The Effects of Platelet-Rich Plasma in Conjunction with Rehabilitation for Lower Extremity Musculoskeletal Pathologies A Systematic Review with Meta-Analysis
Main Article Content
Keywords
Exercise, Platelet-rich plasma, Rehabilitation
Abstract
Background: Platelet-rich plasma (PRP) has been considered for its role in facilitating the body’s own healing processes, with the potential to complement rehabilitation in the management of lower extremity
musculoskeletal pathologies.
Methods: Eligible studies were randomized clinical trials and quasi-experimental trials with completed data analysis; published in English; recruited participants aged >18 years; had at least two groups, with one intervention group receiving PRP injection alone or PRP injection and rehabilitation, and the comparison group receiving either rehabilitation alone or a control group receiving saline and rehabilitation; included at least one outcome measure of pain, disability, quality of life, or return to play. An electronic search was conducted using PubMed, Embase, Cochrane, Pedro, and clinicaltrials.gov. Methodological quality was assessed using the Cochrane Collaboration Risk of Bias (RoB) tool. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the quality of evidence. Meta-analyses were conducted across outcomes in each pathology when possible.
Results: Twenty-one studies assessed Achilles rupture, Achilles tendinopathy, lateral ankle sprain, high ankle sprain, hamstring injury, knee osteoarthritis, acute muscle injury, patellar tendinopathy, and plantar fasciitis, with an average RoB score of 9.9 out of 12. Meta-analyses for Achilles rupture (n = 270) revealed a nonsignificant effect on disability in the short and long term (high level of evidence) when comparing PRP, immobilization, and exercise/physical therapy to placebo, immobilization, and exercise/physical therapy. Meta-analyses for Achilles tendinopathy revealed a nonsignificant effect on pain (n = 64) in the short term, and disability in the short (n = 138) as well as long term (n = 192) (very low to low level of evidence) when comparing PRP and exercise to placebo and exercise.
Conclusions: While individual studies demonstrated significant findings across outcomes, the non-significant pooled results and inability to perform further meta-analyses made it difficult to provide definitive recommendations for the addition of PRP to exercise for lower extremity musculoskeletal pathologies. Future studies should standardized PRP exercise rehabilitation protocols with better dosage parameters, consider larger sample sizes, and have short and long term follow-up periods consistent with the Cochrane Collaboration.
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3. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646-56. https://www.ncbi.nlm.nih.gov/pubmed/14710506
4. Bachynsky N. Implications for policy: The Triple Aim, Quadruple Aim, and interprofessional collaboration. Nurs Forum. 2020;55(1):54-64. https://www.ncbi.nlm.nih.gov/pubmed/31432533
5. Transparency market research, platelet rich plasma (PRP) market (type—Pureplatelet rich plasma (P-PRP), leukocyteplatelet rich plasma (L-PRP), and pure-platelet-rich fibrin (P-PRF); origin— Autologous, homologous, and allogeneic; application—Orthopedic surgery, neurosurgery, cosmetic surgery, general surgery, urological surgery, cardiothoracic surgery, and periodontal surgery)—Global industry analysis, size, share, growth, trends and forecast 2016–2024. Albany, NY. 2016 [Available from: https://wwwtransparencymarketresearch.com/platelet-rich-plasma-market.html.
6. Kolber MJ, Purita J, Paulus C, Carreno JA, Hanney WJ. Platelet rich plasma: postprocedural considerations for the sports medicine professional. Strength Cond J. 2018;40:95-107.
7. Kolber MJ, Purita J, Paulus C, Carreno JA, Hanney WJ. Platelet-rich plasma: basic science and biological effects. Strength Cond J. 2018;40:77-94.
8. Kolber MJ, Salamh PA. Platelet-rich plasma: have we reached a consensus or understanding? Strength Cond J. 2019;41:81-6.
9. Dallari D, Tschon M, Sabbioni G, Giavaresi G. PRP and HA for Hip Osteoarthritis: Response. Am J Sports Med. 2016;44(9):NP44-6. https://www.ncbi.nlm.nih.gov/pubmed/27587846
10. Kothari SY, Srikumar V, Singh N. Comparative Efficacy of Platelet Rich Plasma Injection, Corticosteroid Injection and Ultrasonic Therapy in the Treatment of Periarthritis Shoulder. J Clin Diagn Res. 2017;11(5):RC15-RC8. https://www.ncbi.nlm.nih.gov/pubmed/28658861
11. Shen L, Yuan T, Chen S, Xie X, Zhang C. The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res. 2017;12(1):16. https://www.ncbi.nlm.nih.gov/pubmed/28115016
