PRP does not improve the objective outcomes of anterior cruciate ligament reconstruction: a systematic review and meta-analysis

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 29; no. 9; pp. 3049 - 3058
• Main Authors: de Andrade, André Luís Lugnani, Sardeli, Amanda Veiga, Garcia, Thiago Alves, Livani, Bruno, Belangero, William Dias
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2021; Springer Nature B.V
• Subjects: Anterior cruciate ligament; Knee; Ligaments; Literature reviews; Magnetic resonance imaging; Medicine; Medicine & Public Health; Meta-analysis; Orthopedics; Rehabilitation; Sports Medicine; Systematic review; Tunnels; Widening; Knee surgery; Platelet-enriched plasma; Anterior cruciate ligament reconstruction; Anterior cruciate ligament; Autologous platelet concentrate
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-020-06348-z

Purpose Platelet rich plasma (PRP) has been used in association with anterior cruciate ligament resconstruction (ACLR) to improve rehabilitation. The purpose was to systematically review the literature to compare the effects of PRP on ACLR in its objective and subjective outcomes. Methods A systematic review of the MEDLINE, Web of Science, Embase, Scopus, and Cochrane databases was performed. Two independent reviewers included all the English language literature of patients undergoing primary ACLR with autograft combined with PRP. The outcomes analyzed were graft ligamentization (MRI), tibial and femoral tunnel widening (MRI), knee laxity, IKDC, Lysholm, Tegner activity scale and visual analog scale. Results Nine studies were included with a total of 525 patients. PRP did not improve ligamentization of graft (standardized mean difference (SMD): 0.01 [95% CI: − 0.37; 0.39]), did not lead to lesser tunnel widening (SMD: 0.71 [95% CI: − 0.12; 1.54]), or lead to lesser knee laxity (raw mean difference: 0.33 [95% CI: − 0.84; 0.19]). Although there was statistical significance for PRP effects on Lysholm score and VAS ( p  < 0.01), their magnitude was limited. Conclusion PRP showed no improvement in objective outcomes like ligamentization and less tunnel widening, while it showed just small improvements in terms of Lysholm, VAS and knee laxity. Therefore, there is not enough evidence to support a recommendation in favor of PRP and more research is needed. Level of evidence I.