The Effectiveness of Platelet-Rich Plasma Injection for the Treatment of Suspected Sacroiliac Joint Complex Pain; a Systematic Review

Pain Medicine ◽  
2020 ◽  
Vol 21 (10) ◽  
pp. 2518-2528 ◽  
Author(s):  
Taylor Burnham ◽  
Josh Sampson ◽  
Rebecca A Speckman ◽  
Aaron Conger ◽  
Daniel M Cushman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sacroiliac Joint ◽  
Evaluation System ◽  
Platelet Rich Plasma ◽  
Corticosteroid Injection ◽  
Case Series ◽  
Comparative Trial ◽  
Functional Improvement ◽  
Secondary Outcome ◽  
Pain Improvement

Abstract Objective To determine the effectiveness of platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) for the treatment of suspected sacroiliac joint complex (SIJC) pain. Design Systematic review. Subjects Persons aged ≥18 with suspected SIJC pain. Comparison Sham, placebo procedure, or active standard of care treatment. Outcomes The primary outcome was ≥50% pain improvement, and the secondary outcome was functional improvement of ≥30% at three or more months after the treatment intervention. Methods Publications in PubMed, MEDLINE, Embase, Scopus, and Cochrane Databases were reviewed up to April 3, 2019. Randomized or nonrandomized comparative studies and nonrandomized studies without internal controls were included. The Grades of Recommendation, Assessment, Development, and Evaluation system and the joint consensus American Academy of Orthopedic Surgery/National Institutes of Health recommendations were used for quality assessment and reporting standards. Results Query identified 151 publications; three were appropriate for inclusion. There were no studies of BMAC that met inclusion criteria. There were three eligible PRP studies: one randomized comparative trial (RCT) and two case series. In the single RCT comparing ultrasound-guided PRP with corticosteroid injection for suspected SIJC pain, the PRP group had a significantly increased likelihood of achieving ≥50% improvement of pain at three months (adjusted odds ratio = 37, 95% confidence interval [CI] = 4.65–298.69). Pooled pain outcomes from two studies showed that 28/30, 93% (95% CI = 93–100%), experienced ≥50% pain improvement at three months. Conclusions The literature supporting the effectiveness of PRP for SIJC pain is very low-quality according to the GRADE system. Well-designed RCTs and large cohort studies with consistent selection protocols and reporting characteristics are needed to determine the effectiveness of PRP and BMAC for the treatment of SIJC pain.

Treating Knee Osteoarthritis With Platelet-Rich Plasma and Hyaluronic Acid Combination Therapy: A Systematic Review

2021 ◽  
pp. 036354652199801
Author(s):  
Michael R. Baria ◽  
W. Kelton Vasileff ◽  
James Borchers ◽  
Alex DiBartola ◽  
David C. Flanigan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hyaluronic Acid ◽  
Combination Therapy ◽  
Knee Osteoarthritis ◽  
Platelet Rich Plasma ◽  
Case Series ◽  
Final Analysis ◽  
Preparation Technique ◽  
Randomized Studies ◽  
Patient Reported

Background: Platelet-rich plasma (PRP) and hyaluronic acid (HA) are injectable treatments for knee osteoarthritis. The focus of previous studies has compared their efficacy against each other as monotherapy. However, a new trend of combining these 2 injections has emerged in an attempt to have a synergistic effect. Purpose: To systematically review the clinical literature examining the combined use of PRP + HA. Design: Systematic review. Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed and Embase. The following search terms were used: knee osteoarthritis AND platelet rich plasma AND hyaluronic acid. The review was performed by 2 independent reviewers who applied the inclusion/exclusion criteria and independently extracted data, including methodologic scoring, PRP preparation technique, HA composition, and patient-reported outcomes (PROs). Results: A total of 431 articles were screened, 12 reviewed in full, and 8 included in the final analysis: 2 case series, 3 comparative, and 3 randomized studies. Average follow-up was 9 months. The modified Coleman Methodology Score was 38.13 ± 13.1 (mean ± SD). Combination therapy resulted in improved PROs in all studies. Of the comparative and randomized studies, 2 demonstrated that combination therapy was superior to HA alone. However, when PRP alone was used as the control arm (4 studies), combination therapy was not superior to PRP alone. Conclusion: Combination therapy with PRP + HA improves PROs and is superior to HA alone but is not superior to PRP alone.

