The Effect of Leukocyte Concentration on Platelet-Rich Plasma Injections for Knee Osteoarthritis A Network Meta-Analysis

被引:31
作者
Abbas, Aazad [1 ,2 ]
Du, Jin Tong [1 ,2 ]
Dhotar, Herman S. [1 ,2 ,3 ,4 ]
机构
[1] Univ Toronto, North York Gen Hosp, Toronto, ON, Canada
[2] Univ Toronto, Temerty Fac Med, Toronto, ON, Canada
[3] Univ Toronto, North York Gen Hosp, Dept Orthopaed Surg, N York, ON, Canada
[4] Univ Toronto, Dept Surg, Toronto, ON, Canada
关键词
FACTORS PRGF-ENDORET; HYALURONIC-ACID; DOUBLE-BLIND; INTRAARTICULAR INJECTION; CLINICAL-OUTCOMES; PRP INJECTIONS; PLACEBO; EFFICACY; VISCOSUPPLEMENTATION; DEGENERATION;
D O I
10.2106/JBJS.20.02258
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: It is hypothesized that leukocyte-poor (LP) platelet-rich plasma (PRP) is preferred over leukocyte-rich (LR) PRP for the treatment of knee osteoarthritis (OA). Methods: The MEDLINE, Embase, and Cochrane databases were reviewed for all English-language studies comparing LP-PRP or LR-PRP with relevant controls or each other. The follow-up periods were 6 months and 12 months. The primary outcome measure was the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between baseline and follow-up. The secondary outcome measures were changes in the WOMAC pain subscale, visual analog scale (VAS) for pain, and International Knee Documentation Committee (IKDC) subjective score between baseline and follow-up, and the incidence of local adverse reactions. Treatment outcomes were analyzed using the mean difference between treatments for continuous outcomes and the odds ratio for binary outcomes, with 95% credibility intervals. Treatment modalities were ranked using the surface under the cumulative ranking (SUCRA) probabilities. Risk of bias was assessed using the relevant Cochrane tools, RoB 2 (version 2 of the Cochrane risk-of-bias tools) for randomized controlled trials (RCTs) and ROBINS-I (Risk of Bias in Non-Randomized Studies - of Interventions) for prospective comparative studies (PCSs). Results: This network meta-analysis included 23 studies: 20 RCTs and 3 PCSs, with a total of 2,260 patients and a mean follow-up period of 9.9 months. The overall risk-of-bias assessment of the RCTs revealed that 9 studies had low risk, 7 had some concerns, and 4 had high risk. The overall risk-of-bias assessment of the PCSs revealed that 1 study had low risk and 2 had moderate risk. We found no significant (p < 0.05) difference in all outcome measures and local adverse reactions between LP-PRP and LR-PRP. SUCRA rankings revealed that, for all outcome measures, LP-PRP is preferred to LR-PRP across follow-up periods. Conclusions: Leukocyte concentration of PRP does not play a significant role in patient-reported outcome measures for knee OA. LP-PRP is preferred to LR-PRP according to SUCRA rankings, but this preference may not be important in clinical practice.
引用
收藏
页码:559 / 570
页数:12
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