The use of platelet rich plasma for acute muscle tears: Systematic review and meta-analysis of current evidence.
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Published:
Jan 30, 2020
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Abstract
Introduction
Muscle tear is the most frequent type of injury in sports activities. An interest has been observed in the search for conditions that reduce and improve the healing time. The use of platelet-rich plasma (PRP) has grown in popularity in recent years, but such popularity was not accompanied by sufficient scientific support to back up its effectiveness. This study aims to summarize, analyze and synthesize published data to clarify the effects of PRP use on muscle tears through systematic review and meta-analysis.
Material and methods
Systematic review of the literature on the use of PRP for the treatment of muscle injuries was carried out. A meta-analysis was conducted to evaluate the effects of PRP.
Results
A total of 7 articles met the inclusion criteria for analysis. Six randomized controlled trials and one cohort study. The overall time to return to sports in PRP treatment was a mean of 29 days (range, 10 to 50.9 days). In the control groups was a mean of 35.4 days (range, 22 to 52.8 days). Meta-analysis (5 of the 7 articles) demonstrated a significant difference in earlier return to sports with the use of PRP when compared to conventional therapy (-7.80 days; p= 0.007). No difference in recurrence rate were reported.
Conclusion
Meta-analysis demonstrated a favorable effect of PRP when compared to conventional therapy. However, our analysis demonstrated significant study heterogeneity. Thus, our findings should be interpreted with caution. We still can not recommend the use of PRP for the treatment of muscle muscles.
Muscle tear is the most frequent type of injury in sports activities. An interest has been observed in the search for conditions that reduce and improve the healing time. The use of platelet-rich plasma (PRP) has grown in popularity in recent years, but such popularity was not accompanied by sufficient scientific support to back up its effectiveness. This study aims to summarize, analyze and synthesize published data to clarify the effects of PRP use on muscle tears through systematic review and meta-analysis.
Material and methods
Systematic review of the literature on the use of PRP for the treatment of muscle injuries was carried out. A meta-analysis was conducted to evaluate the effects of PRP.
Results
A total of 7 articles met the inclusion criteria for analysis. Six randomized controlled trials and one cohort study. The overall time to return to sports in PRP treatment was a mean of 29 days (range, 10 to 50.9 days). In the control groups was a mean of 35.4 days (range, 22 to 52.8 days). Meta-analysis (5 of the 7 articles) demonstrated a significant difference in earlier return to sports with the use of PRP when compared to conventional therapy (-7.80 days; p= 0.007). No difference in recurrence rate were reported.
Conclusion
Meta-analysis demonstrated a favorable effect of PRP when compared to conventional therapy. However, our analysis demonstrated significant study heterogeneity. Thus, our findings should be interpreted with caution. We still can not recommend the use of PRP for the treatment of muscle muscles.
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How to Cite
Molina Rómoli, A. R., Rossi, L. A., Bertona Altieri, A., Gwam, C., & Piuzzi, N. S. (2020). The use of platelet rich plasma for acute muscle tears: Systematic review and meta-analysis of current evidence. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 85(1), 82-90. https://doi.org/10.15417/issn.1852-7434.2020.85.1.983
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Section
Metanálisis
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References
1. A Hamid MS, Mohamed Ali MR, Yusof A, George J, Lee LPC. Platelet-Rich Plasma Injections for the Treatment of Hamstring Injuries. Am. J. Sports Med. 2014;42(10):2410-2418. doi:10.1177/0363546514541540.
2. Alsousou J, Thompson M, Hulley P, Noble A, Willett K. The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: a review of the literature. J. Bone Joint Surg. Br. 2009;91(8):987-96. doi:10.1302/0301-620X.91B8.22546.
3. Bubnov R, Yevseenko V, Semeniv I. Ultrasound guided injections of platelets rich plasma for muscle injury in professional athletes. Comparative study. Med. Ultrason. 2013;15(2):101-5.
4. Dimauro I, Grasso L, Fittipaldi S, et al. Platelet-rich plasma and skeletal muscle healing: A molecular analysis of the early phases of the regeneration process in an experimental animal model. PLoS One 2014;9(7). doi:10.1371/journal.pone.0102993.
5. Ekstrand J. Keeping your top players on the pitch: the key to football medicine at a professional level. Br. J. Sports Med. 2013;47(12):723-724. doi:10.1136/bjsports-2013-092771.
6. Ekstrand J, Hägglund M, Waldén M. Epidemiology of Muscle Injuries in Professional Football (Soccer). Am. J. Sports Med. 2011;39(6):1226-1232. doi:10.1177/0363546510395879.
7. Guillodo Y, Madouas G, Simon T, Le Dauphin H, Saraux A. Platelet-rich plasma (PRP) treatment of sports-related severe acute hamstring injuries. Muscles. Ligaments Tendons J. 2015;5(4):284-8. doi:10.11138/mltj/2015.5.4.284.
8. Guillodo Y, Madouas G, Simon T, Le Dauphin H, Saraux A. Platelet-rich plasma (PRP) treatment of sports-related severe acute hamstring injuries. Muscles. Ligaments Tendons J. 2015;5(4):284-8. doi:10.11138/mltj/2015.5.4.284.
