Effects of Platelet-Rich Plasma on Clinical Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

Abstract

Background: Many studies have documented the use of platelet-rich plasma (PRP) alongside anterior cruciate ligament (ACL) reconstruction (ACLR) in the management of ACL injury, but evidence on the benefits of PRP in improving the clinical outcomes of ACLR is inconsistent. Purpose: To help in our understanding, we undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) that evaluated the effects of PRP on patient-reported functional scores, the clinical assessments of knee function and structure, and complications. Study Design: Systematic review; Level of evidence, 1. Methods: We searched 9 online databases for RCTs published in English or Chinese that examined the effects of PRP on ACLR. The primary outcome measures were visual analog scale (VAS) for pain and International Knee Documentation Committee (IKDC) scores. The secondary outcomes included KT-1000 arthrometer, pivot-shift test, Lysholm and Tegner scores, tunnel widening, graft characterization, and complications. Subgroup analyses were performed according to time of assessments. Fixed- and random-effects models were selected for data analysis. Results: A total of 14 studies were included. When PRP was injected to graft tunnels, the pooled VAS scores of the 2 groups were similar ( P = .31), and the subgroup analysis found that VAS and IKDC only improved at 3 months postoperatively ( P = .0003 and P < .00001, respectively). When PRP was used at the bone–patellar tendon–bone harvest sites, VAS was decreased in the first 6 months postoperatively ( P < .00001), whereas IKDC score was not remarkably different ( P = .07). After PRP injection, Lysholm scores at 3 months postoperatively was different between the 2 groups ( P < .00001), but the Tegner scores ( P = .86), KT-1000 measurements ( P = .12), the positive rate of pivot-shift test ( P = .64), the enlargement of tunnels (femoral, P = .91; tibial, P = .80), and the characterization of grafts ( P = .05) were not different. No difference in complications was found in either group. Conclusion: PRP applied alongside ACLR could reduce postoperative pain and improve knee function in the short and medium terms but is ineffective in the long term. PRP does not improve knee stability and the enlargement of tunnels and does not accelerate the healing of grafts. Further studies would be required.

A Cross-Sectional Survey Of Availability And Technical Feasibility Of Basic Medical Equipment To Run Community-Based Clinical Trial Sites, In Cross River State, Nigeria

“…al., [67] as the PRP/bMSC group's ACL grafts had a more native ACL appearance and superior maturation at 12 weeks pointing to enhanced ACL graft healing. These findings have possible future clinical importance as current therapeutic use of PRP has shown to be unsuccessful by itself in improving graft maturation and bone tunnel healing [69]. Setiawati et.…”

Intraoperative Administration of Adipose Stromal Vascular Fraction Does Not Improve Functional Outcomes in Young Patients with Anterior Cruciate Ligament Reconstruction

“…To improve clinical outcomes, there has been a growing interest in the development of novel, biologically augmented ACLR techniques [ 1 , 5 ]. To date, among these techniques, the most widely used therapies in the clinical setting are ACLR combined with either stem cells or PRP but yielded unsatisfactory results or a low level of evidence [ 5 , 7 , 8 , 9 , 10 , 11 , 12 ]. For example, Nin et al [ 7 ] reported that the use of platelet-derived growth factor in patients treated with bone-patellar tendon-bone allografts has no discernable clinical or biomechanical effect at 2 years of follow-up.…”

“…Alentorn-Geli et al [ 8 ] showed that patients receiving adipose-derived regenerative stem cells at the time of ACLR did not provide additional benefits regarding knee function and the healing/maturation of the graft at 12 months. In a recent meta-analysis including 14 studies, Zhu et al [ 12 ] concluded that PRP applied alongside ACLR did not improve knee stability and the enlargement of tunnels and did not accelerate the healing of grafts. These two types of therapies mainly focus on the regenerative and healing properties of stem cells or platelets [ 9 , 10 , 11 , 12 ].…”

“…In a recent meta-analysis including 14 studies, Zhu et al [ 12 ] concluded that PRP applied alongside ACLR did not improve knee stability and the enlargement of tunnels and did not accelerate the healing of grafts. These two types of therapies mainly focus on the regenerative and healing properties of stem cells or platelets [ 9 , 10 , 11 , 12 ]. Recently, SVF has been proposed as a biological product superior to single-type cell therapies because it contains versatile cell types, including stem cells with therapeutic potential involving paracrine activity modulation, and preparing it for intraoperative application is easy [ 13 , 14 , 15 , 16 , 17 , 18 ].…”

“…To improve the results, recent advances in the area of regenerative medicine have led to the emergence of novel biologically augmented ACLR techniques [ 1 , 5 ]. However, the clinical studies investigating ACLR combined with platelet-derived growth factor, various types of stem cells, or platelet-rich plasma (PRP) either yielded disappointing results [ 5 , 7 , 8 , 9 ] or provided a low degree of evidence [ 10 , 11 , 12 ]. Thus, the effectiveness of the augmentation of ACLR with other biological treatments warrants investigation.…”