Ahmad Zafar, Ang Swee, Rushton Neil, Harvey Adrian, Akhtar Kash, Dawson-Bowling Sebastian, Noorani Ali
Barts Health NHS Trust, London, United Kingdom.
Arthrosc Sports Med Rehabil. 2022 Feb 5;4(2):e823-e833. doi: 10.1016/j.asmr.2021.12.012. eCollection 2022 Apr.
The purpose of this study is to conduct a systematic review of meta-analyses of rotator cuff repair using platelet-rich plasma (PRP) to identify whether PRP improves clinical function and rate of tendon retears. We will (1) conduct a systematic review of the current meta-analyses of rotator cuff repair using platelet-rich plasma available in the literature, (2) evaluate the quality of these meta-analyses using the Preferred Reporting Items for Systematic Review (PRISMA) methodology, (3) identify whether PRP improves clinical function and rate of tendon retears, and develop guidance to improve future studies in this area.
We carried out a systematic review of previous meta-analyses published on the clinical outcomes of PRP used in the treatment of rotator cuff tears. We performed a comprehensive search of PubMed, Medline, Cochrane, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Embase databases, using various combinations of the commercial names of each PRP preparation and "rotator cuff" (with its associated terms), looking specifically at human meta-analysis studies involving the repair of the rotator cuff tendon surgically in the English language. Data validity was assessed and collected on clinical outcomes. Following this, a meta-analysis was undertaken.
Thirteen meta-analyses met the inclusion and exclusion criteria. All were considered of similar quality with Oxman-Guyatt index of 9 and PRISMA score of more than 24. A total of 1,800 patients with an average follow up of 12 to 36 months. The use of PRP for arthroscopic rotator cuff tear, when compared with controls, leads to a lower number of retears, improved short-term postoperative scores, and functional outcome. The following postoperative scores were reported: Constant: 12, Simple Shoulder Test: 10, ASES (American Shoulder and Elbow Surgeons): 9, UCLA (University of California, Los Angeles) 11, SANE (Single Assessment Numeric Evaluation) 1, VAS (visual analog scale): 6, and Retears: 13. Subgroup analysis showed that leukocyte content and gel application make no difference in the effectiveness of PRP. VAS score subgroup analysis showed short-term pain relief.
Our study shows that PRP is effective in reducing retears after rotator cuff repair and improving functional outcome scores and reducing short-term pain.
Level III, systematic review of Level I-III studies.
本研究旨在对使用富血小板血浆（PRP）修复肩袖的荟萃分析进行系统评价，以确定PRP是否能改善临床功能和肌腱再撕裂率。我们将：（1）对文献中现有的使用PRP修复肩袖的荟萃分析进行系统评价；（2）使用系统评价的首选报告项目（PRISMA）方法评估这些荟萃分析的质量；（3）确定PRP是否能改善临床功能和肌腱再撕裂率，并制定指导意见以改进该领域未来的研究。
我们对先前发表的关于PRP治疗肩袖撕裂临床结果的荟萃分析进行了系统评价。我们使用每种PRP制剂的商品名与“肩袖”（及其相关术语）的各种组合，对PubMed、Medline、Cochrane、CINAHL（护理及相关健康文献累积索引）和Embase数据库进行了全面检索，特别关注涉及肩袖肌腱手术修复的英文人体荟萃分析研究。对临床结果的数据有效性进行评估并收集。在此之后，进行了荟萃分析。
13项荟萃分析符合纳入和排除标准。所有分析的质量相似，Oxman-Guyatt指数为9，PRISMA评分超过24。共有1800例患者，平均随访12至36个月。与对照组相比，使用PRP治疗关节镜下肩袖撕裂导致再撕裂的数量减少，术后短期评分和功能结果得到改善。报告的术后评分如下：Constant评分：12分，简易肩关节测试评分：10分，美国肩肘外科医师学会（ASES）评分：9分，加利福尼亚大学洛杉矶分校（UCLA）评分：11分，单一评估数值评定（SANE）评分：1分，视觉模拟量表（VAS）评分：6分，再撕裂率：13%。亚组分析表明，白细胞含量和凝胶应用对PRP的有效性没有影响。VAS评分亚组分析显示短期疼痛缓解。
我们的研究表明，PRP在减少肩袖修复术后再撕裂、改善功能结果评分和减轻短期疼痛方面是有效的。
III级，对I-III级研究的系统评价。
