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Scientific Articles   |    
Efficacy of Autologous Platelet-Rich Plasma Use for Orthopaedic Indications: A Meta-Analysis
Ujash Sheth, BHSc1; Nicole Simunovic, MSc1; Guy Klein, DO2; Freddie Fu, MD3; Thomas A. Einhorn, MD4; Emil Schemitsch, MD5; Olufemi R. Ayeni, MD6; Mohit Bhandari, MD, PhD1
1 Center for Evidence-Based Orthopaedics, Division of Orthopaedic Surgery, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON L8L 8E7, Canada. E-mail address for U. Sheth: usheth@qmed.ca. E-mail address for M. Bhandari: bhandam@mcmaster.ca
2 University Hospitals Richmond Medical Center, 27100 Chardon Road, Richmond Heights, OH 44143
3 UPMC Center for Sports Medicine, 3200 South Water Street, Pittsburgh, PA 15203
4 Boston University Orthopaedic Surgical Associates, 725 Albany Street, Shapiro 4th Floor, Suite 4B, Boston, MA 02118
5 St. Michael's Hospital, 55 Queen Street East, Suite 800, Toronto, ON M5C 1R6, Canada
6 McMaster University Medical Centre, 1200 Main Street West, Room 4E17, Hamilton, ON L8N 3Z5, Canada
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  • Disclosure statement for author(s): PDF

Investigation performed at the Center for Evidence-Based Orthopaedics, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada

This article was chosen to appear electronically on January 11, 2012, before publication of the final, definitive version.

A commentary by Matthew J. Matava, MD, is linked to the online version of this article at jbjs.org.



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Feb 15;94(4):298-307. doi: 10.2106/JBJS.K.00154
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Abstract

Background: 

The recent emergence of autologous blood concentrates, such as platelet-rich plasma, as a treatment option for patients with orthopaedic injuries has led to an extensive debate about their clinical benefit. We conducted a systematic review and meta-analysis to determine the efficacy of autologous blood concentrates in decreasing pain and improving healing and function in patients with orthopaedic bone and soft-tissue injuries.

Methods: 

We searched MEDLINE and Embase for randomized controlled trials or prospective cohort studies that compared autologous blood concentrates with a control therapy in patients with an orthopaedic injury. We identified additional studies by searching through the bibliographies of eligible studies as well as the archives of orthopaedic conferences and meetings.

Results: 

Twenty-three randomized trials and ten prospective cohort studies were identified. There was a lack of consistency in outcome measures across all studies. In six randomized controlled trials (n = 358) and three prospective cohort studies (n = 88), the authors reported visual analog scale (VAS) scores when comparing platelet-rich plasma with a control therapy across injuries to the acromion, rotator cuff, lateral humeral epicondyle, anterior cruciate ligament, patella, tibia, and spine. The use of platelet-rich plasma provided no significant benefit up to (and including) twenty-four months across the randomized trials (standardized mean difference, −0.34; 95% confidence interval [CI], −0.75 to 0.06) or the prospective cohort studies (standardized mean difference, −0.20; 95% CI, −0.64 to 0.23). Both point estimates suggested a small trend favoring platelet-rich plasma, but the associated wide confidence intervals were consistent with nonsignificant effects.

Conclusions: 

The current literature is complicated by a lack of standardization of study protocols, platelet-separation techniques, and outcome measures. As a result, there is uncertainty about the evidence to support the increasing clinical use of platelet-rich plasma and autologous blood concentrates as a treatment modality for orthopaedic bone and soft-tissue injuries.

Level of Evidence: 

Therapeutic Level II. Please see Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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