Published online Jun 18, 2023. doi: 10.5312/wjo.v14.i6.485
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
Processing time: 176 Days and 21.4 Hours
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.
But the effectiveness of PRP in the treatment of patients with ATR and AT has been controversial.
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.
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.
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.
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.
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.