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A systematic review and meta-analysis of platelet-rich plasma versus corticosteroid injections for plantar fasciopathy

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Abstract

Purpose

To determine whether platelet-rich plasma (PRP) injections are associated with improved pain and function scores when compared with corticosteroid injections for plantar fasciopathy.

Methods

A systematic review of published literature was performed for studies comparing PRP injections and corticosteroid injections for plantar fasciopathy. Studies were assessed using the Cochrane Risk of Bias Tool and the Newcastle Ottawa Scale (NOS). The primary endpoint was pain and function score at three and six month follow-up. Sensitivity analysis was performed for high quality studies and randomised studies.

Results

Ten studies totalling 517 patients were included. Seven studies were randomised. All studies included patients who had failed conservative measures and excluded patients with systemic illness and other causes of foot pain. Studies reported outcomes using the visual analogue score (VAS) and American Orthopaedic Foot and Ankle Score (AOFAS). At 3-month follow-up, PRP injections were associated with improved VAS scores (standard mean difference [SMD], -0.66; 95% CI, -1.3 to -0.02; p = 0.04) and AOFAS scores (SMD, 1.87; 95% CI, 0.16–3.58; p = 0.03). At 6-month follow-up, there was no difference in VAS score (SMD, -0.66; 95% CI, -1.65 to 0.3; p = 0.17) or AOFAS scores (SMD, 1.69; 95% CI, -1.06 to 4.45; p = 0.23). No studies reported adverse event rates or cost analysis. There was no difference in pain or function score at one, six- or 12-month follow-up. Sensitivity analyses of high-quality studies showed no differences between the PRP and steroid group at any of the follow-up points.

Conclusions

PRP injections are associated with improved pain and function scores at three month follow-up when compared with corticosteroid injections. Information regarding relative adverse event rates and cost implications is lacking. Further, large-scale, high-quality, randomised controlled trials with blinding of outcome assessment and longer follow-up are required.

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Author information

Authors and Affiliations

  1. Department of Trauma and Orthopaedic Surgery, Kingston Hospital NHS Foundation Trust, Galsworthy Road, Kingston upon Thames, KT2 7QB, UK

    Prashant Singh & Ian Gill

  2. Royal Free London NHS Trust, London, UK

    Suroosh Madanipour

  3. Lewisham and Greenwich NHS Trust, London, UK

    Jagmeet S. Bhamra

Authors
  1. Prashant Singh
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  2. Suroosh Madanipour
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  3. Jagmeet S. Bhamra
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  4. Ian Gill
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Contributions

• Study conception and design: P.S., S.M., J.S.B.

• Acquisition of data: P.S., S.M.

• Analysis and interpretation of data: P.S., S.M., J.S.B.

• Writing manuscript: P.S., S.M., J.S.B., I.G.

Corresponding author

Correspondence to Prashant Singh.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Singh, P., Madanipour, S., Bhamra, J.S. et al. A systematic review and meta-analysis of platelet-rich plasma versus corticosteroid injections for plantar fasciopathy. International Orthopaedics (SICOT) 41, 1169–1181 (2017). https://doi.org/10.1007/s00264-017-3470-x

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  • DOI: https://doi.org/10.1007/s00264-017-3470-x

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