NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, USA.
Liverpool Football Club, Liverpool, UK.
Am J Sports Med. 2021 Feb;49(2):529-537. doi: 10.1177/0363546520916729. Epub 2020 May 19.
Hamstring injuries are common and account for considerable time lost to play in athletes. Platelet-rich plasma has potential as a means to accelerate healing of these injuries.
(1) To present the evidence of platelet-rich plasma injection in the treatment of hamstring injuries, (2) evaluate the "best-case scenario" in dichotomous outcomes, and (3) evaluate the "worst-case scenario" in dichotomous outcomes.
Systematic review and meta-analysis.
Two authors systematically reviewed the PubMed, Embase, and Cochrane Library databases according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with any discrepancies resolved by mutual consensus. The level of evidence was assessed per the criteria of the Oxford Centre for Evidence-Based Medicine and the quality of evidence by the Coleman Methodology Score. Meta-analysis by fixed effects models was used if heterogeneity was low ( < 25%) and random effects models if heterogeneity was moderate to high (≥ 25%). values <.05 were considered statistically significant.
A total of 10 studies were included with 207 hamstring injuries in the platelet-rich plasma group and 149 in the control group. Random-effects model for mean time to return to play that compared platelet-rich plasma + physical therapy to physical therapy alone non-significantly favored platelet-rich plasma + physical therapy (mean difference, -5.67 days). The fixed effects model for reinjury rates, which also compared platelet-rich plasma + physical therapy with physical therapy alone nonsignificantly favored platelet-rich plasma + physical therapy (risk ratio, 0.88). The best-case scenario fixed effects model for reinjury rates nonsignificantly favored platelet-rich plasma + physical therapy (risk ratio, 0.82). The worst-case scenario fixed effects model for reinjury rates nonsignificantly favored physical therapy alone (risk ratio, 1.13). The mean ± SD complication rate for either postinjection discomfort, pain, or sciatic nerve irritation was 5.2% ± 2.9% (range, 2.7% to 9.1%).
There has been statistically nonsignificant evidence to suggest that PRP injection ± PT reduced mean time to RTP or reinjury rates compared to no treatment or PT alone for hamstring injuries in a short-term follow-up. The complication profiles were favorable. Further studies of high quality and large cohorts are needed to better support or disprove the consensus of the systematic review and meta-analysis.
腘绳肌损伤很常见，会导致运动员大量的比赛时间损失。富含血小板的血浆有加速这些损伤愈合的潜力。
（1）介绍富含血小板的血浆注射治疗腘绳肌损伤的证据，（2）评估二项结果中的“最佳情况”，（3）评估二项结果中的“最差情况”。
系统评价和荟萃分析。
两名作者按照 PRISMA（系统评价和荟萃分析的首选报告项目）指南系统地检索了 PubMed、Embase 和 Cochrane 图书馆数据库，任何分歧都通过共同协商解决。证据水平根据牛津循证医学中心的标准进行评估，证据质量根据 Coleman 方法学评分进行评估。如果异质性低（<25%），则使用固定效应模型进行荟萃分析；如果异质性中度到高度（≥25%），则使用随机效应模型。<0.05 被认为具有统计学意义。
共纳入 10 项研究，富含血小板的血浆组有 207 例腘绳肌损伤，对照组有 149 例。与单独物理治疗相比，比较富含血小板的血浆+物理治疗与单独物理治疗的平均重返赛场时间的随机效应模型无显著优势（平均差异，-5.67 天）。同样比较富含血小板的血浆+物理治疗与单独物理治疗的再损伤率的固定效应模型也无显著优势（风险比，0.88）。再损伤率的最佳情况固定效应模型也无显著优势（风险比，0.82）。再损伤率的最差情况固定效应模型也无显著优势（风险比，1.13）。注射后不适、疼痛或坐骨神经刺激的并发症发生率平均为 5.2%±2.9%（范围，2.7%至 9.1%）。
在短期随访中，与不治疗或单独物理治疗相比，富含血小板的血浆注射+物理治疗在减少腘绳肌损伤的平均重返赛场时间或再损伤率方面有统计学上无显著意义的证据。并发症情况良好。需要进行高质量和大样本队列的进一步研究，以更好地支持或反驳系统评价和荟萃分析的共识。
