采用富血小板血浆进行非手术治疗的退行性半月板撕裂可产生不同的临床和影像学结果：系统回顾

Q3 Medicine Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2024-02-23 DOI:10.1016/j.asmr.2024.100916

Varun Gopinatth B.S. , Anjay K. Batra B.S. , Jorge Chahla M.D., Ph.D. , Matthew V. Smith M.D. , Matthew J. Matava M.D. , Robert H. Brophy M.D. , Derrick M. Knapik M.D.

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引用次数: 0

摘要

目的对使用富血小板血浆（PRP）非手术治疗半月板撕裂的临床和放射学结果进行系统综述。方法根据 2020 年系统综述和元分析首选报告项目指南，使用关键词和布尔运算符在 SCOPUS、PubMed、Medline 和 Cochrane Central Register for Controlled Trials（2023 年 4 月对照试验中央注册）中进行文献检索。纳入标准仅限于报告使用 PRP 非手术治疗半月板撕裂疗效的 I 至 IV 级人类研究。其中有 1 项一级研究和 5 项四级研究。患者平均年龄为 47.8 ± 7.9 岁，62%（n = 114/184）为女性。95.7%的患者（n = 157/164）接受了内侧半月板治疗。平均随访时间从 75.9 天到 31.9 个月不等。半月板撕裂一般被描述为慢性、退行性或实质内撕裂。在 4 项研究中，磁共振成像显示半月板等级有不同程度的改善，0% 到 44% 的患者完全愈合，0% 到 40% 的患者部分愈合。5 项研究中有 4 项报告称，从基线到最终随访，疼痛在统计学上有明显改善。报告临床结果的研究显示，Lysholm 评分（2 项研究）、膝关节损伤和骨关节炎结果评分总分（2 项研究）和 Tegner 评分（1 项研究）均有明显改善。60%到100%的患者都能成功恢复运动。结论根据术后磁共振评估和临床结果的改善，使用 PRP 注射治疗半月板撕裂的结果各不相同，但临床意义仍不明确。PRP方案的异质性、短期随访以及缺乏对比研究限制了研究结果。

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Degenerative Meniscus Tears Treated Nonoperatively With Platelet-Rich Plasma Yield Variable Clinical and Imaging Outcomes: A Systematic Review

Purpose

To perform a systematic review on clinical and radiologic outcomes for meniscus tears treated nonoperatively with platelet-rich plasma (PRP).

Methods

A literature search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using keywords and Boolean operators in SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials in April 2023. Inclusion criteria were limited to Level I to IV human studies reporting on outcomes of meniscus tears treated nonoperatively with PRP.

Results

A total of 6 studies, consisting of 184 patients, were identified. There was 1 Level I study and 5 Level IV studies. Mean patient age was 47.8 ± 7.9 years, with 62% (n = 114/184) being female. The medial meniscus was treated in 95.7% (n = 157/164) of patients. Mean follow-up ranged from 75.9 days to 31.9 months. Meniscus tears were generally described as chronic, degenerative, or intrasubstance. In 4 studies, magnetic resonance imaging revealed variable improvement in meniscus grade with complete healing in 0% to 44% of patients and partial healing in 0% to 40% of patients. Four of 5 studies reported significant statistical improvement in pain from baseline to final follow-up. Studies reporting on clinical outcomes showed significant improvements Lysholm score (2 studies), Knee injury and Osteoarthritis Outcome Score total score (2 studies), and Tegner score (1 study). Successful return to sport occurred in 60% to 100% of patients. Two studies reported that most patients were either very satisfied or satisfied following treatment.

Conclusions

The use of PRP injections for the treatment of meniscus tears led to variable results based on postoperative magnetic resonance evaluation and improvements in clinical outcomes, although the clinical significance remains unclear. The heterogeneity of PRP protocols, short-term follow-up, and lack of comparative studies limit findings.