Cochrane in CORR ®: Platelet-rich Therapies for Musculoskeletal Soft Tissue Injuries (Review)

Khan, Moin; Bedi, Asheesh

doi:10.1007/s11999-015-4207-z

Cited by 22 publications

(14 citation statements)

References 9 publications

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“…PRP is recommended as an ideal autologous blood‐derived product . In the short‐term period, our results suggested that PRP ranked first or second in indexes related to pain.…”

Section: Discussionmentioning

confidence: 70%

Platelet‐Rich Plasma Vs Autologous Blood Vs Corticosteroid Injections in the Treatment of Lateral Epicondylitis: A Systematic Review, Pairwise and Network Meta‐Analysis of Randomized Controlled Trials

Tang

Wang

et al. 2020

PM&R

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Objective To compare the effectiveness of platelet‐rich plasma (PRP), autologous blood (AB), and corticosteroid injections in patients with lateral epicondylitis. Type of Study Network meta‐analysis. Literature Survey Randomized controlled trials (RCTs) that compared any two forms of injections among PRP, AB, and corticosteroid for the treatment of lateral epicondylitis were searched from inception to 30 November 2018, on PubMed, Embase, and Cochrane library. Methodology Two researchers independently selected and assessed the quality of RCTs with the Cochrane Risk of Bias Tool. All relevant data from the included studies were extracted and heterogeneity was checked by Cochran's Q test and inconsistency statistic (I2). Publication bias was evaluated by constructing contour‐enhanced funnel plots. Stata 15 software was applied for pairwise meta‐analysis and network meta‐analysis. To explore the efficacy between different follow‐up periods, we considered the duration within 2 months to be short term, whereas 2 months or more was considered long term. Synthesis Twenty RCTs (n = 1271) were included in this network meta‐analysis. According to ranking probabilities, corticosteroid ranked first for visual analog score (VAS) (surface under the cumulative ranking [SUCRA] = 90.7), modified Nirschl score (82.9), maximum grip strength (69.5), modified Mayo score (MMS) (77.9), and Patient‐Related Tennis Elbow Evaluation (PRTEE) score (93.3) for the short‐term period. For the long‐term period, PRP ranked first for VAS (94.3), pressure pain threshold (99.8), Disabilities of Arm Shoulder and Hand (DASH) score (75.2), MMS (88.2), and the PRTEE score (81.8). Conclusion PRP was associated with more improvement in pain intensity and function in the long term than were the comparators. However, in the short term, corticosteroids were associated with the most improvement.

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“…PRP is recommended as an ideal autologous blood‐derived product . In the short‐term period, our results suggested that PRP ranked first or second in indexes related to pain.…”

Section: Discussionmentioning

confidence: 70%

Platelet‐Rich Plasma Vs Autologous Blood Vs Corticosteroid Injections in the Treatment of Lateral Epicondylitis: A Systematic Review, Pairwise and Network Meta‐Analysis of Randomized Controlled Trials

Tang

Wang

et al. 2020

PM&R

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“…A major reason for this is the scarcity of trials that have enrolled large cohorts of patients, as well as substantial variation in PRP preparation and delivery, patient demographics, and the chronicity and site of injury 25 . Another limitation to the widespread acceptance of PRP for use in clinical practice is an inadequate understanding of its biological mechanism of action.…”

Section: Resultsmentioning

confidence: 99%

“…The justification for the use of PRP clinically stems from an attempt to recapitulate or augment this natural biologic process 1 . Despite numerous clinical outcome studies on the effects of PRP in sports medicine, there remains a paucity of information on its mechanism of action 19,25 .…”

Section: Introductionmentioning

confidence: 99%

Platelet-Rich Plasma Activates Proinflammatory Signaling Pathways and Induces Oxidative Stress in Tendon Fibroblasts

