Meta-Analysis
Copyright ©The Author(s) 2022.
World J Meta-Anal. Jun 28, 2022; 10(3): 143-161
Published online Jun 28, 2022. doi: 10.13105/wjma.v10.i3.143
Table 6 Systematic Reviews or Meta-analyses with their level of evidence with the authors’ rationale for repeating the systematic review along with their concluding remarks
Sl. No.
Ref.
Date of publication
Date of last literature search
Level of evidence
Rationale for repeating meta-analysis
Conclusion
1Chahal et al[32], 2012June 14, 2012December 30, 2011IIIEarliest meta-analysisNo effect of PRP on overall retear rates or shoulder-specific outcomes after ARCR
2Moraes et al[31], 2013December 23, 2013March 25, 2013IOnly included studies with intra-operative PRP application after ARCRSome benefit of PRP in improving pain with comparable rates of retear (after 2 yr) between PRP and non-PRP groups
3Zhang et al[30], 2013July 12, 2013April 20, 2013IIncluded studies with high methodological quality and provided results without significant heterogeneity supported by larger number of patientsNo benefit of PRP on overall clinical outcomes and retear rate in full-thickness rotator cuff tears and decrease in rate of retears with PRP for small- and medium-sized rotator cuff tear
4Li et al[33], 2014June 7, 2014May 1, 2013IIAll high-quality (7 studies) RCTs included (compared with previous studies)No benefit with PRP regarding retear and clinical outcomes for ARCR
5Zhao et al[29], 2014September 30, 2014September, 2013INewer RCTs as compared with previous meta-analysisNo benefit of PRP in ARCR of full-thickness tears in terms of similar retear rates and clinical outcomes
6Warth et al[35], 2014September 13, 2014September, 2013IIMeta-regression analyses to evaluate the effects of 6 covariates such as inclusion of Level II studies, initial tear size, single- vs double-row repair constructs, varying PRP preparation, manual vs commercially available PRP preparation systems, method of PRP application on overall clinical and structural outcomes No statistically significant differences in outcome scores or retear rate with the use of PRP. However, significant improvement in Constant scores when PRPs applied at tendon-bone interface and significant reduction in retear rate with PRP in tears > 3 cm repaired with double-row technique
7Vavken et al[36], 2015March 12, 2015August 1, 2014ITo know if addition of PRP to ARCR results in statistically relevant as well as clinically meaningful reduction in retear rates along with analysis of its safety with difference in complication rates and its cost-effectivenessPRP proved to be an effective and safe way of reducing retear rates in the arthroscopic repair of small- and medium-sized rotator cuff tears. However, no evidence to support its use in large and massive tear
8Cai et al[38], 2015October 8, 2015January, 2015IMeta-analysis of level I studiesPRP in full-thickness rotator cuff repairs showed no statistically significant difference in clinical outcome but demonstrated significant reduction in failure-to-heal rate for small-to-moderate tears
9Xiao et al[37], 2016October 30, 2016February 1, 2016IIAll level I and II evidence studies – included to enhance power of meta-analysis (15 studies)No significant difference in the re-tear rates and clinical efficacy
10Hurley et al[40], 2018February 21, 2018March 24, 2017IFirst study to find that PRP was associated with significant improvement in tendon healing rates in tears > 3 cm with 9 new studies that have been published till Cai et al[38], 2015Use of PRP in rotator cuff repair improves the healing rates, pain levels, and functional outcomes. But PRF shows no benefit in improving tendon healing rates or functional outcomes
11Han et al[39], 2019June 20, 2019September, 2016IInclusion of new RCTs, as compared with previous meta-analysis with improved pooled effect sizePRP treatment with ARCR showed decreases retear rate and improves clinical outcome
12Wang et al[41], 2019July 29, 2019September 15, 2018ITo ensure homogeneity of data, only studies using PRP in full-thickness tears included along with addition of new high-level RCTs PRP improved the short-term outcomes such as pain, retear rate, and shoulder function after ARCR in full-thickness rotator cuff tears. PRP when used in single-row fixation of ARCR demonstrated improved clinical outcomes.
