2021 ISAKOS Biennial Congress ePoster
Preparation Methods In Platelet-Rich Plasma Injections For Patella Tendinopathy: Effective Despite Marked Variations
Katelyn Kaye-Ling Lim, MBBS (Candidate), Singapore, Singapore SINGAPORE
Joshua Zhi En Koh, MBBS (Candidate), Singapore, Singapore SINGAPORE
Phoebe Wen Lin Tay, MBBS (Candidate), Singapore, Singapore SINGAPORE
Zachariah Gene Wing Ow, MBBS (Candidate), Singapore SINGAPORE
Aprine Tan, MBBS, Singapore, Singapore SINGAPORE
Keng Lin Francis Wong, MMed(Orth), MCI (NUS), FRCSEd (Orth), FAMS, PhD, Singapore SINGAPORE
Heng An Lin, MBBS, FRCSEd(Orth), Singapore SINGAPORE
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, SINGAPORE
FDA Status Not Applicable
Summary
There is great heterogeneity within Platelet-Rich Plasma preparation techniques, hence we aimed to perform a meta-analysis to investigate the various effects of different methods of PRP preparation.
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Abstract
Background
and Aims: Patellar Tendinopathy (PT) is common and characterized by anterior knee pain and tenderness over the inferior pole of the patella. The condition is usually activity related, with a high incidence amongst athletes engaged in jumping sports, however it also afflicts a proportion of the sedentary population as a work-related condition. Numerous studies have demonstrated the efficacy of PRP injections in reducing pain and promoting healing in PT, due to the presence of growth factors within the plasma. However, there is a lack of standardization with regards to the method of PRP preparation, resulting in substantial heterogeneity in the biologic constituents of the serum. As such, the efficacy of PRP as a regenerative option is largely varied. Hence, this systematic review and meta-analysis aims to investigate the difference in clinical outcomes when utilizing various methods of PRP preparation to treat PT.
Methods
A search of the literature was performed using Medline and Embase databases on January 1, 2021. Articles describing the use of PRP in PT were included. Statistical analysis was performed to determine mean differences for continuous outcomes. Meta-analysis was performed on all articles reporting Victorian Institute of Sports Assessment (VISA-P) and visual analogue scale (VAS) scores for patellar tendinopathy, in order to evaluate the efficacy of each preparation method. Data was pooled using random effects with the inverse-variance model.
Results
20 studies consisting of 431 participants were included in the final analysis. VISA-p scores were significantly improved in patients receiving PRP therapy prepared using all included techniques; Arthrex (Naples, Florida, USA) (WMD = 36.82; 95% CI: 22.06 to 51.57, p <0.01), Recover (Kaylight Ltd, Ramat-Hasharon, Israel) (WMD = 28.62; 95% CI: 12.54 to 44.70; p <0.01), COM.TEC (Fresenius-Kabi, Bad-Hom-burg, Germany) (WMD = 26.30; 95% CI: 11.69 to 40.91; p < 0.01), Regenlabs (Lausanne, Vaud, Switzerland) (WMD=18.0; CI: 10.35 – 25.65; p < 0.01) and BioMet-GPS (Warsaw, Indiana, USA) (WMD = 17.8; 95% CI: 7.62 to 27.98; p <0.01), (I2 = 88.0%). However, the differences between different preparation techniques were not significant (p=0.23). VAS score improvements were comparable amongst all included preparation techniques, with a similar lack of difference amongst different preparation techniques (I2 = 62.9%).
Conclusion
Preparation of PRP remains largely heterogenous. Various preparation systems combine a myriad of constituents to produce serums with varying concentrations of active biologic factors. Despite all methods of PRP preparation displaying significant improvements in patient outcomes, no system displays a clear superiority. Hence, there remains a need for high quality randomized clinical trials for the development of a standardised method of PRP preparation in order to obtain an optimal platelet yield that demonstrates consistent effectiveness in the area of PT treatment.