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Safety and efficacy of intra-articular injection of platelet-rich plasma for the treatment of ankle osteoarthritis: a systematic review and meta-analysis

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A Letter to the Editor to this article was published on 05 December 2023

Abstract

Purpose

To evaluate the safety and efficacy of platelet-rich plasma (PRP) intra-articular injective treatments for ankle osteoarthritis (OA).

Methods

A systematic literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in PubMed, Scopus, Embase, Google Scholar, and the Cochrane library until May 2022. Both randomized and non-randomized studies were included with the assessment of the risk of bias. We recorded the participant’s age, gender, type of PRP, injection volume, the kit used, and activating agent. We subsequently assessed the short-term and long-term efficacy of PRP using the functional scores and visual analog scale (VAS).

Results

We included four studies with a total of 127 patients, with a mean age of 56.1 years. 47.2% were male (60/127), according to eligibility criteria. There were three cohort studies and one randomized controlled trial (RCT) study, and no study reported severe adverse events. All included studies used the Leukocyte-poor PRP. Short-term follow-up results suggested significant improvement of the American Orthopaedic Foot and Ankle Society (AOFAS) score in the PRP injection group compared to the control group (n = 87 patients; MD: 6.94 [95% CI: 3.59, 10.29]; P < 0.01). Consistently, there was a statistical difference in AOFAS score between PRP injection and control groups in the final follow-up (≥ 6 months) (n = 87 patients; MD: 9.63 [95% CI: 6.31, 12.94]; P < 0.01). Furthermore, we found a significant reduction in VAS scores in the PRP groups at both the short-term follow-up (n = 59 patients; MD, − 1.90 [95% CI, − 2.54, − 1.26]; P < 0.01) and the ≥ six months follow-up (n = 79 patients; MD, − 3.07 [95% CI, − 5.08, − 1.05]; P < 0.01). The improvement of AOFAS and VAS scores at ≥ six months follow-up reached the minimal clinically important difference (MCID). Nevertheless, the treatment effect of AOFAS and VAS scores offered by PRP at short-term follow-up did not exceed the MCID. Substantial heterogeneity was reported at the ≥ six months follow-up in VAS scores (I2: 93%, P < 0.01).

Conclusion

This meta-analysis supports the safety of PRP intra-articular injection for ankle OA. The improvements of AOFAS and VAS scores in the PRP group at short-term follow-up do not exceed the MCID to be clinically significant. PRP injection provides significant improvement of AOFAS score and reduced pain at ≥ six months follow-up. The efficacy of PRP should be interpreted with caution regarding the high heterogeneity and the scarcity of available literature, which urges large-scale RCTs with longer follow-up to confirm the potential efficacy of PRP injection for ankle OA.

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Data availability

All relevant data are reported within this manuscript, additional information will be available upon request to the corresponding author.

Code availability

All computer codes required to generate these results will be available upon request to the corresponding author.

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Funding

This work was supported by the National Natural Science Foundation of China (Grant No. 81773091), the Natural Science Foundation of Beijing Municipality (Grant No. 7212020), Science and Technology Planning Project of Beijing Municipal Education Commission (Grant No. KM202110025013), and the Beijing Municipal Excellent Talents Project (Grant No. 2020A43).

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Authors and Affiliations

  1. Department of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, No.1, Dong Jiao Min Lane, Dong Cheng District, Beijing, 100730, People’s Republic of China

    Sheng-Long Ding, Lin-Feng Ji, Ming-Zhu Zhang, Wei Xiong, Cheng-Yi Sun, Ze-Yu Han & Chao Wang

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Contributions

Sheng-Long Ding: study design, data acquisition, and drafting the manuscript. Lin-Feng Ji: data acquisition and interpretation, drafting the manuscript. Wei Xiong and Cheng-Yi Sun: data acquisition and editing of the manuscript. Ze-Yu Han and Chao Wang: data interpretation. Ming-Zhu Zhang: study design, reviewing & editing of the manuscript, and project funding. All authors have read and approved the final submitted manuscript.

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Correspondence to Ming-Zhu Zhang.

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Sheng-Long Ding and Lin-Feng Ji contributed equally to this work.

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Ding, SL., Ji, LF., Zhang, MZ. et al. Safety and efficacy of intra-articular injection of platelet-rich plasma for the treatment of ankle osteoarthritis: a systematic review and meta-analysis. International Orthopaedics (SICOT) 47, 1963–1974 (2023). https://doi.org/10.1007/s00264-023-05773-2

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