13Chen et al[42], 2019September 19, 2019December, 2017IExclusively reviewed only level 1 RCTs with multiple sub-groups, and comparative quantitative analysis with MCID on effects of LR-PRP vs LP-PRP, gel vs non-gel preparations, and tendon-specific outcomes analyzedLong-term retear significantly decreased with PRP. Several PROs such as constant score, VAS, retear rate significantly improved in PRP-treated patients. However, all analyzed PROs failed to reach the 5% MCID threshold. Hence authors neither recommended nor discouraged the use of PRP for rotator cuff injuries
14Cavendish et al[43], 2020May 1, 2020May 23, 2018IIIncluded 7 out of 16 studies published in the past 4 yr with larger sample size to reduce risk of type II error noted in previous studiesIntraoperative use of PRP reduces the failure risk following rotator cuff repair and has a consistent effect regardless of tear size and showed 25% reduction in the overall risk of failure in rotator cuff repairs
15Hurley et al[44], 2020July 30, 2020March, 2020ITo ascertain whether there is evidence to support the use of LP- or LR-PRP as an adjunct to ARCRLP-PRP reduces rate of retear and/or incomplete tendon healing after ARCR and improves patient-reported outcomes as compared with control whereas whether LP-PRP improves the tendon healing rate when compared with LR-PRP remained unclear
16Yang et al[45], 2020October 14, 2020February 15, 2020IInclusion of studies that dealt with PRP application on bone–tendon interface only during arthroscopic repair and studies that administered only PRP and not any other platelet-rich matrix to lower bias caused by different materials. All included RCTs were conducted on patients with full thickness rotator cuff tear who received diagnoses based on preoperative MRI or sonographyApplication of PRP shown to be beneficial in reducing the retear rate and improving the functional outcomes during the short-term follow-up of single-row repair
17Zhao et al[46], 2020November 18, 2020March, 2020IIMeta-analysis of level I and II studies based on MCID values to comprehensively assess clinical efficacy of LP-PRP only for ARCR mainly to avoid heterogeneity due to different types of PRPLP-PRP - significantly reduces the postoperative retear rate in medium and long term regardless of tear size and method used for repair. But no clinically meaningful effects in terms of postoperative pain and patient-reported outcomes were noted
18Ryan et al[1], 2021March 17, 2021June, 2020IInvolved stratified pooled data on basis of leukocyte concentration, liquid and solid formulation, and all 4 types of PRP (P-PRP, P-PRF, LP-PRP, LP-PRF)This analysis demonstrates significant reductions in retear when rotator cuff repair is augmented with PRP. LP-PRP appears to be most effective formulation, resulting in significantly improved retear rates and clinical outcome scores when compared with controls
19Xu et al[48], 2021May 27, 2021October 29, 2020IIAnalyzed PRP and PRF separately and PRP was sub grouped into leukocyte-poor and leukocyte-rich PRP. Compared with study by Hurley et al 5 more RCTs included. Cochrane Collaboration risk of bias tool- adopted and retear rate was analyzed based on duration of follow-up into 2 subgroups with a cut off of 2 yrPRP in ARCR improved pain and functional outcome, reduces retear rates. PRF improved only the Constant score. Significant reduction of retear rate in leukocyte-poor PRP when followed-up > 2 yr
20Li et al[47], 2021July 13, 2021June 20, 2020IStrict eligibility criteria enforced in the inclusion of RCTs along with subgroup analysis, based on PRP preparation, time of administration, size of tear, type of repair, to assess the real utility of PRP ARCR with PRP significantly improved long-term retear, shoulder pain and long-term shoulder function scores and intraoperative application of leukocyte-poor plasma for large to massive tears contributed to significant decrease in retear rates