Influence of platelet-rich plasma (PRP) analogues on healing and clinical outcomes following anterior cruciate ligament (ACL) reconstructive surgery: a systematic review

Abstract

Purpose To systematically review the effect of PRP on healing (vascularization, inflammation and ligamentization) and clinical outcomes (pain, knee function and stability) in patients undergoing ACL reconstruction and compare the preparation and application of PRP. Methods Independent systematic searches of online databases (Medline, Embase and Web of Science) were conducted following PRISMA guidelines (final search 10th July 2021). Studies were screened against inclusion criteria and risk of bias assessed using Critical appraisal skills programme (CASP) Randomised controlled trial (RCT) checklist. Independent data extraction preceded narrative analysis. Results 13 RCTs were included. The methods of PRP collection and application were varied. Significant early increases in rate of ligamentization and vascularisation were observed alongside early decreases in inflammation. No significant results were achieved in the later stages of the healing process. Significantly improved pain and knee function was found but no consensus reached. Conclusions PRP influences healing through early vascularisation, culminating in higher rates of ligamentization. Long-term effects were not demonstrated suggesting the influence of PRP is limited. No consensus was reached on the impact of PRP on pain, knee stability and resultant knee function, providing avenues for further research. Subsequent investigations could incorporate multiple doses over time, more frequent observation and comparisons of different forms of PRP. The lack of standardisation of PRP collection and application techniques makes comparison difficult. Due to considerable heterogeneity, (I2 > 50%), a formal meta-analysis was not possible highlighting the need for further high quality RCTs to assess the effectiveness of PRP. The biasing towards young males highlights the need for a more diverse range of participants to make the study more applicable to the general population. Trail registration CRD42021242078CRD, 15th March 2021, retrospectively registered.

Platelet‐rich plasma augmentation in anterior cruciate ligament reconstruction: Evidence is still too scattered. A scoping review of randomised controlled trials

“…In the same year, by including a larger number of 17 RCTs, Lv et al [32] found moderate quality of evidence suggesting that PRP could provide short-term pain reduction. More recently, the meta-analysis of McRobb et al [39] on 13 RCTs concluded that PRP influences healing through early vascularisation, culminating in higher rates of ligamentisation, and the meta-analysis of Zhu et al [65] on 14 studies confirmed that PRP applied alongside ACLR could reduce postoperative pain and improve knee function in the short and medium terms.…”

“…This corresponded to a simultaneous growth in the clinical application and in scientific publications, including those on ligament pathologies such as ACLR. With the aim of summarising the growing body of evidence, many systematic reviews have been published on this topic, and recently even meta-analyses in the attempt to quantify the potential benefits of this biological augmentation [14,32,39,65]. In 2021, the meta-analysis of de Andrade et al [14] focusing on nine studies concluded that PRP showed no improvement in objective outcomes like ligamentisation and less tunnel widening, while it showed small improvements in terms of Lysholm, VAS and knee laxity.…”

Severe mucoid degeneration of the anterior cruciate ligament (ACL) treated with conservative arthroscopic debridement and platelet-rich plasma (PRP) injection

“…This is similar to our case which exhibited improvements in mean grey value following PRP treatment; however, our methodology utilised a control ROI around the PCL to reduce variability between scans and increase the interpretability of our findings (figure 4). However, evidence for PRP-augmented ACLR is less promising, where several systematic reviews have demonstrated limited improvements in long-term healing, functional outcomes or postoperative pain 10. Nevertheless, the use of PRP in ACL rupture may be a viable treatment in select patients such as those with partial tears or those who elect more conservative management options.…”

Efficacy of Platelet-Rich Plasma for Chronic Lateral Ankle Instability After Modified Broström-Gould surgery: A Randomized, Single-Blinded, Prospective Controlled Trial

“…Some of these studies have shown the positive effect of PRP in reducing pain and function improvement in lateral elbow tendinosis and patellar tendinopathy. McRobb et al 23 conducted a systematic review on the effect of PRP on healing and clinical outcomes after anterior cruciate ligament reconstructive surgery and showed no consensus on the impact of PRP on pain, knee stability, and resultant knee function. Currently, there is scarcity of evidence supporting the use of PRP for treating musculoskeletal soft tissue injuries.…”