Midwest Orthopedics at Rush University, Chicago, Illinois, U.S.A.
Midwest Orthopedics at Rush University, Chicago, Illinois, U.S.A..
Arthroscopy. 2020 Jun;36(6):1765-1774. doi: 10.1016/j.arthro.2020.01.038. Epub 2020 Feb 10.
To systematically review the literature on meniscal repair surgery and assess functional and radiographic outcomes of platelet-rich plasma (PRP)-augmented repair compared with standard repair techniques.
A systematic review of the literature was completed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using the PubMed, MEDLINE, Embase, and Cochrane databases. The inclusion criteria included all human studies testing PRP augmentation of meniscal repair written in the English language. All cadaveric, animal, and basic science studies were excluded from review. The quality of the included publications was assessed prior to data extraction through the Jadad score. Risk of bias was further determined by Methodological Index for Non-randomized Studies (MINORS) and Cochrane risk-of-bias assessments. Heterogeneity in outcomes reported across studies was evaluated using I statistic calculations.
A total of 5 studies (1 with Level I evidence; 1, Level II; and 3, Level III) met the inclusion criteria for this review, all comparing PRP augmentation of meniscal repair surgery versus meniscal repair with no augmentation. Overall quality and risk of bias in the included studies varied substantially (Jadad score, 1-5; Methodological Index for Non-randomized Studies score, 7-18). Three comparative studies found no significant difference in outcome or failure, whereas the other two showed a significant improvement in PRP-augmented repairs at final follow-up. Two studies assessed healing with postoperative magnetic resonance imaging or second-look arthroscopy, with both showing significantly improved outcomes in the PRP-treated groups (P < .01 and P = .048). PRP preparation techniques and composition differed among all studies and were inconsistently reported.
In early and limited investigations, there is insufficient evidence to support PRP augmentation of meniscal repair surgery improving functional and radiographic outcomes and resulting in lower failure rates compared with standard repair techniques. There is considerable heterogeneity in the reporting and preparation of PRP used for augmentation.
Level III, systematic review of Level I to III studies.
系统回顾关于半月板修复手术的文献，并评估富血小板血浆（PRP）增强修复与标准修复技术相比的功能和影像学结果。
根据系统评价和荟萃分析（PRISMA）指南，使用 PubMed、MEDLINE、Embase 和 Cochrane 数据库进行系统文献回顾。纳入标准包括所有测试 PRP 增强半月板修复的人类研究，语言为英文。所有尸体、动物和基础科学研究均排除在综述之外。在提取数据之前，通过 Jadad 评分评估纳入文献的质量。通过方法学非随机研究指数（MINORS）和 Cochrane 偏倚风险评估进一步确定偏倚风险。使用 I 统计量评估研究间报告的结果的异质性。
共有 5 项研究（1 项具有 I 级证据；1 项具有 II 级证据；3 项具有 III 级证据）符合本综述的纳入标准，均比较了 PRP 增强半月板修复手术与无增强半月板修复手术。纳入研究的整体质量和偏倚风险差异很大（Jadad 评分，1-5 分；方法学非随机研究指数评分，7-18 分）。三项比较研究发现，在结果或失败方面没有显著差异，而另外两项研究在最终随访时显示 PRP 增强修复有显著改善。两项研究通过术后磁共振成像或二次关节镜检查评估愈合情况，均显示 PRP 治疗组的结果显著改善（P <.01 和 P =.048）。所有研究的 PRP 制备技术和组成均不同，且报告不一致。
在早期和有限的研究中，没有足够的证据支持 PRP 增强半月板修复手术改善功能和影像学结果，并与标准修复技术相比降低失败率。PRP 用于增强的报告和制备存在相当大的异质性。
III 级，对 I 级至 III 级研究的系统评价。
