自体富血小板血浆注射治疗 3 级有症状退行性半月板病变的疗效：为期 1 年的前瞻性研究。
Efficacy of Autologous Platelet-Rich Plasma Injections for Grade 3 Symptomatic Degenerative Meniscal Lesions: A 1-Year Follow-up Prospective Study.
机构信息
Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy.
Clinica Ortopedica e Traumatologica, Ospedale Policlinico San Martino, Genoa, Italy.
出版信息
Sports Health. 2022 Mar-Apr;14(2):227-236. doi: 10.1177/19417381211011074. Epub 2021 Apr 24.
BACKGROUND
Platelet-rich plasma (PRP) injections have been proposed as a biologic option to provide symptomatic relief and delay surgery in patients with degenerative joint disease of osteoarthritis (OA). The efficacy of autologous PRP on symptomatic degenerative meniscal lesions (DMLs) has never been investigated.
HYPOTHESIS
We hypothesized that patients with symptomatic DMLs without OA undergoing autologous PRP injections experience a significant clinical improvement at 12 months.
STUDY DESIGN
Prospective case series.
LEVEL OF EVIDENCE
Level 4.
METHODS
A total of 69 patients with symptomatic DMLs without radiographic evidence of knee OA (Kellgren-Lawrence radiographic grading scale 0-1) received 4 autologous PRP injections once a week. Patients were prospectively evaluated before the injection and then at 1, 3, 6, and 12 months. Evaluation was based on Lysholm knee scoring scale (primary outcome), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Tegner activity scale, and visual analogue scale scores.
RESULTS
Patients treated with PRP injections demonstrated an improving knee function and symptoms over the duration of the study. A significant improvement from baseline to 12 months was observed in all the outcome measures, and no patients experienced failure or required surgery during the follow-up. Patients younger than 50 years reported lower subjective level of pain and higher Tegner activity scale at baseline and had significantly better Lysholm knee scoring scale ( = 0.03) and WOMAC ( = 0.03) scores at 6 months, as well as better range of motion at 3, 6, and 12 months ( < 0.001). Thirty-three (47.8%) patients were very satisfied, 26 (37.7%) satisfied, 8 (11.6%) partially satisfied, and 2 (2.9 %) not satisfied, with 62 (89.8%) patients willing to repeat the same treatment. No patient was lost to follow-up and no patient experienced adverse reaction, infection, failure, recurrence or underwent further surgery.
CONCLUSION
PRP injections provide short-term benefits in symptomatic DMLs. Although promising results were evident at 12 months, this is a preliminary study and no definitive recommendation can be made based, for example, on longer follow-up.
CLINICAL RELEVANCE
This research supports the use of autologous PRP injections for symptomatic DMLs.
背景
富含血小板的血浆（PRP）注射已被提议作为一种生物选择，为退行性骨关节炎（OA）患者的退行性关节疾病提供症状缓解并延迟手术。自体 PRP 对有症状的半月板退行性病变（DML）的疗效从未被研究过。
假设
我们假设患有 DML 且没有 OA 症状的患者接受自体 PRP 注射治疗后，在 12 个月时会有明显的临床改善。
研究设计
前瞻性病例系列研究。
证据等级
4 级。
方法
共 69 例有症状的 DML 患者，无膝关节 OA 的影像学证据（Kellgren-Lawrence 放射学分级 0-1），每周接受 4 次自体 PRP 注射。患者在注射前和 1、3、6 和 12 个月进行前瞻性评估。评估基于 Lysholm 膝关节评分量表（主要结果）、西安大略和麦克马斯特大学关节炎指数（WOMAC）、Tegner 活动量表和视觉模拟评分量表。
结果
接受 PRP 注射治疗的患者在研究期间膝关节功能和症状逐渐改善。所有结局指标在基线至 12 个月时均有显著改善，随访期间无患者出现失败或需要手术。年龄小于 50 岁的患者报告基线时疼痛程度较低，Tegner 活动量表评分较高，在 6 个月时 Lysholm 膝关节评分量表（ = 0.03）和 WOMAC（ = 0.03）评分显著改善，在 3、6 和 12 个月时的运动范围显著改善（<0.001）。33 例（47.8%）患者非常满意，26 例（37.7%）满意，8 例（11.6%）部分满意，2 例（2.9%）不满意，62 例（89.8%）患者愿意重复同样的治疗。无患者失访，无患者出现不良反应、感染、失败、复发或进一步手术。
结论
PRP 注射为有症状的 DML 提供了短期益处。尽管 12 个月时的结果很有希望，但这是一项初步研究，不能基于例如更长的随访来做出明确的推荐。
临床相关性
本研究支持使用自体 PRP 注射治疗有症状的 DML。
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