9. Hamilton B. Hamstring muscle strain injuries: what can we learn from history? Br. J. Sports Med. 2012;46(13):900-3. doi:10.1136/bjsports-2012-090931.
10. Hamilton B, Tol JL, Almusa E, et al. Platelet-rich plasma does not enhance return to play in hamstring injuries: a randomised controlled trial. Br. J. Sports Med. 2015;49(14):943-950. doi:10.1136/bjsports-2015-094603.
11. Hamilton BH, Best TM. Platelet-enriched plasma and muscle strain injuries: challenges imposed by the burden of proof. Clin. J. Sport Med. 2011;21(1):31-36. doi:10.1097/JSM.0b013e318205a658.
12. Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation, and Injury Prevention. J. Orthop. Sport. Phys. Ther. 2010;40(2):67-81. doi:10.2519/jospt.2010.3047.
13. Kelc R, Trapecar M, Gradisnik L, Rupnik MS, Vogrin M. Platelet-rich plasma, especially when combined with a TGF-?? inhibitor promotes proliferation, viability and myogenic differentiation of myoblasts in vitro. PLoS One 2015;10(2):1-13. doi:10.1371/journal.pone.0117302.
14. Laudy ABM, Bakker EWP, Rekers M, Moen MH. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br. J. Sports Med. 2015;49(10):657-72. doi:10.1136/bjsports-2014-094036.
15. Martinez-Zapata MJ, Orozco L, Balius R, et al. Efficacy of autologous platelet-rich plasma for the treatment of muscle rupture with haematoma: a multicentre, randomised, double-blind, placebo-controlled clinical trial. Blood Transfus. 2016;14(2):245-54. doi:10.2450/2015.0099-15.
16. Miroshnychenko O, Chang W, Dragoo JL. The Use of Platelet-Rich and Platelet-Poor Plasma to Enhance Differentiation of Skeletal Myoblasts Implications for the Use of Autologous Blood Products for Muscle Regeneration. Am. J. Sports Med. 2016;4((7 suppl4)):1-9. doi:10.1177/0363546516677547.
17. Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. Platelet-rich therapies for musculoskeletal soft tissue injuries. In: Moraes VY, ed. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2014:CD010071. doi:10.1002/14651858.CD010071.pub3.
18. Orchard J, Best TM, Verrall GM. Return to Play Following Muscle Strains. 2005;15(6):436-441.
19. Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive Effect of an Autologous Platelet Concentrate in Lateral Epicondylitis in a Double-Blind Randomized Controlled Trial. Am. J. Sports Med. 2010;38(2):255-262. doi:10.1177/0363546509355445.
20. Quarteiro ML, Tognini JRF, de Oliveira ELF, Silveira I. The effect of platelet-rich plasma on the repair of muscle injuries in rats. Rev. Bras. Ortop. (English Ed. 2015;50(5):586-595. doi:10.1016/j.rboe.2015.08.009.
21. Randelli P, Arrigoni P, Ragone V, Aliprandi A, Cabitza P. Platelet Rich Plasma In Arthroscopic Rotator Cuff Repair: A Prospective Rct Study, 2-Year Follow-Up. J. Shoulder Elb. Surg. 2011;20(4):518-528. doi:10.1016/j.jse.2011.02.008.
22. Reurink G, Goudswaard GJ, Moen MH, et al. Rationale, secondary outcome scores and 1-year follow-up of a randomised trial of platelet-rich plasma injections in acute hamstring muscle injury: the Dutch Hamstring Injection Therapy study. Br. J. Sports Med. 2015;49(18):1206-12. doi:10.1136/bjsports-2014-094250.
23. Rossi LA, Molina Rómoli AR, Bertona Altieri BA, Burgos Flor JA, Scordo WE, Elizondo CM. Does platelet-rich plasma decrease time to return to sports in acute muscle tear? A randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy. April 2016:1-7.
24. Rossi LA, Molina Rómoli AR, Bertona Altieri BA, Burgos Flor JA, Scordo WE, Elizondo CM. Does platelet-rich plasma decrease time to return to sports in acute muscle tear? A randomized controlled trial. Knee Surg. Sports Traumatol. Arthrosc. 2016. doi:10.1007/s00167-016-4129-7.
2. Alsousou J, Thompson M, Hulley P, Noble A, Willett K. The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: a review of the literature. J. Bone Joint Surg. Br. 2009;91(8):987-96. doi:10.1302/0301-620X.91B8.22546.
3. Bubnov R, Yevseenko V, Semeniv I. Ultrasound guided injections of platelets rich plasma for muscle injury in professional athletes. Comparative study. Med. Ultrason. 2013;15(2):101-5.
4. Dimauro I, Grasso L, Fittipaldi S, et al. Platelet-rich plasma and skeletal muscle healing: A molecular analysis of the early phases of the regeneration process in an experimental animal model. PLoS One 2014;9(7). doi:10.1371/journal.pone.0102993.
5. Ekstrand J. Keeping your top players on the pitch: the key to football medicine at a professional level. Br. J. Sports Med. 2013;47(12):723-724. doi:10.1136/bjsports-2013-092771.
