Platelet-Rich Plasma Injections as a Treatment for Refractory Patellar Tendinosis: A MetaAnalysis of Randomised Trials
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Purpose: Patellar tendinosis (PT) is a common condition amongst athletes. In this study, we perform a metaanalysis on randomised controlled trials (RCTs) to evaluate the use of plateletrich plasma (PRP) for refractory PT. Methods: A literature search was undertaken in various databases from their year of inception to October 2015. The primary outcome measure was the Victorian Institute of Sports AssessmentPatella (VISAP) score. Results: We identified 2 RCTs comparing PRP injections to alternative treatment options (extracorporeal shockwave therapy [ESWT] and dry needling of the tendon). Metaanalysis showed no significant difference in mean VISAP scores between PRP injection and control at early assessment (2 or 3 months; estimated difference in means, 11.9; standard error [SE], 7.4; 95% confidence interval [CI], –2.7 to 26.4; p=0.109). However, PRP was statistically better than control with regards to VISAP scores at longer followup (6 months or longer; estimated difference in means, 12.7; SE, 4.4; 95% CI, 4.1 to 21.3; p=0.004). Conclusions: There is a paucity of RCTs evaluating the role of PRP in PT. Our results suggest that, based on limited evidence, PRP is superior over other established nonsurgical treatments (dry needling and ESWT) for refractory PT. Larger RCTs may allow better characterisation of the role of PRP in this condition.
Abstract
Purpose: Patellar tendinosis (PT) is a common condition amongst athletes. In this study, we perform a metaanalysis on randomised controlled trials (RCTs) to evaluate the use of plateletrich plasma (PRP) for refractory PT. Methods: A literature search was undertaken in various databases from their year of inception to October 2015. The primary outcome measure was the Victorian Institute of Sports AssessmentPatella (VISAP) score. Results: We identified 2 RCTs comparing PRP injections to alternative treatment options (extracorporeal shockwave therapy [ESWT] and dry needling of the tendon). Metaanalysis showed no significant difference in mean VISAP scores between PRP injection and control at early assessment (2 or 3 months; estimated difference in means, 11.9; standard error [SE], 7.4; 95% confidence interval [CI], –2.7 to 26.4; p=0.109). However, PRP was statistically better than control with regards to VISAP scores at longer followup (6 months or longer; estimated difference in means, 12.7; SE, 4.4; 95% CI, 4.1 to 21.3; p=0.004). Conclusions: There is a paucity of RCTs evaluating the role of PRP in PT. Our results suggest that, based on limited evidence, PRP is superior over other established nonsurgical treatments (dry needling and ESWT) for refractory PT. Larger RCTs may allow better characterisation of the role of PRP in this condition.
참고문헌 (29)
- Ferretti A, "The natural history of jumper’s knee : patellar or quadriceps tendonitis", Int Orthop, 8, pp.239~242 (1985)
- Lian OB, "Prevalence of jumper’s knee among elite athletes from different sports : a cross-sectional study", Am J Sports Med, 33, pp.561~567 (2005)
- Woodley BL, "Chronic tendinopathy : effectiveness of eccentric exercise", Br J Sports Med, 41, pp.188~198 (2007)
- Halpern B, "Clinical and magnetic resonance imaging outcomes following platelet rich plasma treatment for elbow tendinosis", J Arthritis, 4, pp.182~ (2015)
- Filardo G, "Platelet-rich plasma injections for the treatment of refractory Achilles tendinopathy : results at 4 years", Blood Transfus, 12, pp.533~540 (2014)
- Kon E, "Platelet-rich plasma : new clinical application : a pilot study for treatment of jumper’s knee", Injury, 40, pp.598~603 (2009)
