Related Research

PRP Research


Comparative Effectiveness of Platelet-rich Plasma Injections for Treating Knee Joint Cartilage Degenerative Pathology: A Systematic Review and Meta-Analysis

Author information: Chang KV1, Hung CY2, Aliwarga F3, Wang TG2, Han DS4, Chen WS5.

OBJECTIVE:
To explore the effectiveness of platelet-rich plasma (PRP) in treating cartilage degenerative pathology in knee joints.

DATA SOURCES:
Electronic databases, including PubMed and Scopus, were searched from the earliest record to September 2013.

STUDY SELECTION:
We included single-arm prospective studies, quasi-experimental studies, and randomized controlled trials that usedPRP to treat knee chondral degenerative lesions. Eight single-arm studies, 3 quasi-experimental studies, and 5 randomized controlled trials were identified, comprising 1543 participants.

DATA EXTRACTION:
We determined effect sizes for the selected studies by extracting changes in functional scales after the interventions and compared the PRP group pooled values with the pretreatment baseline and the groups receiving placebo or hyaluronic acid (HA) injections.

DATA SYNTHESIS:
PRP injections in patients with knee degenerative pathology showed continual efficacy for 12 months compared with their pretreatment condition. The effectiveness of PRP was likely better and more prolonged than that of HA. Injection doses ≤2, the use of a single-spinning approach, and lack of additional activators led to an uncertainty in the treatment effects. Patients with lower degrees of cartilage degeneration achieved superior outcomes as opposed to those affected by advanced osteoarthritis.

CONCLUSIONS:
PRP application improves function from basal evaluations in patients with knee joint cartilage degenerative pathology and tends to be more effective than HA administration. Discrepancy in the degenerative severity modifies the treatment responses, leading to participants with lower degrees of degeneration benefiting more from PRP injections.

Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
 

Platelet-rich Plasma Intra-articular Injection versus Hyaluronic Acid Viscosupplementation as Treatments for Cartilage Pathology: from Early Degeneration to Osteoarthritis

Author information: Kon E1, Mandelbaum B, Buda R, Filardo G, Delcogliano M, Timoncini A, Fornasari PM, Giannini S, Marcacci M.

PURPOSE:
The aim of our study is to compare the efficacy of platelet-rich plasma (PRP) and viscosupplementation (hyaluronic acid [HA]) intra-articular injections for the treatment of knee cartilage degenerative lesions and osteoarthritis (OA).

METHODS:
The study involved 150 patients affected by cartilage degenerative lesions and early and severe OA. Fifty symptomatic patients were treated with 3 autologous PRP intra-articular injections and were evaluated prospectively at enrollment and at 2- and 6-month follow-up. The results obtained were compared with 2 homogeneous groups of patients treated with HA injections. One group was treated with injections of high-molecular weight HA; the other group was treated with low-molecular weight (LW) HA. International KneeDocumentation Committee and EQ VAS scores were used for clinical evaluation; adverse events and patient satisfaction were also recorded.

RESULTS:
At 2 months' follow-up, the PRP and LW HA groups showed a similar improvement, with higher results compared with the high-molecular weight HA group (P < .005). At 6 months' follow-up, better results were observed in the PRP group (P < .005). PRP and LW HA treatments offered similar results in patients aged over 50 years and in the treatment of advanced OA. PRP showed a better performance compared with HA in younger patients affected by cartilage lesions or early OA.

CONCLUSIONS:
Autologous PRP injections showed more and longer efficacy than HA injections in reducing pain and symptoms and recovering articular function. Better results were achieved in younger and more active patients with a low degree of cartilage degeneration, whereas a worse outcome was obtained in more degenerated joints and in older patients, in whom results similar to those of viscosupplementation have been observed.

LEVEL OF EVIDENCE:
Level II, prospective comparative study.
Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
 

ACL Prevention


Anterior Cruciate Ligament and Knee Injury Prevention Programs for Soccer Players: A Systematic Review and Meta-analysis

Author Information: 
  • 1Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA nathan.grimm@duke.edu.
  • 2University of Utah School of Medicine, Salt Lake City, Utah, USA.
  • 3Division of Public Health, Study Design, & Biostatistic Center, University of Utah School of Medicine, Salt Lake City, Utah, USA.
  • 4St Luke's Intermountain Orthopaedics, Boise, Idaho, USA

BACKGROUND:
Soccer has one of the highest incidences of anterior cruciate ligament (ACL) injuries for both males and females. Several injury prevention programs have been developed to address this concern. However, an analysis of the pooled effect has yet to be elicited.

PURPOSE:
To conduct a systematic review and meta-analysis of ACL and knee injury prevention programs for soccer players, assess the heterogeneity among the studies, and evaluate the reported effectiveness of the prevention programs.

STUDY DESIGN:
Systematic review and meta-analysis.

METHODS:
A systematic search of the literature was conducted on PubMed (Medline), Embase, CINAHL, and Central-Cochrane Database. Studies were limited to randomized controlled trials (RCTs) of injury prevention programs specific to the knee and/or ACL in soccer players. The Cochrane Q test and I 2 index were independently used to assess heterogeneity among the studies. The pooled risk difference, assessing knee and/or ACL injury rates between intervention and control groups, was calculated by random-effects models with use of the DerSimonian-Laird method. Publication bias was assessed with a funnel plot and Egger weighted regression technique.

