Efficacy of platelet-rich plasma injections for symptomatic tendinopathy: systematic review and meta-analysis of randomised injection-controlled trials

Abstract

AimTo determine the efficacy of platelet-rich plasma (PRP) injections for symptomatic tendinopathy.DesignSystematic review of randomised, injection-controlled trials with meta-analysis.Data sourcesSystematic searches of MEDLINE and EMBASE, supplemented by manual searches.Eligibility criteria for selecting studiesRandomised controlled trials with 3 months minimum follow-up that evaluated pain reduction with PRP versus control (saline, local anaesthetic, corticosteroid) injections in patients with symptomatic tendinopathy.ResultsA total of 16 randomised controlled trials (18 groups) of PRP versus control were included. Median sample size was 35 patients, a study size that would require an effect size ≥1.0 to achieve statistical significance. PRP was more efficacious than control in reducing tendinopathy pain, with an effect size of 0.47 (95% CI 0.22 to 0.72, p<0.001), signifying a moderate treatment effect. Heterogeneity among studies was moderate (I2=67%, p<0.001). In subgroup analysis and meta-regression, studies with a higher proportion of female patients were associated with greater treatment benefits with PRP.ConclusionsInjection of PRP is more efficacious than control injections in patients with symptomatic tendinopathy.

Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial

“…Injection of PRP in these patients may have reduced the carpal tunnel tendon and MN inflammation present in this cohort, thus benefitting, not only the muscles innervated by the distal branches of the MN, but all the irrigated flexor tendons within the carpal tunnel which are the primarily responsible for transferring tensile loads to hand grip (digitorum profundus and superficialis tendons). In this sense, several in vitro and in vivo studies have shown that PRP has anti-inflammatory effects and improves tendon healing, and have elucidated its molecular mechanism of action in this context [51][52][53][54][55][56][57][58][59][60][61] . Nonetheless, other human studies reported that PRP had no beneficial effects on tendon healing [62][63][64][65][66] , or only found them after longer follow-ups [67][68][69][70] .…”

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

“…In the first stage of screening titles and abstracts, 79 references were selected. 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 …”

“…Three SRS assessing the clinical efficacy of PRP for the treatment of different types of tendinopathies were identified . These SRs presented variable methodological quality (AMSTAR scores from 4 to 12).…”

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“…However, substantial heterogeneity was reported at baseline and different time-point follow-ups. Miller et al [79] included 16 RCTs with a minimum follow-up of three months. PRP was more effective than controls in reducing pain with a moderate effect size (0.47, 95%CI (0.22-0.72, p < 0.001)) and moderate heterogeneity.…”

“…However, this conclusion is barely supported by the studies taken individually. Miller et al [79] attributed the discrepancy to the fact that studies are underpowered (median 35 patients per group) to detect the effect size. According to their meta-analysis, a sample size of 73 patients per group would be required to be able to detect differences.…”