Platelet-Rich Plasma Augmentation for Isolated Arthroscopic Meniscal Repairs Leads to Significantly Lower Failure Rates: A Systematic Review of Comparative Studies

Background: Studies have reported relatively high failure rates of isolated meniscal repairs. Platelet-rich plasma (PRP) has been suggested as a way to increase growth factors that enhance healing. Purpose: To compare (1) meniscal repair failures and (2) patient-reported outcomes after isolated arthroscopic meniscal repair augmented with and without PRP. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed using the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. Multiple databases were searched for studies that compared outcomes of isolated arthroscopic meniscal repair augmented with PRP versus without PRP in human patients. Failures and patient-reported outcome scores were reported for each study and compared between groups. Study heterogeneity was assessed using I 2 for each outcome measure before meta-analysis. Study methodological quality was analyzed. Continuous variable data were reported as mean and standard deviation from the mean. Categorical variable data were reported as frequency with percentage. All P values were reported with significance set at P < .05. Results: Five articles were analyzed (274 patients [110 with PRP and 164 without PRP]; 65.8% male; mean age, 29.1 ± 4.6 years; mean follow-up, 29.2 ± 22.1 months). The risk of meniscal repair failure ranged from 4.4% to 26.7% for PRP-augmented repairs and 13.3% to 50.0% for repairs without PRP. Meniscal repairs augmented with PRP had significantly lower failure rates than repairs without PRP (odds ratio, 0.32; 95% CI, 0.12-0.90; P = .03). One of the 5 studies reported significantly higher outcomes in the PRP-augmented group versus the no-PRP group for the International Knee Documentation Committee (IKDC), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee injury and Osteoarthritis Outcome Score (KOOS) ( P < .05 for all). The remaining 4 studies reported no significant difference between groups with regard to outcomes for the IKDC, Lysholm knee scale, visual analog scale for pain, or Tegner activity level. Conclusion: Although the studies were of mostly of low quality, isolated arthroscopic meniscal repairs augmented with PRP led to significantly lower failure rates (10.8% vs 27.0%; odds ratio, 0.32; P = .03) as compared with repairs without PRP. However, most studies reported no significant differences in patient-reported outcomes.

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The impact of platelet-rich plasma on postoperative outcomes after spinal fusion: a systematic review and meta-analysis

Journal of Neurosurgery Spine ◽

10.3171/2020.3.spine2046 ◽

2020 ◽

Vol 33 (4) ◽

pp. 540-547 ◽

Cited By ~ 1

Author(s):

Yagiz Ugur Yolcu ◽

Waseem Wahood ◽

Abdullah T. Eissa ◽

Mohammed Ali Alvi ◽

Brett A. Freedman ◽

...

Keyword(s):

Systematic Review ◽

Bone Graft ◽

Spinal Fusion ◽

Literature Search ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Significant Difference ◽

Patient Reported ◽

Vas Scores ◽

The Impact

OBJECTIVEPlatelet-rich plasma (PRP) is a biological agent obtained by centrifuging a sample of blood and retrieving a high concentration of platelets and plasma components. The concentrate is then stimulated for platelet secretion of various growth factors and cytokines. Although it is not widely used in clinical practice, its role in augmenting bony union among patients undergoing spinal fusion has been assessed in several clinical studies. The objective of this study was to perform a systematic review and meta-analysis of the existing literature to determine the efficacy of PRP use in spinal fusion procedures.METHODSA comprehensive literature search was conducted using PubMed, Scopus, and EMBASE for studies from all available dates. From eligible studies, data regarding the fusion rate and method of assessing fusion, estimated blood loss (EBL), and baseline and final visual analog scale (VAS) scores were collected as the primary outcomes of interest. Patients were grouped by those undergoing spinal fusion with PRP and bone graft (PRP group) and those only with bone graft (graft-only group).RESULTSThe literature search resulted in 207 articles. Forty-five full-text articles were screened, of which 11 studies were included, resulting in a meta-analysis including 741 patients. Patients without PRP were more likely to have a successful fusion at the last follow-up compared with those with PRP in their bone grafts (OR 0.53, 95% CI 0.34–0.84; p = 0.006). There was no statistically significant difference with regard to change in VAS scores (OR 0.00, 95% CI −2.84 to 2.84; p > 0.99) or change in EBL (OR 3.67, 95% CI −67.13–74.48; p = 0.92) between the groups.CONCLUSIONSThis study found that the additional use of PRP was not associated with any significant improvement in patient-reported outcomes and was actually found to be associated with lower fusion rates compared with standard grafting techniques. Thus, PRP may have a limited role in augmenting spinal fusion.

