platelet-rich plasma injections for acute musculoskeletal ......i, johannes tol, or a family...
TRANSCRIPT
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Platelet-rich plasma injections for acute musculoskeletal injuries:
do they work?
Johannes Tol
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DISCLOSUREI, Johannes Tol, or a family member(s), have relevant
financial relationships to be discussed, directly or
indirectly, referred to or illustrated with or without
recognition within the presentation as follows:
Grants for conducting trials on the effect of PRP in
acute hamstring injuries (Arthrex) and Achilles
(Biomet)
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• Achilles tendon rupture
• Acute muscle injury
Literature: PRP use in acute MSK injuries
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• 2014 De Carli et al. AJSM FU 34 m– PRP group (n=20) 4 ml at surgery and 2 wks–No injection group (N=20)
• mini-open Kakiuchi• My cells PRP
Outcome: VISA-A, VAS, FAOS, US, MRI
Results: No significant difference at 1, 3, 6, 24 m
RCT acute Achilles rupture
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• 2011 Schepull et al. AJSM FU 6, 12 m
– PRP group (n=12) 10 ml
– No injection group (N=14)
– PRP 3700 109 platelets
Primary outcome:
Mechanical properties (E-modulus): no significant difference
Secondary outcomes:
Heel-raise index: no significant difference
Achilles Tendon Total Rupture Score: PRP significantly worse
RCT acute Achilles rupture
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Best evidence synthesis:
Strong evidence against PRP in acute Achilles tendon rupture
Conclusion
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PRP in muscle injury
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Lazy rats and athletes
1: PRP in Rats, promising new stuff
2: PRP in Athletes, confusing results
3: The Athletic Rat, confusion unravelled
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Menetrey et al. JBJS 2000; Wright-Carpenter et al. IJSM 2004; Hammond et al. AJSM 2009
1. PRP in Rats: promising new stuff
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Wright-Carpenter et al. IJSM 2004; Hammond et al. AJSM 2009
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Hammond et al. AJSM 2009
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→Where is the evidence?
2. PRP in Athletes: confusing results
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PRP works in muscle injuries ??
Grassi A. et al. Is PRP effective in the treatment of acute muscle injuries? A systematic review and meta analysisSports Med 2018
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PRP works !!! (…??)
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PRP works in muscle injuries ??
No blinding
No blinding
No blinding
Grassi A. et al. Is PRP effective in the treatment of acute muscle injuries? A systematic review and meta analysisSports Med 2018
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RCTs on PRP in muscle injury
NO EFFECT PRP
• Reurink et al. 2014
• Hamilton et al. 2015
• Martinez-Zapata et al. 2016
POSITIVE EFFECT PRP
• Hamid et al. 2014
• Rossi et al. 2016
• Bubnov et al. 2013
Reurink et al. NEJM 2014; Hamilton et al. BJSM 2015; Martines- Zapata et al. Blood Transfus2016; Hamid et al. AJSM 2014; Rossi et al. KSSTA 2016
Time to recover:
PLACEBO CONTROLLED NO PLACEBO
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Why Platelet Rich Plasma?
Expected increase $45 million (2009) to $126 million in 2016
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Muscle re-injury
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3. The Athletic Rat: confusion unravelled
Contreras-Munoz et al. AJSM 2017
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5 groups of rats with muscle injuries
– Untreated
– Saline
– PRP
– PRP + exercise
– Exercise
Contreras-Munoz et al. AJSM 2017
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Contreras-Munoz et al. AJSM 2017
Muscle Force
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Summarizing the evidence onPRP in muscle injury
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Take home message
Muscle injuries:
PRP works in lazy rats
but not in athletes
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PRP works in muscle injuries ??
Grassi A. et al. Is PRP effective in the treatment of acute muscle injuries? A systematic review and meta analysisSports Med 2018
![Page 26: Platelet-rich plasma injections for acute musculoskeletal ......I, Johannes Tol, or a family member(s), have relevant financial relationships to be discussed, directly or indirectly,](https://reader033.vdocuments.site/reader033/viewer/2022050601/5fa86abc3a8007612d7d51ed/html5/thumbnails/26.jpg)
PRP works !!! (…??)
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PRP works in muscle injuries ??
No blinding
No blinding
No blinding
Grassi A. et al. Is PRP effective in the treatment of acute muscle injuries? A systematic review and meta analysisSports Med 2018
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1 injection PRP Biometsuperior to physio
Strength:Grade 2 lesions
Limitation:Non-blinded design
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3 arm RCT (N=90)• PRP Biomet plus physio• P Poor P plus physio• Physio
Injection procedure– Localization on MRI and US– One procedure 3 injections PPP or PRP
• < 5 days after injury
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Results
90% professional athletes / 83% Football
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Why Platelet Rich Plasma?
Expected increase $45 million (2009) to $126 million in 2016
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Adjusted Hazard Ratio
Adj HR: PRP vs. PPP = 2.29(95% CI 1.30 to 4.04) P=0.004
Adj HR: Physio vs. PRP = 0 .67 (95% CI 0.39 to -1.16) P=0.15
Adj HR: Physio vs PPP = 1.57(95% CI 0.88 to - 2.80) P=0.13
- Weeks
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• Injection procedure saline or PRP Arthrex
2x injections:• < 5 days after injury
• 5-7 days later
• Standardized rehabilitation program
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3 RCTs acute hamstring
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Re-injury
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Strong evidence NOT
to support the use of PRP injections for
Achilles tendon ruptureshamstring injuries
Conclusion