Campbell Kirk A, Saltzman Bryan M, Mascarenhas Randy, Khair M Michael, Verma Nikhil N, Bach Bernard R, Cole Brian J
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.
Arthroscopy. 2015 Nov;31(11):2213-21. doi: 10.1016/j.arthro.2015.03.041. Epub 2015 May 29.
The aims of this study were (1) to perform a systematic review of meta-analyses evaluating platelet-rich plasma (PRP) injection in the treatment of knee joint cartilage degenerative pathology, (2) to provide a framework for analysis and interpretation of the best available evidence to provide recommendations for use (or lack thereof) of PRP in the setting of knee osteoarthritis (OA), and (3) to identify literature gaps where continued investigation would be suggested.
Literature searches were performed for meta-analyses examining use of PRP versus corticosteroids, hyaluronic acid, oral nonsteroidal anti-inflammatory drugs, or placebo. Clinical data were extracted, and meta-analysis quality was assessed. The Jadad algorithm was applied to determine meta-analyses that provided the highest level of evidence.
Three meta-analyses met the eligibility criteria and ranged in quality from Level II to Level IV evidence. All studies compared outcomes of treatment with intra-articular platelet-rich plasma (IA-PRP) versus control (intra-articular hyaluronic acid or intra-articular placebo). Use of PRP led to significant improvements in patient outcomes at 6 months after injection, and these improvements were seen starting at 2 months and were maintained for up to 12 months. It is unclear if the use of multiple PRP injections, the double-spinning technique, or activating agents leads to better outcomes. Patients with less radiographic evidence of arthritis benefit more from PRP treatment. The use of multiple PRP injections may increase the risk of self-limited local adverse reactions. After application of the Jadad algorithm, 3 concordant high-quality meta-analyses were selected and all showed that IA-PRP provided clinically relevant improvements in pain and function compared with the control treatment.
IA-PRP is a viable treatment for knee OA and has the potential to lead to symptomatic relief for up to 12 months. There appears to be an increased risk of local adverse reactions after multiple PRP injections. IA-PRP offers better symptomatic relief to patients with early knee degenerative changes, and its use should be considered in patients with knee OA.
Level IV, systematic review of Level II through IV studies.
本研究的目的是：（1）对评估富血小板血浆（PRP）注射治疗膝关节软骨退行性病变的荟萃分析进行系统评价；（2）提供一个分析和解释现有最佳证据的框架，以便为在膝关节骨关节炎（OA）中使用（或不使用）PRP提供建议；（3）识别建议继续进行研究的文献空白。
对比较PRP与皮质类固醇、透明质酸、口服非甾体抗炎药或安慰剂使用情况的荟萃分析进行文献检索。提取临床数据，并评估荟萃分析的质量。应用Jadad算法确定提供最高证据水平的荟萃分析。
三项荟萃分析符合纳入标准，质量范围为II级至IV级证据。所有研究均比较了关节内注射富血小板血浆（IA-PRP）与对照（关节内透明质酸或关节内安慰剂）的治疗结果。使用PRP可使注射后6个月时患者的预后得到显著改善，这些改善在2个月时开始出现，并持续长达12个月。尚不清楚多次注射PRP、二次离心技术或激活剂的使用是否能带来更好的结果。关节炎影像学证据较少的患者从PRP治疗中获益更多。多次注射PRP可能会增加自限性局部不良反应的风险。应用Jadad算法后，选择了3项一致的高质量荟萃分析，所有分析均表明，与对照治疗相比，IA-PRP在疼痛和功能方面提供了具有临床意义的改善。
IA-PRP是膝关节OA的一种可行治疗方法，有可能在长达12个月的时间内缓解症状。多次注射PRP后局部不良反应的风险似乎有所增加。IA-PRP能为早期膝关节退行性改变的患者提供更好的症状缓解，膝关节OA患者应考虑使用。
IV级，对II级至IV级研究的系统评价。
