A systematic review and meta-analysis of the application of platelet rich plasma in sports medicine

Gholami, Masoumeh; Ravaghi, Hamid; Salehi, Masoud; Yekta, Abbasali; Doaee, Shila; Jaafaripooyan, Ebrahim

doi:10.19082/2325

Cited by 19 publications

(19 citation statements)

References 34 publications

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“…Although PRP shows some promise as a treatment for promoting faster healing in tendons, 20,50,51 the potential enhancement of healing demonstrated in laboratory studies is yet to be evidenced in the patient setting. The mechanisms of action through which PRP exerts its regenerative effects in humans are not completely understood.…”

Section: Achilles Tendon Injury and Platelet-rich Plasmamentioning

confidence: 99%

“…52 An early systematic review of clinical trials of PRP in humans by Taylor et al 50 reported faster healing and better function in the management of tendon and ligament injuries. However, a more recent review by Gholami et al 51 reported no beneficial effects of PRP in the management of sports injuries for pain or function compared with other management options.…”

Section: Achilles Tendon Injury and Platelet-rich Plasmamentioning

confidence: 99%

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Platelet-rich plasma injection for adults with acute Achilles tendon rupture: the PATH-2 RCT

et al. 2019

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Background Achilles tendon rupture (ATR) has a long healing period, which is challenging for patients and clinicians. Platelet-rich plasma (PRP) is an autologous concentration of platelets thought to improve tendon function recovery. Although preliminary research has indicated positive effects, there is, as yet, no evidence of clinical efficacy from adequately powered robust clinical trials. Objectives The objectives were to determine the clinical efficacy of PRP in patients with acute ATR using an objective mechanical muscle–tendon function measure and patient-reported outcome measures (PROMs), and to determine which PRP components contribute to its mechanism. Design This was a multicentre, parallel-group, participant- and outcome assessor-blinded randomised controlled trial (RCT) comparing PRP with placebo. Two embedded substudies investigated the PRP’s quality and composition and its effects on healing tendon tissues. Setting This trial was set in trauma and orthopaedic surgery departments in 19 NHS hospitals in England and Wales. Participants Adults with acute ATR presenting within 12 days of injury to be treated non-surgically were eligible. Patients with platelet dysfunction or leg functional deficiency were excluded. Interventions Participants were randomised 1 : 1 to the PRP injection group or the placebo group (dry needle in the rupture gap) by central computer-based randomisation using minimisation, stratified by centre and age. Main outcome measures The primary outcome measure was the Limb Symmetry Index (LSI) of work during the heel-rise endurance test at 24 weeks. Secondary outcomes measures, collected at 4, 7, 13 and 24 weeks, were repetitions, maximum heel-rise height, Achilles tendon Total Rupture Score (ATRS), quality of life (as measured using the Short Form questionnaire-12 items version 2), pain and participant goal attainment. Needle biopsies of the affected tendon zone were taken under ultrasound guidance at 6 weeks from 16 participants from one centre. Whole blood was analysed for cell count. PRP was analysed for cell count, platelet activation and growth factor concentration. The primary analysis was intention to treat. Results A total of 230 participants were randomised: 114 to the PRP group (103 treated) and 116 to the placebo group (all treated). One participant withdrew after randomisation but before the intervention. At 24 weeks, 201 out of 230 participants (87.4%) completed the primary outcome and 216 out of 230 participants (93.9%) completed the PROMs. The treatment groups had similar participant characteristics. At 24 weeks, there was no difference in work LSI (mean difference –3.872; 95% confidence interval –10.454 to 2.710; p = 0.231), ATRS, pain or goal attainment between PRP- and placebo-injected participants. There were no differences between the groups in any PROM at any time point or in complication rates, including re-rupture and deep-vein thrombosis. There was no correlation between work LSI and platelet activation in PRP, or erythrocyte, leucocyte or platelet counts in whole blood or PRP. Biopsies showed similar cellularity and vascularity between groups. Conclusions This trial design and standardised PRP preparation gives the first robust RCT evidence about PRP’s role in managing ATR, which suggests that PRP offers no patient benefit. Equally robust evidence to investigate PRP application in tendon and soft tissue injuries is required. The 24-month follow-up will be completed in April 2020. Trial registration Current Controlled Trials ISRCTN54992179. Funding This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership. The trial was supported by the NIHR Biomedical Research Centre, Oxford, and the NIHR Fellowship programme.

