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Platelet-rich plasma injection for the treatment of chronic Achilles tendinopathy: A meta-analysis

BACKGROUND: Platelet-rich plasma (PRP) is used as an alternative therapy to reduce pain and improve functional restoration in patients with Achilles tendinopathy (AT). We evaluated the current evidence for the efficacy of PRP as a treatment for chronic AT. METHODS: The PubMed, Embase, Web of Science...

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Autores principales: Liu, Chun-jie, Yu, Kun-lun, Bai, Jiang-bo, Tian, De-hu, Liu, Guo-li
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494278/
https://www.ncbi.nlm.nih.gov/pubmed/31008973
http://dx.doi.org/10.1097/MD.0000000000015278
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author Liu, Chun-jie
Yu, Kun-lun
Bai, Jiang-bo
Tian, De-hu
Liu, Guo-li
author_facet Liu, Chun-jie
Yu, Kun-lun
Bai, Jiang-bo
Tian, De-hu
Liu, Guo-li
author_sort Liu, Chun-jie
collection PubMed
description BACKGROUND: Platelet-rich plasma (PRP) is used as an alternative therapy to reduce pain and improve functional restoration in patients with Achilles tendinopathy (AT). We evaluated the current evidence for the efficacy of PRP as a treatment for chronic AT. METHODS: The PubMed, Embase, Web of Science, and The Cochrane Library databases were searched for articles on randomized controlled trials (RCTs) that compared the efficacy of PRP with that of with placebo injections plus eccentric training as treatment for AT. The articles were uploaded over the establishment of the databases to May 01, 2018. The Cochrane risk of bias (ROB) tool was used to assess methodological quality. Outcome measurements included the Victorian Institute of Sports Assessment-Achilles (VISA-A), visual analog scale (VAS) and Achilles tendon thickness. Statistical analysis was performed with RevMan 5.3.5 software. RESULTS: Five RCTs (n = 189) were included in this meta-analysis. Significant differences in the VISA-A were not observed between the PRP and placebo groups after 12 weeks [standardized mean difference (SMD) = 0.2, 95% confidence interval (95% CI): 0.36 to 0.76, I(2) = 71%], 24 weeks (SMD = 0.77, 95% CI: −0.10–1.65, I(2) = 85%) and 1 year (SMD = 0.83, 95% CI: −0.76–2.42, I(2) = 72%) of treatment. However, PRP exhibited better efficacy than the placebo treatment after 6 weeks (SMD = 0.46, 95% CI: 0.15–0.77, I(2) = 34%). Two studies included VAS scores and tendon thickness. VAS scores after 6 weeks (SMD = 1.35, 95% CI: −0.1.04–3.74, I(2) = 93%) and 24 weeks (SMD = 1.48, 95% CI: −0.1.59–4.55, I(2) = 95%) were not significantly different. However, VAS scores at the 12th week (SMD = 1.10, 95% CI: 0.53–1.68, I(2) = 83%) and tendon thickness (SMD = 1.51, 95% CI: 0.39–2.63, I(2) = 53%) were significantly different. CONCLUSION: PRP injection around the Achilles tendon is an option for the treatment of chronic AT. Limited evidence supports the conclusion that PRP is not superior to placebo treatment. These results still require verification by a large number of well designed, heterogeneous RCT studies.
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spelling pubmed-64942782019-05-29 Platelet-rich plasma injection for the treatment of chronic Achilles tendinopathy: A meta-analysis Liu, Chun-jie Yu, Kun-lun Bai, Jiang-bo Tian, De-hu Liu, Guo-li Medicine (Baltimore) Research Article BACKGROUND: Platelet-rich plasma (PRP) is used as an alternative therapy to reduce pain and improve functional restoration in patients with Achilles tendinopathy (AT). We evaluated the current evidence for the efficacy of PRP as a treatment for chronic AT. METHODS: The PubMed, Embase, Web of Science, and The Cochrane Library databases were searched for articles on randomized controlled trials (RCTs) that compared the efficacy of PRP with that of with placebo injections plus eccentric training as treatment for AT. The articles were uploaded over the establishment of the databases to May 01, 2018. The Cochrane risk of bias (ROB) tool was used to assess methodological quality. Outcome measurements included the Victorian Institute of Sports Assessment-Achilles (VISA-A), visual analog scale (VAS) and Achilles tendon thickness. Statistical analysis was performed with RevMan 5.3.5 software. RESULTS: Five RCTs (n = 189) were included in this meta-analysis. Significant differences in the VISA-A were not observed between the PRP and placebo groups after 12 weeks [standardized mean difference (SMD) = 0.2, 95% confidence interval (95% CI): 0.36 to 0.76, I(2) = 71%], 24 weeks (SMD = 0.77, 95% CI: −0.10–1.65, I(2) = 85%) and 1 year (SMD = 0.83, 95% CI: −0.76–2.42, I(2) = 72%) of treatment. However, PRP exhibited better efficacy than the placebo treatment after 6 weeks (SMD = 0.46, 95% CI: 0.15–0.77, I(2) = 34%). Two studies included VAS scores and tendon thickness. VAS scores after 6 weeks (SMD = 1.35, 95% CI: −0.1.04–3.74, I(2) = 93%) and 24 weeks (SMD = 1.48, 95% CI: −0.1.59–4.55, I(2) = 95%) were not significantly different. However, VAS scores at the 12th week (SMD = 1.10, 95% CI: 0.53–1.68, I(2) = 83%) and tendon thickness (SMD = 1.51, 95% CI: 0.39–2.63, I(2) = 53%) were significantly different. CONCLUSION: PRP injection around the Achilles tendon is an option for the treatment of chronic AT. Limited evidence supports the conclusion that PRP is not superior to placebo treatment. These results still require verification by a large number of well designed, heterogeneous RCT studies. Wolters Kluwer Health 2019-04-19 /pmc/articles/PMC6494278/ /pubmed/31008973 http://dx.doi.org/10.1097/MD.0000000000015278 Text en Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0
spellingShingle Research Article
Liu, Chun-jie
Yu, Kun-lun
Bai, Jiang-bo
Tian, De-hu
Liu, Guo-li
Platelet-rich plasma injection for the treatment of chronic Achilles tendinopathy: A meta-analysis
title Platelet-rich plasma injection for the treatment of chronic Achilles tendinopathy: A meta-analysis
title_full Platelet-rich plasma injection for the treatment of chronic Achilles tendinopathy: A meta-analysis
title_fullStr Platelet-rich plasma injection for the treatment of chronic Achilles tendinopathy: A meta-analysis
title_full_unstemmed Platelet-rich plasma injection for the treatment of chronic Achilles tendinopathy: A meta-analysis
title_short Platelet-rich plasma injection for the treatment of chronic Achilles tendinopathy: A meta-analysis
title_sort platelet-rich plasma injection for the treatment of chronic achilles tendinopathy: a meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494278/
https://www.ncbi.nlm.nih.gov/pubmed/31008973
http://dx.doi.org/10.1097/MD.0000000000015278
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