Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2023; 14(6): 485-501
Published online Jun 18, 2023. doi: 10.5312/wjo.v14.i6.485
Effectiveness of platelet-rich plasma in the treatment of Achilles tendon disease
Dan Huang, Djandan Tadum Arthur Vithran, Hao-Li Gong, Ming Zeng, Zhong-Wen Tang, Zhou-Zhou Rao, Jie Wen, Sheng Xiao
Dan Huang, Hao-Li Gong, Ming Zeng, Zhong-Wen Tang, Jie Wen, Sheng Xiao, Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
Djandan Tadum Arthur Vithran, Department of Orthopaedics, Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Zhou-Zhou Rao, Department of Physiology, Hunan Normal University School of Medicine, Changsha 410005, Hunan Province, China
Jie Wen, Department of Anatomy, Hunan Normal University School of Medicine, Changsha 410005, Hunan Province, China
Author contributions: Huang D, Arthur Vithran DT and Gong HL contribute equally to this study, they share co-first author; Wen J conceived and coordinated the study, designed; Xiao S performed and analyzed the experiments; Tang ZW wrote the paper; Zeng M, Arthur Vithran DT and Gong HL did the data analysis and carried out the data collection; Zeng M revised the paper; and all authors approved the final version of the manuscript.
Supported by Scientific Research Project of Hunan Education Department, No. 21B0031 and No. 21B0042.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jie Wen, PhD, Associate Professor, Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, No. 61 West Jiefang Road, Changsha 410013, Hunan Province, China. cashwj@qq.com
Received: December 24, 2022
Peer-review started: December 24, 2022
First decision: March 28, 2023
Revised: March 28, 2023
Accepted: April 20, 2023
Article in press: April 20, 2023
Published online: June 18, 2023
ARTICLE HIGHLIGHTS
Research background

Achilles tendon rupture (ATR) and Achilles tendinopathy (AT) are commonly seen in orthopaedic outpatient clinics. These conditions have serious complications and are treated clinically, mainly by conservative treatment. However, this treatment is ineffective and prone to recurrence. Along with the deep investigation of research, it is found that growth factors promoted Achilles tendon repair. The use of Platelet-Rich Plasma (PRP) was indicated to treat Achilles tendon diseases.

Research motivation

But the effectiveness of PRP in the treatment of patients with ATR and AT has been controversial.

Research objectives

To determine whether PRP injection is viable for patients with AT and to inform the decisions of physicians faced with challenges when making treatment choices.

Research methods

This study conducted a comprehensive review of relevant literature was conducted utilizing multiple databases such as Cochrane Library, PubMed, Web of Science, Chinese Science and Technology Journal, EMBASE, and China Biomedical CD-ROM. The present investigation integrated randomized controlled trials that assessed the effectiveness of platelet-rich plasma injections in managing individuals with ATR and AT. The eligibility criteria for the trials encompassed publications that were published within the timeframe of January 1, 1966 to December 2022. The statistical analysis was performed utilizing the Review Manager 5.4.1. The Victorian Institute Ankle Function Scale (VISA-A), Visual Analogue Scale (VAS) and Achilles tendon thickness were used to assess outcomes.

Research results

This meta-analysis included 13 randomized controlled trials, 8 of which were randomized controlled trials of PRP for AT and 5 of which were randomized controlled trials of PRP for ATR. PRP for AT at 6 wk, at 3 mo, and 6 mo after which there was no significant difference in VISA-A scores between the PRP and control groups. There was no significant difference in VAS scores between the PRP group and the control group after 6 wk and 6 mo of treatment, and at mid-treatment at 3 mo after mid-treatment, the PRP group demonstrated better outcomes than the control group. Post-treatment patient satisfaction, Achilles tendon thickness and return to sport were not significantly different between the PRP and control groups. There was no significant difference between the PRP and control groups for VISA-A score improvement at 3 mo, 6 mo, and 12 mo for ATR patients. Additionally, no significant difference was observed between the PRP and the control groups in improving heel lift height respectively at 6 mo and 12 mo for ATR patients. There was no significant difference in calf circumference between the PRP group and the control group after 6 mo and 12 mo of treatment. There was no significant difference in ankle mobility between the PRP and control groups at 6 mo of treatment and after 12 mo of treatment there was a significant improvement in ankle mobility between the PRP and control groups. There was no significant difference in the rate of return to exercise after treatment and the rate of adverse events between the PRP group and the control group.

Research conclusions

This study showed no significant efficacy of PRP injection alone in patients with ATR and AT. Thirteen high-quality RCT articles were reviewed to reach this conclusion. Future studies should focus on completing randomized controlled trials with large sample sizes and standardizing the preparation/procedure of PRP injections. As well as exploring the clinical efficacy of PRP injections combined with minimally invasive AT techniques.

Research perspectives

This meta-analysis reviewed 13 high-quality randomized controlled trials articles and the result suggested that there is no significant efficacy of PRP injection alone in patients with ATR and AT.