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Section: Achilles Tendon Injury and Platelet-rich Plasmamentioning

confidence: 99%

Section: Achilles Tendon Injury and Platelet-rich Plasmamentioning

confidence: 99%

Platelet-rich plasma injection for adults with acute Achilles tendon rupture: the PATH-2 RCT

et al. 2019

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“…Full texts were scrutinised against the inclusion and exclusion criteria, with a final inclusion of 29 SRs (Figure ) . Reasons for exclusion of studies at the second stage are presented by topic and clinical indication in Files …”

Section: Resultsmentioning

confidence: 99%

Efficacy of platelet‐rich plasma for non‐transfusion use: Overview of systematic reviews

2019

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Platelet-rich plasma (PRP) is a blood component with a supraphysiologic concentration of platelets, usually obtained from the processing of autologous blood by different techniques, such as centrifugation and filtering. Despite the fact that strict recommendations on the most adequate techniques that should be employed for the production of PRP are still lacking, it is logical to assume that the type of method used for blood processing may determine the resulting concentration of platelet and other components, possibly impacting on its therapeutic potential. 1 The physiological rationale of the non-transfusion use of PRP relies on the high concentration of growth factors contained in platelets, such as the platelet derived-growth factor, the vascular endothelial growth factor and the fibroblast growth factor. 2 Several biological functions are attributed to these growth factors, including the proliferation of epithelial and mesenchymal cells, the stimulation of myoblasts and fibroblasts and angiogenesis. 3-5 Abstract Introduction: Platelet-rich plasma (PRP) is a blood component therapy with a supraphysiological concentration of platelets derived from allogenic or, more commonly, autologous blood. PRP has been used in different non-transfusion indications because of its role in the promotion of tissue repair and healing, in fields such as Traumatology, Dermatology and Dentistry.Objective: To provide a synthesis of the efficacy of PRP for different clinical situations. Methods: Systematic searches were carried out in MEDLINE, Embase, CochraneLibrary and LILACS in July 2018 to identify systematic reviews (SRs) of randomized clinical trials (RCTs) focusing on PRP for non-transfusion use. Two authors independently screened all retrieved references in two stages (titles and abstracts at a first stage and full texts at a second stage). The methodological quality of SRs that met the eligibility criteria was appraised by AMSTAR 2. Conclusions were based on the most recent SRs with highest quality. Results:One thousand two hundred and forty references were retrieved. After checking the inclusion criteria, 29 SRs of RCTs related to three different fields (wound care, Orthopedics and Dentistry) were included. The results suggest the benefit of PRP for different clinical situations, such as diabetic wounds, acute lesions of musculoskeletal system, rotator cuff lesions, tendinopathies, knee and hip osteoarthritis, total knee arthroplasty, allogenic bone graft for dental implants and periodontal intrabony defects. Conclusion:There is low to moderate quality evidence supporting the efficacy of PRP for specific clinical situations. The low quality of the evidence limits the certainty of these findings. Well-planned and well-conducted RCTs are still needed to further assess the efficacy of PRP.

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“…The inclusion of explanations regarding the reasoning behind the conclusion can help the readers and affect the final conclusion. Age group of those studied as well as the duration of follow-up of effects should also be included in study evaluation [ 154 ].…”

Section: Discussionmentioning

confidence: 99%

An Overview of Platelet Products (PRP, PRGF, PRF, etc.) in the Iranian Studies

et al. 2017

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Aim:The aim of the study was to carry out a review of published studies on various platelet products in Iranian studies.Materials & methods:Electronic databases were searched for relevant articles. Two review authors independently extracted data via a tested extraction sheet, and disagreements were resolved by a meeting with a third review author.Results:Bone disorders (25%), wound and fistula (16%), dental and gingival disorders (14%) and osteoarthritis (11%) have more relative frequency based on different fields.Conclusion:The necessity of pursuing standard protocols in the preparation of platelet products, stating the precise content of platelets and growth factors, and long-term follow-up of study subjects were the most important points in Iranian studies.

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A systematic review and meta-analysis of the application of platelet rich plasma in sports medicine

Cited by 19 publications

References 34 publications

Platelet-rich plasma injection for adults with acute Achilles tendon rupture: the PATH-2 RCT

Platelet-rich plasma injection for adults with acute Achilles tendon rupture: the PATH-2 RCT

Efficacy of platelet‐rich plasma for non‐transfusion use: Overview of systematic reviews

An Overview of Platelet Products (PRP, PRGF, PRF, etc.) in the Iranian Studies

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