RESULTS:
Nine studies met the inclusion criteria as RCTs. A total of 11,562 athletes were included, of whom 7889 were analyzed for ACL-specific injuries. Moderate heterogeneity was found among studies of knee injury prevention (P = .041); however, there was insignificant variation found among studies of ACL injury prevention programs (P = .222). For studies of knee injury prevention programs, the risk ratio was 0.74 (95% CI, 0.55-0.89), and a significant reduction in risk of knee injury was found in the prevention group (P = .039). For studies of ACL injury prevention programs, the risk ratio was 0.66 (95% CI, 0.33-1.32), and a nonsignificant reduction in risk of ACL injury was found in the prevention group (P = .238). No evidence of publication bias was found among studies of either knee or ACL injury prevention programs.

CONCLUSION:
This systematic review and meta-analysis of ACL and knee injury prevention program studies found a statistically significant reduction in injury risk for knee injuries but did not find a statistically significant reduction of ACL injuries.

.© 2014 The Author(s)


Effectiveness of Anterior Cruciate Ligament Injury Prevention Training Programs

Author Information: Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria. Patrick.sadoghi@klinikum-graz.at

The objective of this study was to systematically review the literature on anterior cruciate ligament (ACL) injury prevention programs and to perform a meta-analysis to address three questions: First, what is the effectiveness of ACL injury prevention programs? Second, is there evidence for a "best" program? Third, what is the quality of the current literature on ACL injury prevention?

METHODS:
We conducted a systematic review with use of the online PubMed, MEDLINE, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health), and Cochrane Central Register of Controlled Trials databases. Search terms were anterior cruciate ligament, knee, injury, prevention, and control. Data on study design and clinical outcomes were extracted independently in triplicate. After assessment of between-study heterogeneity, DerSimonian-Laird random-effect models were used to calculate pooled risk ratios and risk differences. The risk difference was used to estimate the number needed to treat (the number of individuals who would need to be treated to avoid one ACL tear).

RESULTS:
The pooled risk ratio was 0.38 (95% confidence interval [CI], 0.20 to 0.72), reflecting a significant reduction in the risk of ACL rupture in the prevention group (p = 0.003). The number needed to treat ranged from five to 187 in the individual studies. Stratified by sex, the pooled risk ratio was 0.48 (95% CI, 0.26 to 0.89) for female athletes and 0.15 (95% CI, 0.08 to 0.28) for male athletes.

CONCLUSIONS:
Our study indicated strong evidence in support of a significant effect of ACL injury prevention programs. Our pooled estimates suggest a substantial beneficial effect of ACL injury prevention programs, with a risk reduction of 52% in the female athletes and 85% in the male athletes.

Copyright © 2012 The Journal of Bone and Joint Surgery - American volume. All rights reserved.


The Efficacy of Platelet-rich Plasma in the Treatment of Symptomatic Knee Osteoarthritis: A Systematic Review with Quantitative Synthesis

Author Information: Khoshbin A1, Leroux T, Wasserstein D, Marks P, Theodoropoulos J, Ogilvie-Harris D, Gandhi R, Takhar K, Lum G, Chahal J.

PURPOSE:
The purpose of this systematic review was to synthesize the available Level I and Level II literature on platelet-rich plasma (PRP) as a therapeutic intervention in the management of symptomatic knee osteoarthritis (OA).

METHODS:
A systematic review of Medline, Embase, Cochrane Central Register of Controlled Trials, PubMed, and www.clinicaltrials.gov was performed to identify all randomized controlled trials and prospective cohort studies that evaluated the clinical efficacy of PRP versus a control injection for knee OA. A random-effects model was used to evaluate the therapeutic effect of PRP at 24 weeks by use of validated outcome measures (Western Ontario and McMaster Universities Arthritis Index, visual analog scale for pain, International KneeDocumentation Committee Subjective Knee Evaluation Form, and overall patient satisfaction).

RESULTS:
Six Level I and II studies satisfied our inclusion criteria (4 randomized controlled trials and 2 prospective nonrandomized studies). A total of 577 patients were included, with 264 patients (45.8%) in the treatment group (PRP) and 313 patients (54.2%) in the control group (hyaluronic acid [HA] or normal saline solution [NS]). The mean age of patients receiving PRP was 56.1 years (51.5% male patients) compared with 57.1 years (49.5% male patients) for the group receiving HA or NS. Pooled results using the Western Ontario and McMaster Universities Arthritis Index scale (4 studies) showed that PRP was significantly better than HA or NS injections (mean difference, -18.0 [95% confidence interval, -28.8 to -8.3]; P < .001). Similarly, the International Knee Documentation Committee scores (3 studies) favored PRP as a treatment modality (mean difference, 7.9 [95% confidence interval, 3.7 to 12.1]; P < .001). There was no difference in the pooled results for visual analog scale score or overall patient satisfaction. Adverse events occurred more frequently in patients treated with PRP than in those treated with HA/placebo (8.4% v 3.8%, P = .002).

CONCLUSIONS:
As compared with HA or NS injection, multiple sequential intra-articular PRP injections may have beneficial effects in the treatment of adult patients with mild to moderate knee OA at approximately 6 months. There appears to be an increased incidence of nonspecific adverse events among patients treated with PRP.

LEVEL OF EVIDENCE:
Level II, systematic review of Level I and II studies.

Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

 

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