6. Ekstrand J, Hägglund M, Waldén M. Epidemiology of Muscle Injuries in Professional Football (Soccer). Am. J. Sports Med. 2011;39(6):1226-1232. doi:10.1177/0363546510395879.
7. Guillodo Y, Madouas G, Simon T, Le Dauphin H, Saraux A. Platelet-rich plasma (PRP) treatment of sports-related severe acute hamstring injuries. Muscles. Ligaments Tendons J. 2015;5(4):284-8. doi:10.11138/mltj/2015.5.4.284.
8. Guillodo Y, Madouas G, Simon T, Le Dauphin H, Saraux A. Platelet-rich plasma (PRP) treatment of sports-related severe acute hamstring injuries. Muscles. Ligaments Tendons J. 2015;5(4):284-8. doi:10.11138/mltj/2015.5.4.284.
9. Hamilton B. Hamstring muscle strain injuries: what can we learn from history? Br. J. Sports Med. 2012;46(13):900-3. doi:10.1136/bjsports-2012-090931.
10. Hamilton B, Tol JL, Almusa E, et al. Platelet-rich plasma does not enhance return to play in hamstring injuries: a randomised controlled trial. Br. J. Sports Med. 2015;49(14):943-950. doi:10.1136/bjsports-2015-094603.
11. Hamilton BH, Best TM. Platelet-enriched plasma and muscle strain injuries: challenges imposed by the burden of proof. Clin. J. Sport Med. 2011;21(1):31-36. doi:10.1097/JSM.0b013e318205a658.
12. Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation, and Injury Prevention. J. Orthop. Sport. Phys. Ther. 2010;40(2):67-81. doi:10.2519/jospt.2010.3047.
13. Kelc R, Trapecar M, Gradisnik L, Rupnik MS, Vogrin M. Platelet-rich plasma, especially when combined with a TGF-?? inhibitor promotes proliferation, viability and myogenic differentiation of myoblasts in vitro. PLoS One 2015;10(2):1-13. doi:10.1371/journal.pone.0117302.
14. Laudy ABM, Bakker EWP, Rekers M, Moen MH. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br. J. Sports Med. 2015;49(10):657-72. doi:10.1136/bjsports-2014-094036.
15. Martinez-Zapata MJ, Orozco L, Balius R, et al. Efficacy of autologous platelet-rich plasma for the treatment of muscle rupture with haematoma: a multicentre, randomised, double-blind, placebo-controlled clinical trial. Blood Transfus. 2016;14(2):245-54. doi:10.2450/2015.0099-15.
16. Miroshnychenko O, Chang W, Dragoo JL. The Use of Platelet-Rich and Platelet-Poor Plasma to Enhance Differentiation of Skeletal Myoblasts Implications for the Use of Autologous Blood Products for Muscle Regeneration. Am. J. Sports Med. 2016;4((7 suppl4)):1-9. doi:10.1177/0363546516677547.
17. Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. Platelet-rich therapies for musculoskeletal soft tissue injuries. In: Moraes VY, ed. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2014:CD010071. doi:10.1002/14651858.CD010071.pub3.
18. Orchard J, Best TM, Verrall GM. Return to Play Following Muscle Strains. 2005;15(6):436-441.
19. Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive Effect of an Autologous Platelet Concentrate in Lateral Epicondylitis in a Double-Blind Randomized Controlled Trial. Am. J. Sports Med. 2010;38(2):255-262. doi:10.1177/0363546509355445.
20. Quarteiro ML, Tognini JRF, de Oliveira ELF, Silveira I. The effect of platelet-rich plasma on the repair of muscle injuries in rats. Rev. Bras. Ortop. (English Ed. 2015;50(5):586-595. doi:10.1016/j.rboe.2015.08.009.
21. Randelli P, Arrigoni P, Ragone V, Aliprandi A, Cabitza P. Platelet Rich Plasma In Arthroscopic Rotator Cuff Repair: A Prospective Rct Study, 2-Year Follow-Up. J. Shoulder Elb. Surg. 2011;20(4):518-528. doi:10.1016/j.jse.2011.02.008.
22. Reurink G, Goudswaard GJ, Moen MH, et al. Rationale, secondary outcome scores and 1-year follow-up of a randomised trial of platelet-rich plasma injections in acute hamstring muscle injury: the Dutch Hamstring Injection Therapy study. Br. J. Sports Med. 2015;49(18):1206-12. doi:10.1136/bjsports-2014-094250.
23. Rossi LA, Molina Rómoli AR, Bertona Altieri BA, Burgos Flor JA, Scordo WE, Elizondo CM. Does platelet-rich plasma decrease time to return to sports in acute muscle tear? A randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy. April 2016:1-7.
24. Rossi LA, Molina Rómoli AR, Bertona Altieri BA, Burgos Flor JA, Scordo WE, Elizondo CM. Does platelet-rich plasma decrease time to return to sports in acute muscle tear? A randomized controlled trial. Knee Surg. Sports Traumatol. Arthrosc. 2016. doi:10.1007/s00167-016-4129-7.