Case series of ultrasound-guided platelet-rich plasma injections for sacroiliac joint dysfunction

2017 ◽  
Vol 30 (2) ◽  
pp. 363-370 ◽  
Author(s):  
Gordon D. Ko ◽  
Sean Mindra ◽  
Gordon E. Lawson ◽  
Scott Whitmore ◽  
Leigh Arseneau
Keyword(s):  
Sacroiliac Joint ◽  
Platelet Rich Plasma ◽  
Case Series ◽  
Ultrasound Guided ◽  
Sacroiliac Joint Dysfunction

SYSTEMATIC REVIEW WITH NETWORK META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS OF ROTATOR CUFF TEAR TREATMENT

2018 ◽  
Vol 34 (1) ◽  
pp. 78-86 ◽  
Author(s):  
Seihee Kim ◽  
Jinseub Hwang ◽  
Min Jee Kim ◽  
Jae-Young Lim ◽  
Woo Hyung Lee ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Open Surgery ◽  
Randomized Clinical Trials ◽  
Structural Integrity ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Functional Improvement ◽  
Cuff Tear

Objectives:Rotator cuff tear is the leading cause of the decline in quality of life for older adults, but comparative evidence on treatment effectiveness is lacking. This study systematically reviewed the effects of various rotator cuff tear treatments through a Bayesian meta-analysis of the related randomized clinical trials (RCTs).Methods:We searched nine electronic databases for RCTs evaluating rotator cuff tear treatments from their inception through June 2017. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the National Institute for Health and Care Excellence-Decision Support Unit guidelines (Supplementary Table 1). Outcomes included functional improvement, pain one year after surgical treatment, and tendon structural integrity. The Bayesian network meta-analysis was applied for functional improvement and pain, based on an assumption of consistency and similarity. Tendon integrity was reported descriptively.Results:Fifteen RCTs were selected. Patients undergoing physiotherapy after open surgery showed statistically significant functional improvements compared with those undergoing physiotherapy only (mean differences, 9.1 [credible interval, 0.9–17.4]). Open surgery with physiotherapy was associated with a decrease in pain 1 year after treatment compared with when physiotherapy was combined with arthroscopic rotator cuff surgery, mini open surgery, platelet-rich plasma therapy, or physiotherapy alone (absolute value of mean difference 1.2 to 1.4). The tendon integrity results were inconsistent.Conclusions:Some surgical treatments were associated with significant improvement in function and pain, but evidence regarding their comparative effectiveness is still lacking. A well-designed RCT discussing functional and structural treatment outcomes is needed in future.

The Management of Otitis Media with Early Routine Insertion of Grommets in Children with Cleft Palate—A Systematic Review

2009 ◽  
Vol 46 (1) ◽  
pp. 30-38 ◽  
Author(s):  
Sirisha Ponduri ◽  
Rebecca Bradley ◽  
Pamela E. Ellis ◽  
Sara T. Brookes ◽  
Jonathan R. Sandy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Language Development ◽  
Cleft Palate ◽  
Cohort Studies ◽  
Outcome Measures ◽  
Case Series ◽  
Secondary Outcome ◽  
Speech And Language ◽  
Historical Cohort ◽  
Speech And Language Development

Objective: To determine whether early routine grommet insertion in children with cleft palate has a beneficial effect on hearing and speech and language development compared with conservative management. Design: Systematic review of randomized controlled trials, controlled clinical trials, case series, and prospective and historical cohort studies. Main Outcome Measures: The main outcome measure was the effect of early routine grommet placement on the degree of conductive hearing loss. Secondary outcome measures included differences in hearing level, possible side effects, speech and language development, and quality of life. Results: We identified 368 citations for review. From a review of the titles, 34 potentially relevant papers were selected. Of these, 18 studies met our inclusion criteria, including eight case series, six historical cohort studies, three prospective cohort studies, and one randomized trial. Most studies were either small or of poor quality or both. The results of the studies were contradictory, with some studies suggesting early placement of grommets was beneficial and others reporting there was no benefit. Conclusions: There is currently insufficient evidence on which to base the clinical practice of early routine grommet placement in children with cleft palate.

