ORTHOPAEDIC REFERENCES AND ABSTRACTS
Pak J, Lee JH, Park KS, Park M, Kang LW, Lee SH. 2017.
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Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Meta-analysis of Randomized Controlled
Dai WL1, Zhou AG1, Zhang H1, Zhang J2.
Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Electronic address:
To use meta-analysis techniques to evaluate the efficacy and safety of platelet-rich plasma (PRP) injections for the treatment knee
of osteoarthritis (OA).
We performed a systematic literature search in PubMed, Embase, Scopus, and the Cochrane database through April 2016 to
identify Level I randomized controlled trials that evaluated the clinical efficacy of PRP versus control treatments for knee OA.
The primary outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores.
The primary outcomes were compared with their minimum clinically important differences (MCID)-defined as the smallest
difference perceived as important by the average patient.
We included 10 randomized controlled trials with a total of 1069 patients. Our analysis showed that at 6 months postinjection,
PRP and hyaluronic acid (HA) had similar effects with respect to pain relief (WOMAC pain score) and functional improvement
(WOMAC function score, WOMAC total score, International Knee Documentation Committee score, Lequesne score). At 12
months postinjection, however, PRP was associated with significantly better pain relief (WOMAC pain score, mean difference
-2.83, 95% confidence interval [CI] -4.26 to -1.39, P = .0001) and functional improvement (WOMAC function score, mean
difference -12.53, 95% CI -14.58 to -10.47, P < .00001; WOMAC total score, International Knee Documentation Committee score,
Lequesne score, standardized mean difference 1.05, 95% CI 0.21-1.89, P = .01) than HA, and the effect sizes of WOMAC pain
and function scores at 12 months exceeded the MCID (-0.79 for WOMAC pain and -2.85 for WOMAC function score). Compared
with saline, PRP was more effective for pain relief (WOMAC pain score) and functional improvement (WOMAC function score)
at 6 months and 12 months postinjection, and the effect sizes of WOMAC pain and function scores at 6 months and 12 months
exceeded the MCID. We also found that PRP did not increase the risk of adverse events compared with HA and saline.
Current evidence indicates that, compared with HA and saline, intra-articular PRP injection may have more benefit in pain relief
and functional improvement in patients with symptomatic knee OA at 1 year postinjection.
LEVEL OF EVIDENCE:
Level I, meta-analysis of Level I studies.
Copyright © 2016. Published by Elsevier Inc.
Arthroscopy. 2013 Dec;29(12):2037-48. doi: 10.1016/j.arthro.2013.09.006.
The efficacy of platelet-rich plasma in the treatment of symptomatic knee osteoarthritis: a systematic review with quantitative synthesis.
Khoshbin A1, Leroux T, Wasserstein D, Marks P, Theodoropoulos J, Ogilvie-Harris D, Gandhi R, Takhar K, Lum G, Chahal J.
University of Toronto Orthopaedic Sports Medicine Program, Women’s College Hospital, Toronto, Ontario, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada.
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).
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 Knee Documentation Committee Subjective Knee Evaluation Form, and overall patient satisfaction).
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).
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.
J Orthop Surg Res. 2017 Jan 23;12(1):16. doi: 10.1186/s13018-017-0521-3.
The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis:
systematic review and meta-analysis of randomized controlled trials.
Shen L1, Yuan T1, Chen S2, Xie X3, Zhang C1.
Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital affiliated to Shanghai Jiaotong University School of
Medicine, 600 Yishan Road, Shanghai, 200233, China.
Section of Clinical Epidemiology, Institute of Orthopaedic Traumatology affiliated to Shanghai Jiaotong University, 600 Yishan
Road, Shanghai, 200233, China.
Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital affiliated to Shanghai Jiaotong University School of
Medicine, 600 Yishan Road, Shanghai, 200233, China. firstname.lastname@example.org.
Quite a few randomized controlled trials (RCTs) investigating the efficacy of platelet-rich plasma (PRP) for treatment of knee
osteoarthritis (OA) have been recently published. Therefore, an updated systematic review was performed to evaluate the
temporal effect of PRP on knee pain and physical function.