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Meniscus repair failure risk does not differ by sex: a systematic review

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2019-000379 ◽

2020 ◽

Vol 5 (2) ◽

pp. 98-102

Author(s):

Christopher Hamilton ◽

David C Flanigan ◽

Kishan H Patel ◽

Nathaniel Lundy ◽

Ryan Blackwell ◽

...

Keyword(s):

Systematic Review ◽

Patient Reported Outcomes ◽

Meniscus Repair ◽

Published Data ◽

Level Of Evidence ◽

Female Patients ◽

Failure Risk ◽

Significant Difference ◽

Patient Reported ◽

Meta Analyses

ImportanceMeniscus tears are common knee pathologies that are frequently treated with meniscus repair with a variety of techniques. Regardless of technique and implant choice, it is critical to understand and consider patient factors, including patient sex, which can influence outcome.ObjectiveWe sought to determine if there is an effect of sex on failure risk following meniscus repair.Evidence reviewA systematic review of the literature was undertaken to identify studies that reported failure risk independently for male and female patients. Meta-analyses were performed to identify the effect of patient sex on meniscus repair failure risk. Differences in patient-reported outcomes by sex were reported qualitatively.FindingsA total of 886 patients analysed were included in the 11 identified studies, including 556 males and 330 females. Meniscus repair failure was reported in 192 patients (21.7%). The failure risk was 21.1% in males and 21.5% in females. Meta-analyses demonstrated no significant difference in meniscus repair failure risk based on sex in neither the three studies that assessed repair success arthroscopically (p=0.66) nor the eight studies in which failure was defined with clinical assessment or as the need for repeat surgery (p=0.92).Conclusions and relevanceThere are no significant differences in meniscus repair failure risk in male versus female patients in the existing literature. More published data are needed to evaluate patient-reported outcomes of meniscus repair based on sex.Level of evidenceIV, systematic review.

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Acute ACL reconstruction shows superior clinical results and can be performed safely without an increased risk of developing arthrofibrosis

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-019-05722-w ◽

2019 ◽

Vol 28 (7) ◽

pp. 2036-2043 ◽

Cited By ~ 3

Author(s):

Christoffer von Essen ◽

Karl Eriksson ◽

Björn Barenius

Keyword(s):

Range Of Motion ◽

Acl Reconstruction ◽

Patient Reported Outcomes ◽

Activity Level ◽

Knee Ligament ◽

Acute Group ◽

Increased Risk ◽

Significant Difference ◽

Patient Reported ◽

Delayed Group

Abstract Purpose To compare acute ACL reconstruction (ACLR) within 8 days of injury with delayed reconstruction after normalized range of motion (ROM), 6–10 weeks after injury. It was hypothesized that acute ACL reconstruction with modern techniques is safe and can be beneficial in terms of patient-reported outcomes and range of motion. Methods The effect of acute and delayed ACLR was randomized studied on 70 patients with high recreational activity level, Tegner level 6 or more, between 2006 and 2013. Patient-reported outcomes, objective IKDC, KOOS, and manual stability measurements were documented during the 24-month follow-up period. Results The acute ACLR group did not result in increased stiffness and showed superior outcome regarding strength and how the patient felt their knee functioning at 24 months. In addition, the acute group was not inferior to the delayed group in any assessment. Regarding patient-related outcomes in KOOS, both groups showed significant improvements in all subscales, but no difference was found between the groups. Functional return (FR) rate was almost double compared to the Swedish knee ligament register and treatment failure (TF) rate was reduced by half, no significant difference between the groups. No difference regarding cyclops removal, re-injury of ACL or meniscus was found between the two surgical timing groups. Conclusion Acute ACLR within 8 days of injury does not appear to adversely affect ROM or result in increased stiffness in the knee joint and was not inferior to the delayed group in any assessment when compared to delayed surgery. Level of evidence I.

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Effect of Gender Differences on Patient-Reported Outcomes and Complications in Total Ankle Replacement

Foot & Ankle International ◽

10.1177/1071100720985292 ◽

2021 ◽

pp. 107110072098529

Author(s):

Amanda N. Fletcher ◽

Kush S. Mody ◽

Samuel B. Adams ◽

James K. DeOrio ◽

Mark E. Easley ◽

...