scholarly journals The effect of corticosteroid versus platelet-rich plasma injection therapies for the management of lateral epicondylitis: A systematic review

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 11 ◽  
Author(s):  
Walid Ben-Nafa ◽  
Wendy Munro
Keyword(s):  
Systematic Review ◽  
Platelet Rich Plasma ◽  
Corticosteroid Injection ◽  
Lateral Epicondylitis ◽  
Extensor Tendon ◽  
Symptomatic Improvement ◽  
Tendon Thickness ◽  
Randomised Controlled ◽  
Level 2 ◽  
Corticosteroid Injections

Introduction: Lateral epicondylitis is a common musculoskeletal disorder of the upper limb. Corticosteroid injection has been widely used as a major mode of treatment. However, better understanding of the pathophysiology of the disease led to a major change in treating the disease, with new options including platelet-rich plasma (PRP) are currently used. Objectives/research aim: To systematically evaluate the effect of corticosteroid versus PRP injections for the treatment of LE. Hypothesis: PRP injections provide longer-term therapeutic effect and less rate of complications compared to corticosteroid injection. Level of evidence: Level 2 evidence (4 included studies are of level 1 evidence, 1 study of level 2 evidence). Design: Systematic Review (according to PRISMA guidelines). Methods: Eleven databases used to search for relevant primary studies comparing the effects of corticosteroid and PRP injections for the treatment of LE. Quality appraisal of studies performed using Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0, CASP Randomised Controlled Trial Checklist, and SIGN Methodology Checklist 2. Results: 732 papers were identified. Five randomised controlled trials (250 Patients) met the inclusion criteria. Clinical findings: Corticosteroid injections provided rapid symptomatic improvement with maximum effect at 6/8/8 weeks before symptoms recurrence, whereas PRP showed slower ongoing improvements up to 24/52/104 weeks(3 studies). Corticosteroid showed more rapid symptomatic improvement of symptoms compared to PRP up to the study end-point of 3 months(1 study). Comparable therapeutic effects of corticosteroid and PRP were observed at 6 weeks(1 study). Ultrasonographic Findings: (1) Doppler activity decreased more significantly in patients who received corticosteroid compared to PRP. (2) Reduced tendon thickness and more patients with cortical erosion noted in corticosteroid group whereas increased tendon thickness and less number of patients with common extensor tendon tears noted in PRP group. (3) Fewer patients reported Probe-induced tenderness and oedema in the common extensor tendon in both corticosteroid and PRP groups (2 studies). Conclusion: Corticosteroid injections provide rapid therapeutic effect in the short-term with recurrence of symptoms afterwards, compared to the relatively slower but longer-term effect of platelet-rich plasma.

scholarly journals Intravenous liposomal amphotericin B efficacy and safety for cutaneous and mucosal leishmaniasis: a systematic review and meta-analysis protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e045707
Author(s):  
Faheel Naeem ◽  
Keren Nathan ◽  
Jeffrey Chivinski ◽  
Taline Ekmekjian ◽  
Michael Libman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Case Series ◽  
Assessment Tools ◽  
Liposomal Amphotericin B ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Efficacy And Safety ◽  
Mucosal Leishmaniasis