et al. 2016

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Background Tendon injuries are one of the most common musculoskeletal conditions in active patients. Platelet rich plasma (PRP) has shown some promise in the treatment of tendon disorders, but little is known as to the mechanisms by which PRP can improve tendon regeneration. PRP contains numerous different growth factors and cytokines which activate various cellular signaling cascades, but it has been difficult to determine precisely which signaling pathways and cellular responses are activated following PRP treatment. Additionally, macrophages play an important role in modulating tendon regeneration, but the influence of PRP on determining whether macrophages assume a proinflammatory or antiinflammatory phenotype remains unknown. Hypothesis/Purpose We used genome wide expression profiling, bioinformatics and protein analysis to determine the cellular pathways activated in fibroblasts treated with PRP. We also evaluated the effect of PRP on macrophage polarization. Study Design Controlled laboratory study. Methods Tendon fibroblasts or macrophages from rats were cultured and treated with either platelet poor plasma (PPP) or PRP. RNA or protein was isolated from cells and analyzed using microarrays, qPCR, immunoblot or bioinformatics techniques. Results Pathway analysis determined that the most highly induced signaling pathways in PRP treated tendon fibroblasts was the TNFα and NFκB pathways. PRP also downregulated the expression of ECM genes and induced the expression of autophagy related genes and reactive oxygen species (ROS) genes and protein markers in tendon fibroblasts. PRP failed to have a major impact on markers of macrophage polarization. Conclusions PRP induces an inflammatory response in tendon fibroblasts which leads to the formation of ROS and activation of oxidative stress pathways. PRP does not appear to significantly modulate macrophage polarization. Clinical Relevance PRP might act by inducing a transient inflammatory event which could then trigger a tissue regeneration response.

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“…The possible mechanisms of pain reduction include reduction of proinflammatory cytokines in the affected joint, which might otherwise stimulate the nociceptors [40], and augmentation of cannabinoid receptors, which provide analgesic effects [41]. Although the precise effect of PRP on soft tissues remains unclear, its use remains popular among high-level athletes, participants with lateral epicondylitis, and in some surgical augmentation procedures [22]. The reservoir of growth factors is believed to stimulate tissue healing and repair, thus enhancing structural integrity [16].…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies of intra-articular PRP have been shown to be effective and safe to reduce pain and improve function in patients with KOA [21]. Extra-articular PRP injections on soft tissue attachment are also commonly used in clinical practice with beneficial effects [22]. Injection of PRP into isolated knee structures has been studied; this has included the augmentation of tissue healing in anterior cruciate ligament reconstruction and patella tendon grafts, with variable degrees of success [23,24].…”

Section: Introductionmentioning

confidence: 99%

Intra-articular and extra-articular platelet-rich plasma injections for knee osteoarthritis: A 26-week, single-arm, pilot feasibility study

Sit

Wu²,

Law

et al. 2019

The Knee

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Aim: Platelet Rich Plasma (PRP) is an emerging therapy for knee osteoarthritis (KOA). Studies have evaluated the effectiveness of intra-articular PRP, which ignores extra-articular tissue dysfunction and may provide incomplete treatment of KOA. The study aimed to pilot test a leukocyte-rich (mononuclear cells) PRP injection protocol for primary KOA, which consisted of single intra-articular injection and extra-articular injections on the medial coronary and medial collateral ligaments.Methods: A prospective 26-week single-arm uncontrolled feasibility pilot study. Patients (N = 12) with primary KOA as defined by the American Rheumatology Association, with moderate to severe medial knee pain which failed conservative management, were recruited in a university primary care clinic and received a single session of PRP injection in week 1. The primary outcome was the feasibility of the protocol at 26 weeks as defined by rates of recruitment, compliance, retention, dropout, side effects or adverse events; and treatment satisfaction. Secondary outcomes included the Western Ontario McMaster University Osteoarthritis Index, the Intermittent and Constant Osteoarthritis Pain total and subscales, objective physical function tests and EuroQol-5D.Results: Twelve of 40 potential patients were recruited in 3 months period (recruitment rate 30%, x2 = 3.33, P = 0.068). All participants adhered to the protocol and completed the follow up assessment with no dropouts (dropout rate 0%, X2= 2.67, P = 0.103). Satisfaction was high; no related adverse events were reported. Most secondary outcomes showed statistically significant improvement. Conclusions:Concomitant intra-articular and extra-articular PRP injections were feasible and produced preliminary favourable outcomes.

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Cochrane in CORR ®: Platelet-rich Therapies for Musculoskeletal Soft Tissue Injuries (Review)

Cited by 22 publications

References 9 publications

Platelet‐Rich Plasma Vs Autologous Blood Vs Corticosteroid Injections in the Treatment of Lateral Epicondylitis: A Systematic Review, Pairwise and Network Meta‐Analysis of Randomized Controlled Trials

Platelet‐Rich Plasma Vs Autologous Blood Vs Corticosteroid Injections in the Treatment of Lateral Epicondylitis: A Systematic Review, Pairwise and Network Meta‐Analysis of Randomized Controlled Trials

Platelet-Rich Plasma Activates Proinflammatory Signaling Pathways and Induces Oxidative Stress in Tendon Fibroblasts

Intra-articular and extra-articular platelet-rich plasma injections for knee osteoarthritis: A 26-week, single-arm, pilot feasibility study

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