double-blind design, but its selective reporting and allocation of uncertainty concealment reduced the quality of the method. Because blind methods were not applied, the other trials were considered high risk of bias.…”

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confidence: 99%

Outcomes of platelet-rich plasma for plantar fasciopathy: a best-evidence synthesis

Jiang

et al. 2020

J Orthop Surg Res

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Background Plantar fasciopathy (PF) is a very common disease, affecting about 1/10 people in their lifetime. Platelet-rich plasma (PRP) had been demonstrated to be useful in achieving helpful effects for plantar fasciopathy. The purpose of this study was to compare the pain and functional outcomes between PRP and corticosteroid (CS) or placebo for plantar fasciopathy through meta-analysis and provide the best evidence. Methods Literature was searched systematically to explore related studies that were published in Cochrane Library, PubMed, Embase, Medline, SpringerLink, OVID, and ClinicalTrials.gov. Articles regarding comparative research about the outcomes of PRP therapy and CS or placebo injection were selected. Data of pain and functional outcomes was extracted and imported into Reviewer Manager 5.3 to analyze. Results Thirteen RCTs were included and analyzed. Analysis results showed significant superiority of PRP in outcome scores when compared with CS (VAS: MD = − 0.85, P < 0.0001, I2 = 85%; AOFAS: MD = 10.05, P < 0.0001, I2 = 85%), whereas there is no statistical difference in well-designed double-blind trials (VAS: MD = 0.15, P = 0.72, I2 = 1%; AOFAS: MD = 2.71, P = 0.17, I2 = 0%). In the comparison of the PRP and the placebo, the pooled mean difference was − 3.76 (P < 0.0001, 95% CI = − 4.34 to − 3.18). Conclusions No superiority of PRP had been found in well-designed double-blind studies, whereas it is implied that the outcomes of PRP are better than placebo based on available evidence.

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“…Across studies, there were a total of 1160 participants, 31% females and 69% males. All studies included patients with various LE musculoskeletal pathologies: Achilles rupture (2), 21,32 Achilles tendinopathy (5), 22,25,26,31,33 lateral ankle sprain (1), 20 high ankle sprain (1), 34 hamstring injury (4), 28,29,36,37 knee osteoarthritis (2), 19,27 acute muscle injury (2), 23,38 patellar tendinopathy (1), 39 and plantar fasciitis (3) 24,30,35 (Table 2). Of the 21 studies, 14 assessed pain 19,20,[22][23][24]27,[30][31][32][33]35,[37][38][39] (VAS, NPRS, KOOS, and EQ-5D), 13 assessed disability [19][20][21][22][24][25][26][27][31][32][33]…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Three studies 24,30,35 included 157 participants, with 58% females. The average RoB score was 9.7 (range 9-10).…”

Section: Plantar Fasciitismentioning

confidence: 99%

The Effects of Platelet-Rich Plasma in Conjunction with Rehabilitation for Lower Extremity Musculoskeletal Pathologies

Masaracchio¹,

Kirker²

2022

Bio Orthop J

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Background: Platelet-rich plasma (PRP) has been considered for its role in facilitating the body’s own healing processes, with the potential to complement rehabilitation in the management of lower extremitymusculoskeletal pathologies.Methods: Eligible studies were randomized clinical trials and quasi-experimental trials with completed data analysis; published in English; recruited participants aged >18 years; had at least two groups, with one intervention group receiving PRP injection alone or PRP injection and rehabilitation, and the comparison group receiving either rehabilitation alone or a control group receiving saline and rehabilitation; included at least one outcome measure of pain, disability, quality of life, or return to play. An electronic search was conducted using PubMed, Embase, Cochrane, Pedro, and clinicaltrials.gov. Methodological quality was assessed using the Cochrane Collaboration Risk of Bias (RoB) tool. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the quality of evidence. Meta-analyses were conducted across outcomes in each pathology when possible.Results: Twenty-one studies assessed Achilles rupture, Achilles tendinopathy, lateral ankle sprain, high ankle sprain, hamstring injury, knee osteoarthritis, acute muscle injury, patellar tendinopathy, and plantar fasciitis, with an average RoB score of 9.9 out of 12. Meta-analyses for Achilles rupture (n = 270) revealed a nonsignificant effect on disability in the short and long term (high level of evidence) when comparing PRP, immobilization, and exercise/physical therapy to placebo, immobilization, and exercise/physical therapy. Meta-analyses for Achilles tendinopathy revealed a nonsignificant effect on pain (n = 64) in the short term, and disability in the short (n = 138) as well as long term (n = 192) (very low to low level of evidence) when comparing PRP and exercise to placebo and exercise.Conclusions: While individual studies demonstrated significant findings across outcomes, the non-significant pooled results and inability to perform further meta-analyses made it difficult to provide definitive recommendations for the addition of PRP to exercise for lower extremity musculoskeletal pathologies. Future studies should standardized PRP exercise rehabilitation protocols with better dosage parameters, consider larger sample sizes, and have short and long term follow-up periods consistent with the Cochrane Collaboration.

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A Feasibility Study Comparing Platelet-Rich Plasma Injection With Saline for the Treatment of Plantar Fasciitis Using a Prospective, Randomized Trial Design

Abstract: Level II.

Cited by 11 publications

References 35 publications

Platelet-Rich Plasma Versus Corticosteroids for the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis

Platelet-Rich Plasma Versus Corticosteroids for the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis

Outcomes of platelet-rich plasma for plantar fasciopathy: a best-evidence synthesis

The Effects of Platelet-Rich Plasma in Conjunction with Rehabilitation for Lower Extremity Musculoskeletal Pathologies

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