Platelet-rich therapies for musculoskeletal soft tissue injuries

• Published in: Cochrane database of systematic reviews 2014-04, Vol.2014 (4), p.CD010071
• Main Authors: Moraes, Vinícius Y, Lenza, Mário, Tamaoki, Marcel Jun, Faloppa, Flávio, Belloti, João Carlos
• Format: Article
• Language: English
• Subjects: Achilles Tendon - injuries; Anterior Cruciate Ligament Reconstruction; Blood Transfusion, Autologous; Female; Humans; Male; Medicine General & Introductory Medical Sciences; Platelet Transfusion - methods; Platelet-Rich Plasma; Randomized Controlled Trials as Topic; Rotator Cuff Injuries; Shoulder Impingement Syndrome - therapy; Soft Tissue Injuries - therapy; Tendinopathy - therapy; Tennis Elbow - therapy
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD010071.pub3

Platelet-rich therapies are being used increasingly in the treatment of musculoskeletal soft tissue injuries such as ligament, muscle and tendon tears and tendinopathies. These therapies can be used as the principal treatment or as an augmentation procedure (application after surgical repair or reconstruction). Platelet-rich therapies are produced by centrifuging a quantity of the patient's own blood and extracting the active, platelet-rich, fraction. The platelet-rich fraction is applied to the injured tissue; for example, by injection. Platelets have the ability to produce several growth factors, so these therapies should enhance tissue healing. There is a need to assess whether this translates into clinical benefit. To assess the effects (benefits and harms) of platelet-rich therapies for treating musculoskeletal soft tissue injuries. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (25 March 2013), the Cochrane Central Register of Controlled Trials (CENTRAL 2013 Issue 2), MEDLINE (1946 to March 2013), EMBASE (1980 to 2013 Week 12) and LILACS (1982 to March 2012). We also searched trial registers (to Week 2 2013) and conference abstracts (2005 to March 2012). No language or publication restrictions were applied. We included randomised and quasi-randomised controlled trials that compared platelet-rich therapy with either placebo, autologous whole blood, dry needling or no platelet-rich therapy for people with acute or chronic musculoskeletal soft tissue injuries. Primary outcomes were functional status, pain and adverse effects. Two review authors independently extracted data and assessed each study's risk of bias. Disagreement was resolved by discussion or by arbitration by a third author. We contacted trial authors for clarification of methods or missing data. Treatment effects were assessed using risk ratios for dichotomous data and mean differences (MD) or standardised mean differences (SMD) for continuous data, together with 95% confidence intervals. Where appropriate, data were pooled using the fixed-effect model for RR and MD, and the random-effects model for SMD. The quality of the evidence for each outcome was assessed using GRADE criteria. We included data from 19 small single centre trials (17 randomised and two quasi-randomised; 1088 participants) that compared platelet-rich therapy with placebo, autologous whole blood, dry needling or no platelet-rich therapy. These trials covered eight clinical conditions: r