The clinical impact of platelet-rich plasma on tendinopathy compared to placebo or dry needling injections: A meta-analysis

Tsikopoulos, Konstantinos; Tsikopoulos, Ioannis; Simeonidis, Evangelos; Papathanasiou, Efthymia; Haidich, Anna‐Bettina; Αναστασόπουλος, Νικόλαος; Natsis, Konstantinos

doi:10.1016/j.ptsp.2015.06.003

Cited by 45 publications

(53 citation statements)

References 37 publications

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“…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 …”

Section: Resultsmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

“…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).…”

Section: Resultsmentioning

confidence: 99%

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

2019

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“…Several reviews25 63–67 have summarised the number of growth factors and cytokines that are secreted by MSCs and how these factors influence, often in animal models, the repair mechanisms of injured tendons. It should be noted that other injection therapies with growth factors, such as platelet-rich plasma, have mostly failed to demonstrate their efficacy within tendon disorder treatment 11 12 68…”

Section: Discussionmentioning

confidence: 99%

“…It is defined by localised swelling, pain and functional limitations of the affected tendon 4. Several therapies, such as eccentric exercises,5 non-steroidal anti-inflammatory drugs,6 shockwave therapy,7–9 corticosteroids,10 platelet-rich plasma11 12 and surgery6 have been used as treatments for tendinopathy, with variable levels of evidence and success. Despite some good results for some of these therapies,5 recalcitrant cases remain.…”

Section: Introductionmentioning

confidence: 99%

No evidence for the use of stem cell therapy for tendon disorders: a systematic review

Pas¹,

Moen²,

Haisma

et al. 2017

Br J Sports Med

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IntroductionStem cells have emerged as a new treatment option for tendon disorders. We systematically reviewed the current evidence for stem cell therapy in tendon disorders.MethodsRandomised and non-randomised controlled trials, cohort studies and case series with a minimum of 5 cases were searched in MEDLINE, CENTRAL, EMBASE, CINAHL, PEDro and SPORTDiscus. In addition, we searched grey literature databases and trial registers. Only human studies were included and no time or language restrictions were applied to our search. All references of included trials were checked for possibly eligible trials. Risk of bias assessment was performed using the Cochrane risk of bias tool for controlled trials and the Newcastle-Ottawa scale for case series. Levels of evidence were assigned according to the Oxford levels of evidence.Results4 published and three unpublished/pending trials were found with a total of 79 patients. No unpublished data were available. Two trials evaluated bone marrow-derived stem cells in rotator cuff repair surgery and found lower retear rates compared with historical controls or the literature. One trial used allogenic adipose-derived stem cells to treat lateral epicondylar tendinopathy. Improved Mayo Elbow Performance Index, Visual Analogue Pain scale and ultrasound findings after 1-year follow-up compared with baseline were found. Bone marrow-derived stem cell-treated patellar tendinopathy showed improved International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score subscales and Tegner scores after 5-year follow-up. One trial reported adverse events and found them to be mild (eg, swelling, effusion). All trials were at high risk of bias and only level 4 evidence was available.ConclusionsNo evidence (level 4) was found for the therapeutic use of stem cells for tendon disorders. The use of stem cell therapy for tendon disorders in clinical practice is currently not advised.

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“…The meta-analysis was conducted according to the updated guidelines of the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) [13]. Searches on PubMed- [14,15]. An overview of the search strategy is presented in Supplementary Appendix A.…”

Section: Search Strategymentioning

confidence: 99%

Current Evidence of Mesenchymal Stem Cells Use in the Treatment of Tendon Disorders: A Systematic Review, Meta-analysis, and Meta-regression of Prospective Clinical Studies

Cho¹,

Chung²,

Kim³

et al. 2020

Preprint

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KEYWORDSmesenchymal stem cells, tendinopathy, rotator cuff disease, tennis elbow, metaanalysis 2 Abstract Purpose: Although several studies with animals have reported the effects of mesenchymal stem cells (MSCs) for tendon regeneration, little is known about the efficacy and safety of MSCs in human tendon disorders. We performed this meta-analysis to evaluate the efficacy and safety of MSC therapy in patients with tendon disorders enrolled in prospective clinical studies. Methods:We systematically searched prospective clinical studies investigating the effects of MSCs administration on human tendon disorders with at least a 6-month follow-up period on PubMed-Medline, Embase, and Cochrane Library databases. The primary outcome of interest was the change in pain on motion related to tendon disorders. We performed a pairwise meta-analysis using the fixedeffects model to assess treatment response, which was calculated by the standardized mean difference. Meta-regression analyses were performed to assess the relationship between MSCs dose and pooled effect sizes in each cell dose.Results: Four prospective clinical trials investigating the effect of MSCs on tendon disorders were retrieved. MSCs showed significant pooled effect size (overall Hedge's g pooled standardized mean difference (SMD) = 1.868; 95% confidence interval [CI], 1.274-2.462; P < 0.001). The treatment with MSCs improved all the aspects analyzed, i.e. pain, functional scores, radiologic parameters (magnetic resonance image or ultrasonography), and arthroscopic findings. In the meta-regression analysis, there was a significant cell dose-dependent response in pain relief (Q = 9.06, P = 0.029). While three studies reported mild adverse events after MSCs injection, these were not severe and relieved spontaneously. Conclusions:Our meta-analysis revealed that MSC therapy may improve pain, function, radiologic, and arthroscopic parameters in patients with tendon disorders. Due to the small number of studies in this meta-analysis and considering the increasing MSCs applications, there is a strong need for largescale randomized controlled trials to confirm the long-term functional improvement as well as the adverse effects of MSC therapies in tendon disorders. BackgroundMesenchymal stem cells (MSCs) treatment is a new regenerative therapy for treating tendon disorder.

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The clinical impact of platelet-rich plasma on tendinopathy compared to placebo or dry needling injections: A meta-analysis

Cited by 45 publications

References 37 publications

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

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

No evidence for the use of stem cell therapy for tendon disorders: a systematic review

Current Evidence of Mesenchymal Stem Cells Use in the Treatment of Tendon Disorders: A Systematic Review, Meta-analysis, and Meta-regression of Prospective Clinical Studies

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