Sports Surgery Clinic, Ireland; Royal College of Surgeons in Ireland, Dublin; National University of Ireland, Galway, Ireland.
Sports Surgery Clinic, Ireland; Royal College of Surgeons in Ireland, Dublin; National University of Ireland, Galway, Ireland.
Arthroscopy. 2020 Apr;36(4):1204-1210. doi: 10.1016/j.arthro.2019.11.004. Epub 2020 Jan 25.
To perform a systematic review of the randomized controlled trials (RCTs) evaluating the efficacy of platelet-rich plasma (PRP) to augment anterior cruciate ligament (ACL) reconstruction.
Two independent reviewers screened the MEDLINE, The Cochrane Library, and EMBASE databases using Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines for applicable RCTs evaluating the efficacy of PRP in ACL reconstruction. A meta-analysis was performed on the papers involving bone-patellar tendon-bone (BPTB) grafting.
Thirteen RCTs fulfilled the inclusion criteria involving 765 patients. There was no clinical improvement (Tegner, Lysholm, Knee Injury and Osteoarthritis Outcome Score, or International Knee Documentation Committee scores) in any of the 7 studies evaluating PRP alongside the hamstring tendon autograft ACL reconstructions versus the control. Two studies evaluating PRP for hamstring tendon autograft demonstrated significantly improved magnetic resonance imaging findings. Two studies analyzed the use of PRP with allograft ACL reconstruction showed no clinical, biochemical, or radiologic improvements in postoperative follow-up. No functional improvements were found when PRP was used alongside BPTB in 4 studies. There was no significant difference in visual analog scale score in the BPTB group (1.1 vs 1.5, P = .18), or tibial filling defects (P = .30).
This study found that the current level I evidence does not support the use of PRP to improve graft healing, improve donor-site morbidity, reduce postoperative pain levels, or improve functional outcomes following ACL reconstruction.
Level I; systematic review of level I evidence.
系统评价评估富血小板血浆（PRP）增强前交叉韧带（ACL）重建疗效的随机对照试验（RCT）。
两名独立评审员根据适用的 RCT 评估 PRP 在 ACL 重建中的疗效，使用系统评价和荟萃分析的 Preferred Reporting 指南筛选 MEDLINE、Cochrane 图书馆和 EMBASE 数据库。对涉及骨-髌腱-骨（BPTB）移植物的论文进行荟萃分析。
符合纳入标准的 13 项 RCT 共涉及 765 例患者。在 7 项评估 PRP 联合腘绳肌腱自体移植物 ACL 重建与对照组的研究中，没有任何一项研究在任何临床评估（Tegner、Lysholm、膝关节损伤和骨关节炎结局评分或国际膝关节文献委员会评分）方面显示出临床改善。两项评估 PRP 用于腘绳肌腱自体移植物的研究显示磁共振成像结果明显改善。两项分析 PRP 联合同种异体 ACL 重建的研究显示术后随访无临床、生化或影像学改善。四项研究中，当 PRP 与 BPTB 联合使用时，未发现功能改善。BPTB 组的视觉模拟评分无显著差异（1.1 对 1.5，P=.18），或胫骨填充缺陷（P=.30）。
本研究发现，目前的一级证据不支持使用 PRP 改善移植物愈合、降低供体部位发病率、减轻术后疼痛水平或改善 ACL 重建后的功能结果。
一级；一级证据的系统评价。
