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Current Reviews in Musculoskeletal Medicine

Erschienen in:

13.09.2018 | Protein-Rich Plasma: From Bench to Treatment of Arthritis (S Choate and J Tokish, section editors)

Platelet-Rich Plasma and the Knee—Applications in Orthopedic Surgery

verfasst von: Alexander Wasserman, Graeme Matthewson, Peter MacDonald

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 4/2018

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Abstract

Purpose of Review

To consolidate and synthesize the most recent evidence on the effects of platelet-rich plasma (PRP) in the knee with respect to osteoarthritis, meniscal injuries, ACL reconstruction, total knee arthroplasty (TKA), and high tibial osteotomy.

Recent Findings

PRP has been shown to be more beneficial in the context of knee osteoarthritis compared to both placebo and hyaluronic acid. Direct comparison with corticosteroid injections has been sparsely studied. It has also been shown to improve the clinical postoperative course in meniscal injuries and to a lesser extent TKA. Radiographic improvements without clinically significant benefits have been observed with ACL reconstructions treated with PRP.

Summary

PRP injections may be more beneficial than other current non-surgical management options for specific knee pathologies. Further research should broaden the knowledge of PRP effects on the knee, and identify the type of PRP, growth factor distribution, and route of administration associated with the most benefit.

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• Fleming BC, Proffen BL, Vavken P, Shalvoy MR, Machan JT, Murray MM. Increased platelet concentration does not improve functional graft healing in bio-enhanced ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2015; https://doi.org/10.1007/s00167-014-2932-6. This study showed that changes in concentration of PRP does not significantly influence tendinous healing. This allows future applications of PRP in this context to use preparations that are more cost effective to produce. CrossRefPubMedPubMedCentral

13.

• LaPrade RF, Goodrich LR, Phillips J, et al. Use of platelet-rich plasma immediately after an injury did not improve ligament healing, and increasing platelet concentrations was detrimental in an in vivo animal model. Am J Sports Med. 2018; https://doi.org/10.1177/0363546517741135. Same reason as (12). CrossRefPubMed

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15.

Chahla J, Cinque ME, Piuzzi NS, Mannava S, Geeslin AG, Murray IR, et al. A call for standardization in platelet-rich plasma preparation protocols and composition reporting: a systematic review of the clinical orthopaedic literature. J Bone Joint Surg Am. 2017;99(20):1769–79. https://doi.org/10.2106/JBJS.16.01374.CrossRefPubMed

16.

•• CPC C, Cheng CH, Hsu CC, Lin HC, Tsai YR, Chen JL. The influence of platelet rich plasma on synovial fluid volumes, protein concentrations, and severity of pain in patients with knee osteoarthritis. Exp Gerontol. 2017;93:68–72. https://doi.org/10.1016/j.exger.2017.04.004. Crucial study showing that the in vitro effect of PRP (including attenuation of pro-inflammatory cytokines, synovial fluid volume reductions) can actuallybe seen in a human in vivo model. This was expecially significant as these biochemical markers were correlated to significant benefits in clinical outcomes as outlined by the Lequesne Algofunctonal Index changes over time with subsequent PRP injections. CrossRef

17.

van Buul GM, Koevoet WL, Kops N, et al. Platelet-rich plasma releasate inhibits inflammatory processes in osteoarthritic chondrocytes. Am J Sports Med. 2011; https://doi.org/10.1177/0363546511419278.CrossRefPubMed

18.

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19.

Assirelli E, Filardo G, Mariani E, et al. Effect of two different preparations of platelet-rich plasma on synoviocytes. Knee Surg Sports Traumatol Arthrosc. 2015; https://doi.org/10.1007/s00167-014-3113-3.CrossRefPubMedPubMedCentral

20.

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21.

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22.

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23.

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27.

Sánchez M, Fiz N, Azofra J, Usabiaga J, Aduriz Recalde E, Garcia Gutierrez A, et al. A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. YJARS. 2012;28:1070–8. https://doi.org/10.1016/j.arthro.2012.05.011.CrossRef

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Vaquerizo V, Plasencia MÁ, Arribas I, Seijas R, Padilla S, Orive G, et al. Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a randomized controlled trial. Arthrosc J Arthrosc Relat Surg. 2013;29:1635–43. https://doi.org/10.1016/j.arthro.2013.07.264.CrossRef

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30.

