The Clinical Use of Platelet-Rich Plasma in Knee Disorders and Surgery—A Systematic Review and Meta-Analysis

Abstract

In recent years, the interest in biological treatment of knee lesions has increased, especially the application of platelet-rich plasma is of particular note. The number of articles evaluating platelet-rich plasma (PRP) efficacy in the recovery of knee disorders and during knee surgery has exponentially increased over the last decade. A systematic review with meta-analyses was performed by assessing selected studies of local PRP injections to the knee joint. The study was completed in accordance with 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A multistep search of PubMed, Embase, Cochrane Database of Systematic Reviews, and Clinicaltrials.gov was performed to identify studies on knee surgery and knee lesion treatment with PRP. Of the 4004 articles initially identified, 357 articles focusing on knee lesions were selected and, consequently, only 83 clinical trials were analyzed using the revised Cochrane risk-of-bias tool to evaluate risk. In total, seven areas of meta-analysis reported a positive effect of PRP. Among them, 10 sub-analyses demonstrated significant differences in favor of PRP when compared to the control groups (p < 0.05). This study showed the positive effects of PRP, both on the recovery of knee disorders and during knee surgery; however further prospective and randomized studies with a higher number of subjects and with lower biases are needed.

Platelet-rich plasma (PRP) augmentation does not result in more favourable outcomes in arthroscopic meniscal repair: a meta-analysis

“…Similar findings were evidenced in a meta-analysis of six studies (111 procedures), in which PRP augmentation did reduce the risk of failure (from 25.7% to 9.9%) [ 60 ]. In 5323 procedures (83 studies), PRP resulted in better outcomes following meniscectomy [ 61 ]. Wang et al.…”

Comprehensive Review of Knee Osteoarthritis Pharmacological Treatment and the Latest Professional Societies’ Guidelines

“…In pooled estimates, there was no statistically significant difference noted for adverse events of PRP therapy compared to the control group (placebo, HA, corticosteroids, and mesenchymal stem cells). Multiple injections were also shown to be superior to a single injection, but this effect was only observed when three injections were applied [ 78 ]. Similar results regarding the frequency of PRP injections were shown in a meta-analysis by Vilchez-Cavazos and colleagues, where no difference in pain improvement was observed for single versus multiple PRP injections; however, there was a significant difference in functional outcomes at 6 months’ follow-up for a triple versus a single injection [ 79 ].…”

Application of Stem Cell Therapy for ACL Graft Regeneration

“…Such as transforming growth factor (TGF), fibroblast growth factor (FGF), insulin-like growth factor (IGF), platelet-derived growth factor (PDGF), and epidermal growth factor (EGF), with all having been proven to increase cell proliferation, fibroblastic differentiation, and ECM deposition. As a combination of these factors, PRP could induce mass release of growth factors within one hour following intra-articular administration, which seems a convenient and efficient tool, but related meta-analysis studies found no significant benefit for ACLR in the clinic [ 80 , 81 ].…”