McRobb, Jonathon, Kamil, Khawaja Hasan, Ahmed, Imran, Dhaif, Fatema and Metcalfe, Andrew J. (2023) Influence of platelet-rich plasma (PRP) analogues on healing and clinical outcomes following anterior cruciate ligament (ACL) reconstructive surgery : a systematic review. European Journal of Orthopaedic Surgery & Traumatology, 33 . pp. 225-253. doi:10.1007/s00590-021-03198-4 ISSN 1633-8065.

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Abstract

Purpose
To systematically review the effect of PRP on healing (vascularization, inflammation and ligamentization) and clinical outcomes (pain, knee function and stability) in patients undergoing ACL reconstruction and compare the preparation and application of PRP.

Methods
Independent systematic searches of online databases (Medline, Embase and Web of Science) were conducted following PRISMA guidelines (final search 10th July 2021). Studies were screened against inclusion criteria and risk of bias assessed using Critical appraisal skills programme (CASP) Randomised controlled trial (RCT) checklist. Independent data extraction preceded narrative analysis.

Results
13 RCTs were included. The methods of PRP collection and application were varied. Significant early increases in rate of ligamentization and vascularisation were observed alongside early decreases in inflammation. No significant results were achieved in the later stages of the healing process. Significantly improved pain and knee function was found but no consensus reached.

Conclusions
PRP influences healing through early vascularisation, culminating in higher rates of ligamentization. Long-term effects were not demonstrated suggesting the influence of PRP is limited. No consensus was reached on the impact of PRP on pain, knee stability and resultant knee function, providing avenues for further research. Subsequent investigations could incorporate multiple doses over time, more frequent observation and comparisons of different forms of PRP. The lack of standardisation of PRP collection and application techniques makes comparison difficult. Due to considerable heterogeneity, (I  > 50%), a formal meta-analysis was not possible highlighting the need for further high quality RCTs to assess the effectiveness of PRP. The biasing towards young males highlights the need for a more diverse range of participants to make the study more applicable to the general population.

Trial registration CRD42021242078CRD, 15th March 2021, retrospectively registered.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine R Medicine > RD Surgery
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
SWORD Depositor:	Library Publications Router
Library of Congress Subject Headings (LCSH):	Blood plasma, Blood platelets, Anterior cruciate ligament -- Surgery, Regenerative medicine
Journal or Publication Title:	European Journal of Orthopaedic Surgery & Traumatology
Publisher:	Springer
ISSN:	1633-8065
Official Date:	February 2023
Dates:	Date Event February 2023 Published 12 January 2022 Available 29 December 2021 Accepted
Volume:	33
Page Range:	pp. 225-253
DOI:	10.1007/s00590-021-03198-4
Status:	Peer Reviewed
Publication Status:	Published
Reuse Statement (publisher, data, author rights):	** From PubMed via Jisc Publications Router ** History: received 23-08-2021; accepted 29-12-2021.
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	8 March 2022
Date of first compliant Open Access:	8 March 2022

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