Platelet-rich plasma in the management of articular cartilage pathology: a systematic review.
OBJECTIVE
Using systematic review methodology, we endeavored to answer the following questions concerning the treatment of osteochondral pathology: (1) what pathologies have been treated in vivo with the use of platelet-rich plasma (PRP); (2) what methods of PRP preparation and delivery have been reported; (3) what assessment tools and comparison group have been used to assess its effectiveness; and (4) what are the clinical outcomes of its use.


METHODS
A systematic literature search was performed of the OVID, EMBASE, and Evidence Based Medicine Reviews databases to identify all studies published up to October 2012 that assessed clinical outcomes of the use of PRP for the treatment of chondral and osteochondral pathology, excluding those including concomitant management of acute fractures or ligament reconstruction.


METHODS
The included studies were reviewed and the following data were extracted and tabulated: study authors' year and journal, study design and level of evidence, pathology treated, methods of PRP preparation and delivery, and clinical outcome scores.


RESULTS
Ten studies were included in the final analysis. The majority of studies assessed the use of PRP in the treatment of degenerative osteoarthritis of the knee or hip (representing 570 of a total of 662 joints). The majority of patients were treated with intra-articular injections, whereas 2 studies used PRP as an adjunct to surgical treatment. Significant improvements in joint-specific clinical scores (7 of 8 studies), general health scores (4 of 4 studies), and pain scores (4 of 6 studies) compared with baseline were reported up to 6-month follow-up, but few studies provided longer-term data. No studies reported worse scores compared with baseline at final follow-up. Three of 4 comparative studies reported significantly better clinical and/or pain scores when compared with hyaluronic acid injections at similar follow-up times.


CONCLUSIONS
Currently, there is a paucity of data supporting the use of PRP for the management of focal traumatic osteochondral defects. There is limited evidence suggesting short-term clinical benefits with the use of PRP for symptomatic osteoarthritis of the knee, but the studies published to date are of poor quality and at high risk for bias. Further high-quality comparative studies with longer follow-up are needed to ascertain whether PRP is beneficial, either alone or as an adjunct to surgical procedures, in the management of articular cartilage pathology.
*Division of Orthopaedic Surgery; and †Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; and ‡Women's College and Toronto Western Hospital; and §Women's College and Mount Sinai Hospital, University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada.
Andrew P
AP
Dold
Michael G
MG
Zywiel
Drew W
DW
Taylor
Tim
T
Dwyer
John
J
Theodoropoulos
D002358:Cartilage, Articular / Q000293:injuries; D006801:Humans; D007718:Knee Injuries / Q000628:therapy*; D015207:Osteoarthritis, Hip / Q000628:therapy; D020370:Osteoarthritis, Knee / Q000628:therapy*; D053657:Platelet-Rich Plasma; D016896:Treatment Outcome