The efficacy of platelet rich plasma on anterior cruciate ligament reconstruction: a systematic review and meta-analysis

Lv, Zheng‐tao; Zhang, Jinming; Pang, Zhiying; Wang, Zhe; Huang, Jian; Zhu, Wentao

doi:10.1080/09537104.2021.1902969

Cited by 7 publications

(4 citation statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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. 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.…”

Section: Discussionmentioning

confidence: 99%

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

Delcogliano,

Sangiorgio,

Bensa

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposePlatelet‐rich plasma (PRP) augmentation has been proposed to improve the results of anterior cruciate ligament reconstruction (ACLR). The present study aims to quantify the available evidence to support the use of PRP as biological augmentation in ACLR surgery.MethodsA systematic literature search was conducted on the PubMed, Cochrane, Web of Science and Embase databases on 10 March 2023. Inclusion criteria were randomised controlled trials (RCTs), written in English, addressing PRP augmentation in ACLR surgery, with no time limitation. A scoping review was performed to map the body of literature by examining the evidence related to specific aspects of patients' treatment and evaluation. Risk of bias evaluation was performed with the Cochrane risk‐of‐bias tool for randomised trials Version 2 (RoB 2), while the quality assessment was performed with the use of the Coleman Score.ResultsOut of 983 articles retrieved, 23 RCTs on 943 knees were included in this scoping review. PRP was administered in a liquid form in nine studies and clotted in 11 studies, while in three studies both liquid and clotted PRP were used. Hamstring auto/allografts were used in 14 studies, patellar tendon auto/allografts were used in eight studies and one study described ACLR with peroneus longus allografts. The map of the evidence documented high heterogeneity also in terms of surgical technique, objective and subjective outcome measures and radiological assessment, as well as follow‐up times ranging from 1 day to 2 years, with virtually no overlapping data among studies neither in terms of treatments nor evaluations. Risk of bias evaluation showed an overall low quality of the included studies.ConclusionsThe available literature addressing PRP augmentation in ACLR is largely scattered. PRP was produced and applied following different procedures, and high variability was detected across the included studies for every aspect of ACLR surgery and evaluation. Currently, a meaningful comparison of the available studies is not possible as the quantification of the literature results is biased by their heterogeneity. Future studies should provide more standardisation to investigate the benefits of biological augmentation in ACL surgery and confirm the promising yet weak evidence of PRP potential as well as the most suitable application modality, before routine use in clinical practice.Level of EvidenceLevels I and II, scoping review.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Delcogliano,

Sangiorgio,

Bensa

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…Based on these data, the authors stated that orthopedic surgeons should cautiously consider the application of PRP during surgery for intra-articular knee injuries [18]. In a systematic review and meta-analysis published in 2021, Lv et al concluded that the use of PRP could significantly decrease pain in the short term but not in the long term [80].…”

Section: Discussionmentioning

confidence: 99%

Anterior Cruciate Ligament Reconstruction: Is Biological Augmentation Beneficial?

Rodríguez-Merchán

2021

IJMS

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Surgical reconstruction in anterior cruciate ligament (ACL) ruptures has proven to be a highly effective technique that usually provides satisfactory results. However, despite the majority of patients recovering their function after this procedure, ACL reconstruction (ACLR) is still imperfect. To improve these results, various biological augmentation (BA) techniques have been employed mostly in animal models. They include: (1) growth factors (bone morphogenetic protein, epidermal growth factor, granulocyte colony-stimulating factor, basic fibroblast growth factor, transforming growth factor-β, hepatocyte growth factor, vascular endothelial growth factor, and platelet concentrates such as platelet-rich plasma, fibrin clot, and autologous conditioned serum), (2) mesenchymal stem cells, (3) autologous tissue, (4) various pharmaceuticals (matrix metalloproteinase-inhibitor alpha-2-macroglobulin bisphosphonates), (5) biophysical/environmental methods (hyperbaric oxygen, low-intensity pulsed ultrasound, extracorporeal shockwave therapy), (6) biomaterials (fixation methods, biological coatings, biosynthetic bone substitutes, osteoconductive materials), and (7) gene therapy. All of them have shown good results in experimental studies; however, the clinical studies on BA published so far are highly heterogeneous and have a low degree of evidence. The most widely used technique to date is platelet-rich plasma. My position is that orthopedic surgeons must be very cautious when considering using PRP or other BA methods in ACLR.

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“…As the primary static, dynamic stabilizing structure of the knee joint, the anterior cruciate ligament (ACL) plays a critical role in maintaining the stability and normal motion of the knee joint [ 1 ]. ACL rupture can lead to knee instability and decreased function, and is associated with secondary meniscal and cartilage injury [ 2 ]. Some evidence stated that anterior cruciate ligament reconstruction (ACLR) is the gold standard for regaining stability and improving knee function [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy on knee function of Kinesio taping among individuals with anterior cruciate ligament reconstruction: A systematic review

Chen,

Wang,

Zhou

et al. 2024

PLoS ONE

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Objective This study aims to evaluate systematically the efficacy of Kinesio taping (KT) on the knee function of individuals who undergo anterior cruciate ligament reconstruction (ACLR). Methods This study was registered in PROSPERO (registration number CRD42023399885) on February 26, 2023. Randomized controlled trials (RCTs) about the effects on the knee function of KT among individuals after ACLR were electronically searched from PubMed, Web of Science, Embase, The Cochrane Library, and EBSCO from inception to July 02, 2023. The outcome measures included six continuous variables: quadriceps strength, hamstring strength, knee swelling, knee flexion angle, Lysholm knee function score, and Visual Analog Scale (VAS) pain scores. The Cochrane Risk Bias Assessment Tool was used to evaluate the quality of the included literature. Results Seven RCTs including 278 patients who underwent ACLR were included in the systematic review. One of three (33%) studies found a remarkable increase in quadricep strength associated with the use of KT compared with the control group. Two of two (100%) studies found substantial increases in hamstring strength associated with KT. Two of four (50%) studies reported KT reduced knee swelling. Two of five (40%) studies reported considerable improvements in knee flexion angle in the groups that used KT. All three (100%) studies found KT did not improve Lysholm knee function scores. Three of four (75%) studies noted a significant reduction in VAS pain scores associated with KT. Conclusion KT may help improve hamstring strength and reduce knee swelling and pain in patients after ACLR. Further studies are needed to determine the effects of KT on quadricep strength and knee flexion angle.

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The efficacy of platelet rich plasma on anterior cruciate ligament reconstruction: a systematic review and meta-analysis

Cited by 7 publications

References 52 publications

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

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

Anterior Cruciate Ligament Reconstruction: Is Biological Augmentation Beneficial?

Efficacy on knee function of Kinesio taping among individuals with anterior cruciate ligament reconstruction: A systematic review

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