Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain.
Advanced Biological Therapy Unit, Hospital Vithas Vitoria, C/Beato Tomás de Zumárraga 10, 01008, Vitoria-Gasteiz, Spain.
Knee Surg Sports Traumatol Arthrosc. 2023 Oct;31(10):4246-4256. doi: 10.1007/s00167-023-07470-4. Epub 2023 Jun 12.
To evaluate the efficacy of applying a combination of intrameniscal and intraarticular infiltrations of Platelet-Rich Plasma (PRP) in patients with meniscal tears, analyzing its failure rate and clinical evolution, as well as factors that may influence the positive response to this treatment.
Three hundred and ninety-two cases out of 696 met the inclusion criteria and were included in this work. Survival and patient-reported outcome measure (PROM) were collected and analyzed. Survival rate was defined as the percentage of patients who did not undergo meniscus surgery during their follow-up time. Patients were asked to complete the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, 6 months and 18 months. Other patient- and pathology-related variables were collected. Blood and PRP samples were randomly tested as a quality control measure. Survival and comparative statistical tests, and multivariate regression were performed for the analysis of the variables.
The PRP applied had a platelet concentration factor of 1.9X in respect to blood levels, with no leukocytes or erythrocytes. Thirty-eight patients required surgical intervention after treatment reaching a survival rate of 90.3% with an estimated mean survival time of 54.4 months. The type of injury (P = 0.002) and the presence of chondropathy were risk factors for surgical intervention after PRP treatment (P = 0.043). All KOOS scores showed a significant statistical increase from baseline to 6 months (N = 93) and 18 months (N = 66) (P < 0.0001). The number of cases with minimal clinically important improvement (MCII) at 6 months and 18 months post-treatment was 65 (69.9%) and 43 (65.2%), respectively.
The combination of intrameniscal and intraarticular PRP infiltrations is a valid conservative treatment for meniscal injuries avoiding the need for surgical intervention. Its efficacy is higher in horizontal tears and decreases when joint degeneration is present.
Level IV.
评估关节内和半月板内富血小板血浆（PRP）联合注射治疗半月板撕裂患者的疗效，分析其失败率和临床转归，并探讨可能影响该治疗方法疗效的因素。
在 696 例符合纳入标准的患者中，有 392 例患者纳入本研究。收集并分析了患者的生存率和患者报告的结局测量（PROM）。生存率定义为随访期间未行半月板手术的患者比例。患者在基线、6 个月和 18 个月时完成膝关节损伤和骨关节炎结果评分（KOOS）。收集其他与患者和病理相关的变量。血液和 PRP 样本作为质量控制措施进行随机检测。进行生存分析和比较统计学检验，以及多变量回归分析。
PRP 应用的血小板浓度因子为血液水平的 1.9 倍，无白细胞或红细胞。38 例患者在治疗后需要手术干预，生存率为 90.3%，估计平均生存时间为 54.4 个月。损伤类型（P = 0.002）和存在软骨病是 PRP 治疗后手术干预的危险因素（P = 0.043）。所有 KOOS 评分在基线至 6 个月（N = 93）和 18 个月（N = 66）时均有显著统计学意义的增加（P < 0.0001）。治疗后 6 个月和 18 个月时，有 65 例（69.9%）和 43 例（65.2%）患者达到最小临床重要改善（MCII）。
关节内和半月板内 PRP 联合注射是一种有效的半月板损伤保守治疗方法，可以避免手术干预。其疗效在水平撕裂中更高，而在关节退变时则降低。
IV 级。
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