Anterior Cruciate Ligament Reconstruction with Platelet-Rich Plasma: A Systematic Review of Randomized Control Trials

Davey, Martin S.; Hurley, Eoghan T.; Withers, Daniel; Moran, Ray; Moran, Cathal J.

doi:10.1016/j.arthro.2019.11.004

Cited by 36 publications

(29 citation statements)

References 27 publications

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“…Thirteen RCTs showed neither significant improvement in any of the clinical outcomes (Tegner, Lysholm, KOOS, IKDC) nor in pain reduction (p = 0.18). PRP also does not support graft healing or donor-site morbidity [100]. In our study including 16 RCTS, we also did not find significant improvements in functional outcomes (IKDC, Lysholm, Tegner), pain reduction (VAS), stability assessment (KT-1000) or tunnel widening.…”

Section: Discussioncontrasting

confidence: 67%

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

Tramś

Kulinski

Kozar-Kamińska

et al. 2020

Life

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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.

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Section: Discussioncontrasting

confidence: 67%

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

Tramś

Kulinski

Kozar-Kamińska

et al. 2020

Life

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“…6 Systematic reviews examining PRP treatment for ligament and tendon injuries 14 have pointed to a positive effect in healing and pain, although this is not a universal finding. 4 Likely, this misinterpretation of previous findings resulted from the fact that PRP-related pain reduction is higher the sooner it is measured after ACLR, as confirmed by our analyses.…”

Section: Discussionsupporting

confidence: 62%

Time-Dependent Effect of Platelet-Rich Plasma in Reducing Donor-Site Pain After Anterior Cruciate Ligament Reconstruction

et al. 2020

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Background: Anterior cruciate ligament reconstruction (ACLR) has a high incidence among sports players, and one important side effect of the surgery is graft donor site morbidity. Although some evidence suggests that application of platelet-rich plasma (PRP) during ACLR reduces pain and improves knee function, it is not a universal finding. Purpose: To perform a meta-analysis of previous studies testing the effects of PRP on donor site morbidity after ACLR. Study Design: Systematic review and meta-analysis. Methods: We reviewed PubMed (Medline), Web of Science, Embase, Scopus, and Cochrane databases to find studies testing the effects of PRP on the donor site of ACLR autograft. After identifying 4 studies, we conducted 2 meta-analyses, 1 for the effects of PRP on pain, assessed by visual analog scale (VAS), and the other for the functional knee scores. We also tested the ability of time after ACLR to predict the PRP-related reduction of pain. Results: In the 4 studies identified, 157 patients were analyzed. Although the VAS score was lower with PRP at 6 months (raw mean difference [RMD], –0.97 [95% CI, −1.59 to −0.36]; P = .001) and 12 months (RMD, −0.61 [95% CI,−1.02 to −0.21]; P = .003), the effects of PRP disappeared at 24 months (RMD, −0.08 [95% CI,−0.38 to 0.22]; P = .586). A univariate regression analysis reinforced the ability of time after ACLR to predict the PRP-related reduction of VAS pain score ( r2 = 0.98). However, knee function after ACLR was not improved by the use of PRP (standardized mean difference, 0.71 [95% CI,−0.17 to 1.60]; P = .114). Conclusion: PRP applied to a bone–patellar tendon–bone donor site could reduce knee pain within a year, and this reduction had a correlation with time, meaning that the effect of PRP decreased with time after surgery. However, pain reduction did not reach clinical relevance and did not lead to better functional knee scores.

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“…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 ].…”

Section: Stem Cell Therapy For Graft Regenerationmentioning

confidence: 99%

Application of Stem Cell Therapy for ACL Graft Regeneration

Wang

Zhang

et al. 2021

Stem Cells International

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Graft regeneration after anterior cruciate ligament (ACL) reconstruction surgery is a complex three-stage process, which usually takes a long duration and often results in fibrous scar tissue formation that exerts a detrimental impact on the patients’ prognosis. Hence, as a regeneration technique, stem cell transplantation has attracted increasing attention. Several different stem cell types have been utilized in animal experiments, and almost all of these have shown good capacity in improving tendon-bone regeneration. Various differentiation inducers have been widely applied together with stem cells to enhance specific lineage differentiation, such as recombinant gene transfection, growth factors, and biomaterials. Among the various different types of stem cells, bone marrow-derived mesenchymal stem cells (BMSCs) have been investigated the most, while ligament stem progenitor cells (LDSCs) have demonstrated the best potential in generating tendon/ligament lineage cells. In the clinic, 4 relevant completed trials have been reported, but only one trial with BMSCs showed improved outcomes, while 5 relevant trials are still in progress. This review describes the process of ACL graft regeneration after implantation and summarizes the current application of stem cells from bench to bedside, as well as discusses future perspectives in this field.

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Anterior Cruciate Ligament Reconstruction with Platelet-Rich Plasma: A Systematic Review of Randomized Control Trials

Cited by 36 publications

References 27 publications

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

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

Time-Dependent Effect of Platelet-Rich Plasma in Reducing Donor-Site Pain After Anterior Cruciate Ligament Reconstruction

Application of Stem Cell Therapy for ACL Graft Regeneration

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