Effectiveness of Platelet‐Rich Plasma in Anterior Cruciate Ligament Reconstruction: A Systematic Review of Randomized Controlled Trials

Abstract

This study aimed to identify the effectiveness of platelet-rich plasma (PRP) for patients operated with anterior cruciate ligament reconstruction (ACLR). Databases of PubMed, Embase, and CENTRAL were independently retrieved by two authors, for identifying the eligible randomized controlled trials (RCTs) comparing the clinical and imaging outcomes of ACL reconstructed patients augmented with or without PRP. The Cochrane Collaboration tool was utilized to assess the risk of bias of the included trials. We qualitatively synthesized the outcomes include the image evaluations on the healing of bone tunnels, graft remodeling, donor site healing and tunnel widening, and clinical evaluations on knee stability and function, pain symptom by visual analogue scale (VAS), inflammatory parameters and so on. A total of 16 RCTs, including 1025 patients, were included for eligibility. Generally, the included studies were of low risk of bias, but the conducting of allocation concealment was not clearly described in many studies. Three imaging techniques, including MRI, CT and ultrasound, were selected in these trials. Significant improvement on graft remodeling, bone tunnel healing, harvest site healing and bone tunnel diameters were demonstrated in one of five (20.0%), three of five (60.0%), two of four (50.0%) and one of five (20.0%) studies respectively, for PRP group. Various clinical outcomes, such as IKDC score, Lysholm score, Tegner score, knee anteroposterior and rotational laxity, range of motion and VAS, could not be improved with PRP application. The PRP is associated with very limited role in improving knee outcomes following ACLR, and there is no indication for PRP procedures in ACLR at this stage.

Intra-Articular Platelet-Rich Plasma Injection After Anterior Cruciate Ligament Reconstruction

“…Recently, several systematic reviews of RCTs reached a consensus that intraoperative injection of PRP is ineffective in improving long-term PROs, knee stability, or radiologic outcomes at more than 6 months after ACLR despite different results for short-term outcomes . Similarly, the 12-month clinical and radiologic outcomes of the present study showed no long-term efficacy of postoperative PRP injection in patients who underwent ACLR.…”

“…Another meta-analysis with pooled follow-up periods showed improved Lysholm and visual analog scale scores in the PRP group; the between-group differences were statistically but not clinically significant. Furthermore, the discrepant biological hypotheses and sites of PRP administration resulted in diverse and incomparable radiologic outcomes among studies, including graft remodeling, tunnel enlargement, and harvest site healing . In terms of graft remodeling, only 1 RCT with intra-articular injection and 1 RCT with intratunnel and intragraft injection reported improved short-term MRI results at 4 to 6 months and 4 to 6 weeks after ACLR, respectively, while the statistical significance diminished over time.…”

“…Fifth, the follow-up duration was relatively short. Although a 12-month follow-up is considered long enough for studies on PRP, the progression of graft maturation and return to sports usually lasts for years, and a longer follow-up period may provide more information.…”

“…Fifth, the follow-up duration was relatively short. Although a 12-month follow-up is considered long enough for studies on PRP, 13,14 the progression of graft maturation and return to sports usually lasts for years, 5,6 and a longer follow-up period may provide more information. a The graft maturity is evaluated on the sagittal plane of fat-saturated proton density-weighted magnetic resonance imaging.…”

“… 7 , 8 It has been considered a promising therapy for musculoskeletal disorders, such as cartilage defects in knee osteoarthritis and tendinopathy in lateral epicondylitis, and for promoting tendon-to-bone healing after arthroscopic rotator cuff repair. 9 , 10 , 11 , 12 Nevertheless, the clinical outcomes of PRP for ACLR are controversial 13 , 14 , 15 , 16 , 17 due to the highly variable levels of evidence, methods of preparation, timing and doses of injection, and sites of administration. Recently, meta-analyses revealed that a single dose of intraoperative PRP injection (at graft harvest sites, in femoral and tibial tunnels, or into the joint cavity) was not associated with long-term clinical or radiologic improvements at more than 6 months postoperatively.…”