Pubmed, Embase, Cochrane library, and Scopus were searched for human RCTs comparing the efficacy and/or safety of PRP
infiltration with other intra-articular injections. A descriptive summary and quality assessment were performed for all the
studies finally included for analysis. For studies reporting outcomes concerning Western Ontario and McMaster Universities
Arthritis Index (WOMAC) or adverse events, a random-effects model was used for data synthesis.
Fourteen RCTs comprising 1423 participants were included. The control included saline placebo, HA, ozone, and corticosteroids.
The follow-up ranged from 12 weeks to 12 months. Risk of bias assessment showed that 4 studies were considered as moderate
risk of bias and 10 as high risk of bias. Compared with control, PRP injections significantly reduced WOMAC pain subscores at
3, 6, and 12 months follow-up (p = 0.02, 0.004, <0.001, respectively); PRP significantly improved WOMAC physical function
subscores at 3, 6, and 12 months (p = 0.002, 0.01, <0.001, respectively); PRP also significantly improved total WOMAC scores at
3, 6 and 12 months (all p < 0.001); nonetheless, PRP did not significantly increased the risk of post-injection adverse events
(RR, 1.40 [95% CI, 0.80 to 2.45], I 2 = 59%, p = 0.24).
Intra-articular PRP injections probably are more efficacious in the treatment of knee OA in terms of pain relief and self-reported
function improvement at 3, 6 and 12 months follow-up, compared with other injections, including saline placebo, HA, ozone, and
PROSPERO CRD42016045410 . Registered 8 August 2016.
PMCID: PMC5260061 Free PMC Article
J Biomed Mater Res B Appl Biomater. 2017 Aug;105(6):1536-1543. doi: 10.1002/jbm.b.33688. Epub 2016 Apr 29.
Intra-articular Injection of platelet-rich fibrin releasates in combination with bone marrow-derived mesenchymal
stem cells in the treatment of articular cartilage defects: An in vivo study in rabbits.
Wu CC1,2, Sheu SY3,4,5, Hsu LH1,2, Yang KC6, Tseng CC7, Kuo TF7,8.
Department of Orthopedics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, 10002,
Department of Orthopedics, En Chu Kong Hospital, New Taipei City, 23702, Taiwan.
School of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan.
Department of Integrated Chinese and Western Medicine, Chung Shan Medical University Hospital, Taichung, 40201, Taiwan.
Department of Occupational Therapy, Asia University, Taichung, 41354, Taiwan.
School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan.
Graduate Institute of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei, 10617, Taiwan.
Department of Post-Baccalaureate Veterinary Medicine, Asia University, Taichung, 41354, Taiwan.
The use of mesenchymal stem cells (MSCs), which can be differentiated into chondrocytes under specific conditions, has been
proposed for the treatment of cartilage defects. Blood-derived platelet-rich fibrin releasate (PRFr), which is rich in growth
factors and cytokines, may improve cartilage regeneration. In this study, the therapeutic effects of PRFr in combination with
bone marrow-derived MSCs for articular cartilage regeneration were evaluated in a rabbit model. Critical osteochondral defects
were surgically created in the femoral condyle of the rabbits, and 3 × 106 of MSCs, 0.8 mL of PRFr, or a combination of MSCs
and PRFr were injected intra-articularly and one week after first administration. The animals were sacrificed 12 weeks
postoperatively, and the regenerated cartilages were assessed by gross inspection and histological examination. No
treatment-related adverse events were noted in any of the rabbits. The size of the defect decreased and the volume of
regenerated cartilage increased in the medial femoral condyles of the MSCs + PRFr group. Relative to the MSCs or PRFr group,
histological examination demonstrated that the MSCs + PRFr group had thicker hyaline-like cartilaginous tissue with normal
glycosaminoglycan production. Grading scores revealed that MSCs + PRFr injection had better matrix, cell distribution, and
surface indices than other groups. The results showed that intra-articular injections of MSCs + PRFr into the knee can reduce
cartilage defects by regenerating hyaline-like cartilage without adverse events. This approach may provide an alternative
method of autologous chondrocyte implantation to repair cartilage defects with an unlimited source of cells and releasate.
© 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1536-1543, 2017.