IntroductionTreatment of cutaneous and mucosal leishmaniasis (CL and ML, respectively) must be individualised as there is no universal therapeutic approach. Intravenous liposomal amphotericin B (L-AmB) is an accessible and relatively safe treatment that has been increasingly used for the treatment of CL and ML. While several descriptive studies have been published on the efficacy and safety of L-AmB, there are no interventional studies. Moreover, the findings from published studies have not yet been integrated and synthesised. Therefore, we aim to evaluate and consolidate the descriptive evidence on the efficacy and the safety of Intravenous L-AmB treatment for CL and ML in both the New and Old World.Methods and analysesA systematic review of all relevant study types with no restriction on date or language of publication will be conducted. Online databases including MEDLINE, The Cochrane Library, EMBASE, EBSCO, Scopus, Ovid and WHO databases were searched on 3 April 2020. The search included all study types that assess Intravenous L-AmB treatment for CL and ML in humans. The Population, Intervention, Comparison, Outcome and Study Design strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be used to determine which studies will be selected for final inclusion. The quality of included case series and case reports will be assessed using modified quality assessment tools. A narrative synthesis of the findings will be provided and the primary outcome and secondary outcome of interest, response rate and adverse events rate, respectively, and the 95% CI will be ascertained. Estimates from individual studies will be pooled using random-effects model.Ethics and disseminationThis systematic review does not require formal ethical approval since no primary data will be collected. Findings will be disseminated through a peer-reviewed publication and relevant conferences.PROSPERO registration numberCRD42020173440.

scholarly journals Efficacy and safety of mesenchymal stem cells for the treatment of patients infected with COVID-19: a systematic review and meta-analysis protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042085
Author(s):  
Yunhui Chen ◽  
Qing Zhang ◽  
Wei Peng ◽  
Dan Liu ◽  
Yanyan You ◽  
...  
Keyword(s):  
Systematic Review ◽  
Evaluation System ◽  
Meta Analysis ◽  
Case Series ◽  
Biomedical Literature ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Progression Rate ◽  
Efficacy And Safety ◽  
Promising Therapeutic Approach

IntroductionTo date, no specific antivirus drugs or vaccines have been available to prevent or treat the COVID-19 pandemic. Mesenchymal stem cell (MSC) therapy may be a promising therapeutic approach that reduces the high mortality in critical cases. This protocol is proposed for a systematic review and meta-analysis that aims to evaluate the efficacy and safety of MSC therapy on patients with COVID-19.Methods and analysisTen databases including PubMed, EMBASE, Cochrane Library, CINAHL, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Wanfang database, China Biomedical Literature Database (CBM) and Chinese Biomedical Literature Service System (SinoMed) will be searched from inception to 1 December 2020. All published randomised controlled trials, clinical controlled trials and case series that meet the prespecified eligibility criteria will be included. The primary outcomes include mortality, incidence and severity of adverse events, respiratory improvement, days from ventilator, duration of fever, progression rate from mild or moderate to severe, improvement of such serious symptoms as difficulty breathing or shortness of breath, chest pain or pressure, and loss of speech or movement, biomarkers of laboratory examination and changes in CT. The secondary outcomes include dexamethasone doses and quality of life. Two reviewers will independently perform study selection, data extraction and assessment of bias risk. Data synthesis will be conducted using RevMan software (V.5.3.5). If necessary, subgroup and sensitivity analysis will be performed. Grading of Recommendations Assessment, Development and Evaluation system will be used to assess the strength of evidence.Ethics and disseminationEthical approval is not necessary since no individual patient or privacy data have been collected. The results of this review will be disseminated in a peer-reviewed journal or an academic conference presentation.PROSPERO registration numberCRD42020190079.

scholarly journals Comparison of the Clinical Effectiveness of Single Versus Multiple Injections of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-analysis

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711988711 ◽  
Author(s):  
Félix Vilchez-Cavazos ◽  
Juan Manuel Millán-Alanís ◽  
Jaime Blázquez-Saldaña ◽  
Neri Álvarez-Villalobos ◽  
Víctor Manuel Peña-Martínez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Single Injection ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Clinical Effectiveness ◽  
Controlled Trials ◽  
Multiple Injections ◽  
Knee Oa ◽  
Pain Improvement ◽  
Single Versus