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34.

Camurcu Y, Hakan S, Ucpunar H, Kockara N, Cobden A, Duman S. Single-dose intra-articular corticosteroid injection prior to platelet-rich plasma injection resulted in better clinical outcomes in patients with knee osteoarthritis: a pilot study. J Back Musculoskelet Rehabil 2018. https://outlook.office.com/owa/?realm=myumanitoba.ca. Accessed 8 July 2018.

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•• Muchedzi TA, Roberts SB. A systematic review of the effects of platelet rich plasma on outcomes for patients with knee osteoarthritis and following total knee arthroplasty. Surg. 2017; https://doi.org/10.1016/j.surge.2017.08.004. This study pooled a large amount of data to see if the literature consistently shows any benefit of PRP in a post-TKA environment in terms of relevant clinical outcomes. While there may have been a slight reduction of pain (albeit only in 5/17 of the pooled studies), there were no significant improvements found in any other outcomes measures in more than 2300 patients across all studies. This suggests that PRP may not be an effective adjunct to knee arthroplasty, and should not be routinely used. CrossRefPubMed

40.

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Morishita M, Ishida K, Matsumoto T, Kuroda R, Kurosaka M, Tsumura N. Intraoperative platelet-rich plasma does not improve outcomes of total knee arthroplasty. J Arthroplast. 2014;29:2337–41. https://doi.org/10.1016/j.arth.2014.04.007.CrossRef

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47.

Pujol N, Salle De Chou E, Boisrenoult P, Beaufils P. Platelet-rich plasma for open meniscal repair in young patients: any benefit? Knee Surg Sports Traumatol Arthrosc. 2014; https://doi.org/10.1007/s00167-014-3417-3.CrossRefPubMed

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Griffin JW, Hadeed MM, Werner BC, Diduch DR, Carson EW, Miller MD. Platelet-rich plasma in meniscal repair: does augmentation improve surgical outcomes? Clin Orthop Relat Res. 2015;473:1665–72. https://doi.org/10.1007/s11999-015-4170-8.CrossRefPubMedPubMedCentral

49.

• Kaminski R, Kulinski K, Kozar Kaminska K, et al. A prospective, randomized, double-blind, parallel-group, placebo-controlled study evaluating meniscal healing, clinical outcomes, and safety in patients undergoing meniscal repair of unstable, complete vertical meniscal tears (bucket handle) augmented wit. Biomed Res Int. 2018; https://doi.org/10.1155/2018/9315815. This well-designed study with long term followup showed quite convincing clinical (at 24 months) and radiographic (at 18 weeks) evidence that PRP injections into the avascular zone of meniscal repairs were beneficial as compared with saline. This supports the use of PRP injections in certain meniscal tears as outlined by this and other studies. CrossRef

50.

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51.

Cook JL, Smith PA, Bozynski CC, Kuroki K, Cook CR, Stoker AM, et al. Multiple injections of leukoreduced platelet rich plasma reduce pain and functional impairment in a canine model of ACL and meniscal deficiency. J Orthop Res. 2016;34(4):607–15. https://doi.org/10.1002/jor.23054.CrossRefPubMed

52.

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56.

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57.

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Orrego M, Larrain C, Rosales J, et al. Effects of platelet concentrate and a bone plug on the healing of hamstring tendons in a bone tunnel. Arthroscopy. 2008; https://doi.org/10.1016/j.arthro.2008.07.016.CrossRef

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60.

Cervellin M, Girolamo L, Bait C, Denti M, Volpi P. Autologous platelet-rich plasma gel to reduce donor-site morbidity after patellar tendon graft harvesting for anterior cruciate ligament reconstruction: a randomized, controlled clinical study. Knee Surg Sports Traumatol Arthrosc. 2012;20:114–20. https://link-springer-com.uml.idm.oclc.org/content/pdf/10.1007%2Fs00167-011-1570-5.pdf. Accessed 30 Mar 2018.CrossRefPubMed

Titel: Platelet-Rich Plasma and the Knee—Applications in Orthopedic Surgery
verfasst von: Alexander Wasserman
Graeme Matthewson
Peter MacDonald
Publikationsdatum: 13.09.2018
Verlag: Springer US
Erschienen in: Current Reviews in Musculoskeletal Medicine / Ausgabe 4/2018
Elektronische ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-018-9521-0

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Summary

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