12. Robins R. Platelet rich plasma: Current indications and use in orthopaedic care. Med Res Arch. 2017;5(6):1-17.
13. Navani A, Li G, Chrystal J. Platelet Rich Plasma in Musculoskeletal Pathology: A Necessary Rescue or a Lost Cause? Pain Physician. 2017;20(3):E345-E56. https://www.ncbi.nlm.nih.gov/pubmed/28339434
14. Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev. 2014(4):CD010071. https://www.ncbi.nlm.nih.gov/pubmed/24782334
15. Bureau of Labor Statistics, U.S. Department of Labor, The Economics Daily, Sports and exercise among Americans. 2016 [Available from: https://www.bls.gov/opub/ted/2016/sports-and-exercise-among-americans.htm.
16. Sheu Y, Chen LH, Hedegaard H. Sports- and Recreation-related Injury Episodes in the United States, 2011-2014. Natl Health Stat Report. 2016(99):1-12. https://www.ncbi.nlm.nih.gov/pubmed/27906643
17. Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014;48(21):1543-52. https://www.ncbi.nlm.nih.gov/pubmed/25157180
18. Clanton TO, Matheny LM, Jarvis HC, Jeronimus AB. Return to play in athletes following ankle injuries. Sports Health. 2012;4(6):471-4. https://www.ncbi.nlm.nih.gov/pubmed/24179584
19. Angoorani H, Mazaherinezhad A, Marjomaki O, Younespour S. Treatment of knee osteoarthritis with platelet-rich plasma in comparison with transcutaneous electrical nerve stimulation plus exercise: a randomized clinical trial. Med J Islam Repub Iran. 2015;29:223. https://www.ncbi.nlm.nih.gov/pubmed/26478881
20. Blanco-Rivera J, Elizondo-Rodriguez J, Simental-Mendia M, Vilchez-Cavazos F, Pena-Martinez VM, Acosta-Olivo C. Treatment of lateral ankle sprain with platelet-rich plasma: A randomized clinical study. Foot Ankle Surg. 2020;26(7):750-4. https://www.ncbi.nlm.nih.gov/pubmed/31640921
21. Boesen AP, Boesen MI, Hansen R, Barfod KW, Lenskjold A, Malliaras P, et al. Effect of Platelet-Rich Plasma on Nonsurgically Treated Acute Achilles Tendon Ruptures: A Randomized, Double-Blinded Prospective Study. Am J Sports Med. 2020;48(9):2268-76. https://www.ncbi.nlm.nih.gov/pubmed/32485112
22. Boesen AP, Hansen R, Boesen MI, Malliaras P, Langberg H. Effect of High-Volume Injection, Platelet-Rich Plasma, and Sham Treatment in Chronic Midportion Achilles Tendinopathy: A Randomized Double-Blinded Prospective Study. Am J Sports Med. 2017;45(9):2034-43. https://www.ncbi.nlm.nih.gov/pubmed/28530451
23. Bubnov R, Yevseenko V, Semeniv I. Ultrasound guided injections of platelets rich plasma for muscle injury in professional athletes. Comparative study. Med Ultrason. 2013;15(2):101-5. https://www.ncbi.nlm.nih.gov/pubmed/23702498
24. Chew KT, Leong D, Lin CY, Lim KK, Tan B. Comparison of autologous conditioned plasma injection, extracorporeal shockwave therapy, and conventional treatment for plantar fasciitis: a randomized trial. PM R. 2013;5(12):1035-43. https://www.ncbi.nlm.nih.gov/pubmed/23973504
25. de Jonge S, de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, et al. One-year follow-up of platelet-rich plasma treatment in chronic Achilles tendinopathy: a double-blind randomized placebo-controlled trial. Am J Sports Med. 2011;39(8):1623-9. https://www.ncbi.nlm.nih.gov/pubmed/21602565
26. de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H, et al. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010;303(2):144-9. https://www.ncbi.nlm.nih.gov/pubmed/20068208
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Aug 23, 2022
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Masaracchio, M., & Kirker, K. (2022). The Effects of Platelet-Rich Plasma in Conjunction with Rehabilitation for Lower Extremity Musculoskeletal Pathologies: A Systematic Review with Meta-Analysis. Biologic Orthopedics Journal, 4(SP1), e30-e60. https://doi.org/10.22374/boj.v4iSP1.47
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Author Biography
Kaitlin Kirker, Department of Physical Therapy, Long Island University, Brooklyn, NY
Department of Physical Therapy, Long Island University, Brooklyn, NY