Background: Reports have concluded that platelet-rich plasma (PRP) is an effective and safe biological approach in the treatment of knee osteoarthritis (OA). However, no consensus has been established regarding the number of injections required to observe a therapeutic effect. Purpose: To compare the clinical effectiveness reported in randomized controlled trials (RCTs) of single versus multiple PRP injections in the treatment of knee OA. Study Design: Systematic review; Level of evidence, 1. Methods: A comprehensive search was conducted for RCTs published between 1970 and 2019 that compared the effect of single versus multiple PRP injections on pain and functionality in patients with knee OA. Searched databases included MEDLINE, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. A data extraction form was designed to obtain bibliographic information of the study as well as patient, intervention, comparison, and outcomes of interest data. A random-effects model was used to pool quantitative data from the primary outcomes. Results: We included 5 clinical trials with a low-moderate risk of bias that reported data for 301 patients. Meta-analysis showed that, at 6 months after the intervention, single and multiple (double or triple) injections had similar pain improvement, with no significant differences (standardized mean difference [SMD], 0.61 [95% CI, −1.09 to 2.31]; I 2 = 97%; P = .48). A significant improvement in knee functionality was observed in favor of multiple injections (SMD, 2.29 [95% CI, 0.45-4.12]; I 2 = 97%; P = .01). Subanalysis showed that the significant improvement was only evident for the results of single versus triple injections (SMD, 3.12 [95% CI, 0.64-5.60]; I 2 = 97%; P = .01). Conclusion: According to our results, a single injection was as effective as multiple PRP injections in pain improvement; however, multiple injections seemed more effective in joint functionality than a single injection at 6 months. We consider that the available evidence is still insufficient, and future research on this specific topic is needed to confirm our results.

scholarly journals Simplicity Radiofrequency Ablation Demonstrates Greater Functional Improvement Than Analgesia: A Prospective Case Series

2021 ◽  
pp. E185-E190
Keyword(s):  
Radiofrequency Ablation ◽  
Sacroiliac Joint ◽  
Rating Scale ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Pain Clinic ◽  
Functional Improvement ◽  
Data Points ◽  
Prospective Case Series

BACKGROUND: Pain originating from the posterior sacroiliac complex is notoriously difficult to effectively treat due to its complex anatomy and variable innervation. Data on radiofrequency ablation (RFA) is limited. The Abbott Simplicity probe creates 3 monopolar lesions along the medial aspect of the sacroiliac joint and 2 bipolar lesions between the active portions of the probe. This device has been studied previously with improvement of pain-associated disability and pain reduction, but insufficient data is present to determine its utility at this time. Using the most recent literature for the potential innervation of the posterior sacroiliac joint, it is reasonable to explore this novel device and its ability to treat sacroiliac joint pain. OBJECTIVES: Identify the percentage of improved posterior sacroiliac complex pain and improved function in patients who completed posterior sacroiliac complex radiofrequency ablation using the Simplicity probe. STUDY DESIGN: Prospective case series. SETTING: A single outpatient pain clinic. METHODS: This prospective case-series occurred at an outpatient pain clinic. Data were analyzed after completion of follow-up appointments. Inclusion criteria included 2 successful lateral branch blocks. Fourteen patients with posterior sacroiliac complex pain were examined and completed sacroiliac ablation with the Simplicity probe. The numeric rating scale and the Modified Oswestry Disability Index were used as outcome measures for pain and function, respectively. The primary outcome measures were improvement in the numeric rating scale score by a reduction of 2.5 points and an improvement in Modified Oswestry Disability Index by 15% based upon previous studies demonstrating these values as the minimal clinical important difference . Patients were followed at a 3 to 6 month interval and 12 month interval (an average of 88 and 352 days, respectively). RESULTS: In total, 14 patients were examined. At the first follow-up, 29% of patients had analgesia and 38% functionally improved. At the second follow-up, 15% of patients had analgesia and 31% functionally improved. LIMITATIONS: Considering data were collected retrospectively, this study relied on completed charts. Therefore, data points of interest were limited to what was previously documented, which included multiple answers or the absence of numerical data points. In addition, patients were disproportionately female (71.4%). Data were also affected by patients lost to follow-up. Also, this study examined a relatively small number of patients, therefore the results should be carefully considered. CONCLUSIONS: Radiofrequency ablation of the posterior sacroiliac complex with the Simplicity probe resulted in more functional improvement than analgesia. This study provides more data for clinicians to utilize in managing posterior sacroiliac complex pain. IRB: Protocol number 20170342HU. Not registered in clinical trials. KEY WORDS: Posterior sacroiliac complex, sacroiliac pain, chronic low back pain, radiofrequency denervation, functional improvement, strip lesion, multi-lesion, Simplicity probe

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