Keyword(s):

Gender Differences ◽

Patient Outcomes ◽

Inflammatory Arthritis ◽

Patient Reported Outcomes ◽

Total Ankle Replacement ◽

Failure Rates ◽

Ankle Replacement ◽

Sf 36 ◽

Significant Difference ◽

Patient Reported

Background: The purpose of this study was to evaluate gender differences in patient outcomes and complications following total ankle replacement (TAR). Methods: Consecutive patients who underwent primary TAR from July 2007 through May 2016 were prospectively followed and retrospectively reviewed. Demographic, operative, patient-reported outcomes (PROs), and complication data were collected and analyzed. PROs included the visual analog scale (VAS), 36-Item Short-Form Health Survey (SF-36), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale, and Short Musculoskeletal Function Assessment (SMFA). A total of 475 patients were evaluated, including 248 males (52.2%) and 227 females (47.8%) with an average of 56.8 months follow-up. Results: Women were more likely to have inflammatory arthritis (13.7% vs 2.8%; P < .01) and significantly worse preoperative SF-36 total, SF-36 mental health component, AOFAS total, AOFAS pain, SMFA function, and SMFA bother scores (all P < .05). Both genders demonstrated significant improvement in PROs at 1, 2, and 5 years. The magnitude of improvement was similar between genders for all PROs (all P < .05) with the exception of SF-36 physical function, which was greater in men. Females underwent more nonrevision reoperations (32.2% vs 22.6%; P = .0191), but there was no significant difference in failure rates (male 7.3% vs female 3.5%; P = .07). The reoperation and failure rates at 2 years postoperation were 10.1% and 1.6% for men and 18.5% and 0.9% for women, respectively. Conclusions: Women undergoing TAR were more likely to have worse preoperative PROs and higher rates of nonrevision reoperations, which remains true when controlling for their increased incidence of inflammatory arthritis. However, women reported similar improvements in PROs and had similar prosthetic survival rates as men. Increased understanding of these disparities, combined with gender-based interventions, may further advance patient outcomes. Level of Evidence: Level III, therapeutic, retrospective comparative series

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Preparation Methods and Clinical Outcomes of Platelet-Rich Plasma for Intra-articular Hip Disorders: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120960414 ◽

2020 ◽

Vol 8 (10) ◽

pp. 232596712096041

Author(s):

Flávio Luís Garcia ◽

Brady T. Williams ◽

Evan M. Polce ◽

Daniel B. Heller ◽

Zachary S. Aman ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Clinical Outcomes ◽

Randomized Clinical Trials ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Preparation Methods ◽

Significant Difference ◽

Patient Reported

Background: Despite its increasing use in the management of musculoskeletal conditions, questions remain regarding the preparation methods of platelet-rich plasma (PRP) and its clinical applications for intra-articular hip disorders, including femoroacetabular impingement syndrome (FAIS), labral pathology, and osteoarthritis (OA). Purpose: To systematically review and assess the preparation methods and clinical outcomes from randomized clinical trials (RCTs) on the use of PRP for intra-articular hip disorders. Study Design: Systematic review; Level of evidence, 2. Methods: A systematic review in accordance with the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed in September 2019. The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed, Ovid Medline, and Embase were queried for studies regarding the use of PRP to treat intra-articular hip disorders. Qualifying articles were English-language RCTs describing the use of PRP for intra-articular hip disorders, either as standalone treatment or surgical augmentation. Two authors independently assessed article eligibility. Data pertaining to patient characteristics, indication for treatment, PRP preparation method, follow-up period, and clinical outcomes were extracted. Study results were qualitatively reported and quantitatively compared using meta-analysis when appropriate. Results: Seven RCTs met inclusion criteria. Four studies described the use of PRP for hip OA and 3 utilized PRP at arthroscopy for FAIS and labral tears. Outcomes after PRP for OA demonstrated improvement in validated patient-reported outcome measures for up to 1 year; however, pooled effect sizes found no statistically significant difference between PRP and hyaluronic acid (HA) regarding pain visual analog scale scores at short-term (≤2 months; P = .27), midterm (4-6 months; P = .85), or long-term (1 year; P = .42) follow-up. When injected at arthroscopy, 1 study reported improved outcomes, 1 reported no difference in outcomes, and 1 reported worse outcomes compared with controls. The meta-analysis demonstrated no statistically significant difference on the modified Harris Hip Score (mHHS) between PRP and control cohorts at a minimum 1-year follow-up. There were considerable deficiencies and heterogeneity in the reporting of PRP preparation methods for both indications. Conclusion: Treatment of OA with PRP demonstrated reductions in pain and improved patient-reported outcomes for up to 1 year. However, there was no statistically significant difference between PRP and HA in pain reduction. Likewise, for FAIS and labral surgery there was no statistically significant difference in mHHS outcomes between patients treated with PRP and controls. Given the limited number of studies and variability in PRP preparations, additional high-quality randomized trials are warranted.

