Andia Isabel, Maffulli Nicola
Regenerative Medicine Laboratory, BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain.
Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Dentistry, Salerno, Italy; Queen Mary University of London, London, England; Barts and The London School of Medicine and Dentistry, London, England; Centre for Sports and Exercise Medicine, Mile End Hospital, London, England.
Arthroscopy. 2015 May;31(5):999-1015. doi: 10.1016/j.arthro.2014.11.024. Epub 2015 Jan 21.
To summarize clinical studies after platelet-rich plasma (PRP) therapy for tendinopathy, plantar fasciopathy, and muscle injuries; to review PRP formulations used across studies; and to identify knowledge deficits that require further investigation.
After a systematic review in PubMed, we identified clinical studies assessing PRP efficacy in tendon and muscle during the past decade. We standardized data extraction by grouping studies based on anatomic location; summarized patient populations, PRP formulations, and clinical outcomes; and identified knowledge deficits that require further investigation.
Overall, 1,541 patients had been treated with PRP in 58 clinical studies; of these, 26 addressed upper limb tendinopathies and 32 addressed the lower limb (810 patients and 731 patients treated with PRP, respectively). The quality of research is higher for the upper limb than for the lower limb (23 controlled studies, of which 17 are Level I, v 19 controlled studies, of which 6 are Level I, respectively). Patients have been treated mostly with leukocyte-platelet-rich plasma, except in the arthroscopic management of the rotator cuff. The safety and efficacy of PRP for muscle injuries has been addressed in 7 studies including 182 patients. Differences across results are mainly attributed to dissimilarities between tissues and different stages of degeneration, numbers of PRP applications, and protocols.
Given the heterogeneity in tendons and tendinopathies, currently, we are not able to decide whether PRP therapies are useful. Despite advances in PRP science, data are insufficient and there is a clear need to optimize protocols and obtain more high-quality clinical data in both tendinopathies and muscle injuries before making treatment recommendations.
Level IV, systematic review of Level I through IV studies.
总结富血小板血浆（PRP）治疗肌腱病、足底筋膜炎和肌肉损伤后的临床研究；回顾各项研究中使用的PRP制剂；并确定需要进一步研究的知识空白。
在PubMed进行系统综述后，我们确定了评估过去十年中PRP对肌腱和肌肉疗效的临床研究。我们通过根据解剖位置对研究进行分组来标准化数据提取；总结了患者群体、PRP制剂和临床结果；并确定了需要进一步研究的知识空白。
总体而言，58项临床研究中共有1541例患者接受了PRP治疗；其中，26项研究针对上肢肌腱病，32项研究针对下肢（分别有810例和731例患者接受PRP治疗）。上肢研究的质量高于下肢（上肢有23项对照研究，其中17项为I级，下肢有19项对照研究，其中6项为I级）。除了关节镜下治疗肩袖损伤外，患者大多接受富含白细胞血小板血浆治疗。7项研究（包括182例患者）探讨了PRP治疗肌肉损伤的安全性和有效性。结果差异主要归因于组织之间以及退变不同阶段的差异、PRP应用次数和方案。
鉴于肌腱和肌腱病的异质性，目前我们无法确定PRP治疗是否有用。尽管PRP科学取得了进展，但数据仍然不足，在提出治疗建议之前，显然需要优化方案并在肌腱病和肌肉损伤方面获得更多高质量的临床数据。
IV级，对I级至IV级研究的系统综述。
