Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland.
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2024 May;32(5):1143-1159. doi: 10.1002/ksa.12127. Epub 2024 Mar 15.
Platelet-rich plasma (PRP) augmentation has been proposed to improve the results of anterior cruciate ligament reconstruction (ACLR). The present study aims to quantify the available evidence to support the use of PRP as biological augmentation in ACLR surgery.
A systematic literature search was conducted on the PubMed, Cochrane, Web of Science and Embase databases on 10 March 2023. Inclusion criteria were randomised controlled trials (RCTs), written in English, addressing PRP augmentation in ACLR surgery, with no time limitation. A scoping review was performed to map the body of literature by examining the evidence related to specific aspects of patients' treatment and evaluation. Risk of bias evaluation was performed with the Cochrane risk-of-bias tool for randomised trials Version 2 (RoB 2), while the quality assessment was performed with the use of the Coleman Score.
Out of 983 articles retrieved, 23 RCTs on 943 knees were included in this scoping review. PRP was administered in a liquid form in nine studies and clotted in 11 studies, while in three studies both liquid and clotted PRP were used. Hamstring auto/allografts were used in 14 studies, patellar tendon auto/allografts were used in eight studies and one study described ACLR with peroneus longus allografts. The map of the evidence documented high heterogeneity also in terms of surgical technique, objective and subjective outcome measures and radiological assessment, as well as follow-up times ranging from 1 day to 2 years, with virtually no overlapping data among studies neither in terms of treatments nor evaluations. Risk of bias evaluation showed an overall low quality of the included studies.
The available literature addressing PRP augmentation in ACLR is largely scattered. PRP was produced and applied following different procedures, and high variability was detected across the included studies for every aspect of ACLR surgery and evaluation. Currently, a meaningful comparison of the available studies is not possible as the quantification of the literature results is biased by their heterogeneity. Future studies should provide more standardisation to investigate the benefits of biological augmentation in ACL surgery and confirm the promising yet weak evidence of PRP potential as well as the most suitable application modality, before routine use in clinical practice.
Levels I and II, scoping review.
富血小板血浆（PRP）的应用被提议用于提高前交叉韧带重建（ACLR）的效果。本研究旨在量化支持将 PRP 作为生物增强剂应用于 ACLR 手术的现有证据。
2023 年 3 月 10 日，我们在 PubMed、Cochrane、Web of Science 和 Embase 数据库中进行了系统的文献检索。纳入标准为随机对照试验（RCT），采用英文撰写，探讨 PRP 增强 ACLR 手术的应用，无时间限制。我们进行了范围综述，通过检查与患者治疗和评估的具体方面相关的证据来绘制文献图谱。使用 Cochrane 偏倚风险工具（RoB 2）对 RCT 进行偏倚风险评估，使用 Coleman 评分进行质量评估。
在检索到的 983 篇文章中，纳入了本范围综述的 23 项 RCT 和 943 个膝关节。在 9 项研究中，PRP 以液体形式给药，在 11 项研究中以凝结形式给药，而在 3 项研究中，液体和凝结的 PRP 均有使用。14 项研究采用了腘绳肌腱自体/同种异体移植物，8 项研究采用了髌腱自体/同种异体移植物，1 项研究描述了使用腓骨长肌腱同种异体移植物的 ACLR。证据图谱记录了高异质性，包括手术技术、客观和主观的结果测量和影像学评估，以及从 1 天到 2 年的随访时间，研究之间几乎没有重叠的数据，无论是在治疗还是评估方面。偏倚风险评估显示，纳入研究的总体质量较低。
目前关于 ACLR 中 PRP 增强的文献广泛分散。PRP 的生产和应用遵循不同的程序，纳入研究在 ACLR 手术和评估的每个方面都存在高度的变异性。目前，由于研究的异质性，对现有研究进行量化比较是不可行的。未来的研究应该提供更多的标准化，以调查生物增强在 ACL 手术中的益处，并确认 PRP 作为潜在治疗方法的有希望但证据薄弱的结果，以及最合适的应用方式，然后再在临床实践中常规应用。
I 级和 II 级，范围综述。