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Enhanced Recovery Experience After Orthopaedic Surgery: A Systematic Review of Patient-Reported Outcomes

International Journal of Medicine in Developing Countries ◽

10.24911/ijmdc.51-1544989841 ◽

2019 ◽

pp. 108-112

Author(s):

Muath Alturkistani ◽

Ali Alahmari ◽

Hussam Alhumaidi ◽

Mohammed Alharbi ◽

Alhanouf Alqernas ◽

...

Keyword(s):

Systematic Review ◽

Orthopaedic Surgery ◽

Patient Reported Outcomes ◽

Enhanced Recovery ◽

Patient Reported

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The Patient-Reported Outcomes Measurement Information System in spine surgery: a systematic review

Journal of Neurosurgery Spine ◽

10.3171/2018.8.spine18608 ◽

2019 ◽

Vol 30 (3) ◽

pp. 405-413 ◽

Cited By ~ 11

Author(s):

Brittany E. Haws ◽

Benjamin Khechen ◽

Mundeep S. Bawa ◽

Dil V. Patel ◽

Harmeet S. Bawa ◽

...

Keyword(s):

Systematic Review ◽

Information System ◽

Patient Reported Outcomes ◽

Neck Disability Index ◽

Measurement Information ◽

Strong Correlations ◽

Comprehensive Overview ◽

Outcomes Measurement ◽

Patient Reported ◽

Measurement Information System

OBJECTIVEThe Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to provide a standardized measure of clinical outcomes that is valid and reliable across a variety of patient populations. PROMIS has exhibited strong correlations with many legacy patient-reported outcome (PRO) measures. However, it is unclear to what extent PROMIS has been used within the spine literature. In this context, the purpose of this systematic review was to provide a comprehensive overview of the PROMIS literature for spine-specific populations that can be used to inform clinicians and guide future work. Specifically, the authors aimed to 1) evaluate publication trends of PROMIS in the spine literature, 2) assess how studies have used PROMIS, and 3) determine the correlations of PROMIS domains with legacy PROs as reported for spine populations.METHODSStudies reporting PROMIS scores among spine populations were identified from PubMed/MEDLINE and a review of reference lists from obtained studies. Articles were excluded if they did not report original results, or if the study population was not evaluated or treated for spine-related complaints. Characteristics of each study and journal in which it was published were recorded. Correlation of PROMIS to legacy PROs was reported with 0.1 ≤ |r| < 0.3, 0.3 ≤ |r| < 0.5, and |r| ≥ 0.5 indicating weak, moderate, and strong correlations, respectively.RESULTSTwenty-one articles were included in this analysis. Twelve studies assessed the validity of PROMIS whereas 9 used PROMIS as an outcome measure. The first study discussing PROMIS in patients with spine disorders was published in 2012, whereas the majority were published in 2017. The most common PROMIS domain used was Pain Interference. Assessments of PROMIS validity were most frequently performed with the Neck Disability Index. PROMIS domains demonstrated moderate to strong correlations with the legacy PROs that were evaluated. Studies assessing the validity of PROMIS exhibited substantial variability in PROMIS domains and legacy PROs used for comparisons.CONCLUSIONSThere has been a recent increase in the use of PROMIS within the spine literature. However, only a minority of studies have incorporated PROMIS for its intended use as an outcomes measure. Overall, PROMIS has exhibited moderate to strong correlations with a majority of legacy PROs used in the spine literature. These results suggest that PROMIS can be effective in the assessment and tracking of PROs among spine populations.

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

The American Journal of Sports Medicine ◽

10.1177/0363546521998010 ◽

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.

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