Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
I Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy.
Knee Surg Sports Traumatol Arthrosc. 2018 Jul;26(7):1984-1999. doi: 10.1007/s00167-016-4261-4. Epub 2016 Sep 24.
PURPOSE: Platelet-rich plasma (PRP) is currently the most exploited strategy in the clinical practice to provide a regenerative stimulus for tendon healing. The aim of the present study was to systematically review the available evidence on the treatment of the main tendon disorders where PRP is currently applied. METHODS: A systematic review of the literature was performed on the use of PRP as a treatment for tendinopathies focusing on the following sites: Achilles tendon, patellar tendon, rotator cuff tendons, and lateral elbow tendons. The following inclusion criteria for relevant articles were used: clinical trials written in English language up to 21 June 2016 on the use of PRP in the conservative or surgical treatment of the aforementioned tendinopathies. RESULTS: The research identified the following clinical trials dealing with the application of PRP in the selected tendons: 19 papers on patellar tendon (6 being RCTs: 4 dealing with PRP conservative application and 2 surgical), 24 papers on Achilles tendon (4 RCTs: 3 conservative and 1 surgical), 29 on lateral elbow tendons (17 RCTs, all conservative), and 32 on rotator cuff (22 RCTs: 18 surgical and 3 conservative). CONCLUSION: Patellar tendons seem to benefit from PRP injections, whereas in the Achilles tendon, PRP application is not indicated neither as a conservative approach nor as a surgical augmentation. Lateral elbow tendinopathy showed an improvement in most of the high-level studies, but the lack of proven superiority with respect to the more simple whole-blood injections still questions its use in the clinical practice. With regard to rotator cuff pathology, the vast majority of surgical RCTs documented a lack of beneficial effects, whereas there is still inconclusive evidence concerning its conservative application in rotator cuff disorders. LEVEL OF EVIDENCE: Systematic review of level I-IV trials, Level IV.
目的:富含血小板的血浆(PRP)是目前临床实践中应用最广泛的策略,可提供肌腱愈合的再生刺激。本研究旨在系统评价 PRP 目前应用于主要肌腱疾病治疗的现有证据。
方法:对 PRP 作为治疗肌腱病的方法进行了系统的文献回顾,重点关注以下部位:跟腱、髌腱、肩袖肌腱和肘外侧肌腱。使用以下纳入标准选择相关文章:截至 2016 年 6 月 21 日,关于 PRP 在上述肌腱病的保守或手术治疗中应用的英文临床研究。
结果:研究确定了以下涉及 PRP 在选定肌腱中应用的临床试验:19 篇关于髌腱的论文(6 篇为 RCT:4 篇涉及 PRP 保守应用,2 篇手术),24 篇关于跟腱的论文(4 篇 RCT:3 篇保守治疗,1 篇手术),29 篇关于肘外侧肌腱的论文(17 篇 RCT,均为保守治疗)和 32 篇关于肩袖的论文(22 篇 RCT:18 篇手术,3 篇保守)。
结论:髌腱似乎从 PRP 注射中受益,而在跟腱中,PRP 应用既不适用于保守治疗,也不适用于手术增强。肘外侧肌腱病在大多数高水平研究中均显示出改善,但与更简单的全血注射相比,缺乏优越性仍使其在临床实践中的应用受到质疑。就肩袖病理而言,绝大多数手术 RCT 记录到缺乏有益效果,而关于其在肩袖疾病中的保守应用仍存在不确定的证据。
证据水平:I-IV 级试验的系统评价,IV 级。
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