Boksh Khalis, Elbashir Mohamed, Thomas Owain, Divall Pip, Mangwani Jitendra
Academic Team of Musculoskeletal Surgery, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK.
Academic Team of Musculoskeletal Surgery, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK.
Foot (Edinb). 2022 Dec;53:101923. doi: 10.1016/j.foot.2022.101923. Epub 2022 Mar 16.
Platelet Rich Plasma (PRP) is known to exert multi-directional biological effects favouring tendon healing. However, conclusions drawn by numerous studies on its clinical efficacy for acute Achilles tendon rupture are limited. We performed a systematic review and meta-analysis to investigate this and to compare to those without PRP treatment.
The Cochrane Controlled Register of Trials, Pubmed, Medline and Embase were used and assessed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: ('plasma' OR 'platelet-rich' OR 'platelet-rich plasma' or 'PRP') AND ('Achilles tendon rupture/tear' OR 'calcaneal tendon rupture/tear' OR 'tendo calcaneus rupture/tear'). Data pertaining to biomechanical outcomes (heel endurance test, isokinetic strength, calf-circumference and range of motion), patient-reported outcome measures (PROMs) and incidence of re-ruptures were extracted. Meta-analysis was performed for same outcomes measured in at least three studies. Pooled outcome data were analysed by random- and fixed-effects models.
After abstract and full-text screening, 6 studies were included. In total there were 510 patients of which 256 had local PRP injection and 254 without. The average age was 41.6 years, mean time from injury to treatment 5.9 days and mean follow-up at 61 weeks. Biomechanically, there was similar heel endurance, isokinetic strength, calf circumference and range of motion between both groups. In general, there were no differences in patient reported outcomes from all scoring systems used in the studies. Both groups returned to their pre-injured level at a similar time and there were no differences on the incidence of re-rupture (OR 1.13, 95% CI, 0.46-2.80, p = 0.79).
PRP injections for acute Achilles tendon ruptures do not improve medium to long-term biomechanical and clinical outcomes. However, future studies incorporating the ideal application and biological composition of PRP are required to investigate its true clinical efficacy.
富血小板血浆（PRP）已知具有多向生物学效应，有利于肌腱愈合。然而，众多关于其对急性跟腱断裂临床疗效的研究得出的结论有限。我们进行了一项系统评价和荟萃分析来研究这一问题，并与未接受PRP治疗的患者进行比较。
使用Cochrane对照试验注册库、Pubmed、Medline和Embase，并根据PRISMA（系统评价和荟萃分析的首选报告项目）标准进行评估，搜索词如下：（“血浆”或“富血小板”或“富血小板血浆”或“PRP”）以及（“跟腱断裂/撕裂”或“跟腱断裂/撕裂”或“跟腱断裂/撕裂”）。提取与生物力学结果（足跟耐力测试、等速肌力、小腿周长和活动范围）、患者报告的结局指标（PROMs）和再断裂发生率相关的数据。对至少三项研究中测量的相同结局进行荟萃分析。汇总的结局数据采用随机效应模型和固定效应模型进行分析。
经过摘要和全文筛选，纳入了6项研究。共有510例患者，其中256例接受局部PRP注射，254例未接受。平均年龄为41.6岁，受伤至治疗的平均时间为5.9天，平均随访61周。在生物力学方面，两组之间的足跟耐力、等速肌力、小腿周长和活动范围相似。总体而言，研究中使用的所有评分系统在患者报告的结局方面没有差异。两组在相似的时间恢复到受伤前水平，再断裂发生率没有差异（OR 1.13，95%CI，0.46 - 2.80，p = 0.79）。
急性跟腱断裂注射PRP并不能改善中长期生物力学和临床结局。然而，未来需要开展纳入PRP理想应用和生物学组成的研究，以调查其真正的临床疗效。