- Filardo G, "Use of platelet-rich plasma for the treatment of refractory jumper’s knee", Int Orthop, 34, pp.909~915 (2010)
- de Almeida AM, "Patellar tendon healing with platelet-rich plasma : a prospective randomized controlled trial", Am J Sports Med, 40, pp.1282~1288 (2012)
- Lyras DN, "The effect of platelet-rich plasma gel in the early phase of patellar tendon healing", Arch Orthop Trauma Surg, 129, pp.1577~1582 (2009)
- Moher D, "Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement", Int J Surg, 8, pp.336~341 (2010)
- Visentini PJ, "The VISA score : an index of severity of symptoms in patients with jumper’s knee(patellar tendinosis) : Victorian Institute of Sport Tendon Study Group", J Sci Med Sport, 1, pp.22~28 (1998)
- Dragoo JL, "Platelet-rich plasma as a treatment for patellar tendinopathy: a double-blind, randomized controlled trial", Am J Sports Med, 42, pp.610~618 (2014)
- Vetrano M, "Platelet-rich plasma versus focused shock waves in the treatment of jumper’s knee in athletes", Am J Sports Med, 41, pp.795~803 (2013)
- Khan KM, "Patellar tendinosis (jumper’s knee): findings at histopathologic examination, US, and MR imaging: Victorian Institute of Sport Tendon Study Group", Radiology, 200, pp.821~827 (1996)
- Chen YJ, "Extracorporeal shock waves promote healing of collagenase-induced Achilles tendinitis and increase TGF-beta1 and IGF-I expression", J Orthop Res, 22, pp.854~861 (2004)
- Berta L, "Extracorporeal shock waves enhance normal fibroblast proliferation in vitro and activate mRNA expression for TGF-beta1 and for collagen types I and III", Acta Orthop, 80, pp.612~617 (2009)
- Vetrano M, "Extracorporeal shock wave therapy promotes cell proliferation and collagen synthesis of primary cultured human tenocytes", Knee Surg Sports Traumatol Arthrosc, 19, pp.2159~2168 (2011)
- Wang CJ, "Shock wave therapy induces neovascularization at the tendon-bone junction : a study in rabbits", J Orthop Res, 21, pp.984~989 (2003)
- Wang CJ, "Shock wave-enhanced neovascularization at the tendon-bone junction : an experiment in dogs", J Foot Ankle Surg, 41, pp.16~22 (2002)
- Vulpiani MC, "Jumper’s knee treatment with extracorporeal shock wave therapy : a long-term follow-up observational study", J Sports Med Phys Fitness, 47, pp.323~328 (2007)
- Wang CJ, "Extracorporeal shockwave for chronic patellar tendinopathy", Am J Sports Med, 35, pp.972~978 (2007)
- Housner JA, "Should ultrasound-guided needle fenestration be considered as a treatment option for recalcitrant patellar tendinopathy? A retrospective study of 47 cases", Clin J Sport Med, 20, pp.488~490 (2010)
- Nagraba L, "Dry needling as a method of tendinopathy treatment", Ortop Traumatol Rehabil, 15, pp.109~116 (2013)
- Bahr R, "Surgical treatment compared with eccentric training for patellar tendinopathy(jumper’s knee) : a randomized, controlled trial", J Bone Joint Surg Am, 88, pp.1689~1698 (2006)
- Peers KH, "Cross-sectional outcome analysis of athletes with chronic patellar tendinopathy treated surgically and by extracorporeal shock wave therapy", Clin J Sport Med, 13, pp.79~83 (2003)
- Andres BM, "Treatment of tendinopathy : what works, what does not, and what is on the horizon", Clin Orthop Relat Res, 466, pp.1539~1554 (2008)
- Dhurat R, "Principles and methods of preparation of platelet-rich plasma : a review and author’s perspective", J Cutan Aesthet Surg, 7, pp.189~197 (2014)
- Kim ES, "Platelet concentration and its effect on bone formation in calvarial defects : an experimental study in rabbits", J Prosthet Dent, 86, pp.428~433 (2001)
- Sanchez AR, "Is platelet-rich plasma the perfect enhancement factor? A current review", Int J Oral Maxillofac Implants, 18, pp.93~103 (2003)