Platelet-rich Plasma in Meniscal Repair: Does Augmentation Improve Surgical Outcomes?
Platelet-rich Plasma in Meniscal Repair: Does Augmentation Improve Surgical Outcomes?
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DOI：
10.1007/s11999-015-4170-8
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发表时间：
2015-05-01
影响因子：
4.2
通讯作者：
Miller, Mark D.
中科院分区：
文献类型：
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作者：
Griffin, Justin W.;Hadeed, Michael M.;Miller, Mark D.
椎间盘切除术后接触应力的增加导致了对椎间盘保护策略的关注，以防止关节软骨退变。富血小板血浆（PRP）作为一种有前途的策略，以帮助诱导愈合，并已被证明在体外和体内都这样做。尽管PRP已在临床实践中应用了一段时间，但迄今为止，很少有临床研究支持其在半月板修复中的应用，我们试图（1）评估在首次半月板修复时PRP增加是否会降低随后进行半月板切除术的可能性;（2）确定关节镜下半月板修复中PRP增加是否会影响功能结局指标;在2008年至2011年期间，3名外科医生进行了35例单独的关节镜下半月板修复术。其中，15例（43%）使用PRP进行了增强，20例（57%）未使用PRP进行增强。在研究期间，PRP用于未进行ACL重建的半月板撕裂患者。11例（73%）PRP加固膝关节和15例（75%）非加固膝关节完成了至少2年（平均4年;范围2-6年）的完整随访。临床结局指标包括国际膝关节文献委员会（IKDC）评分、Tegner Lysholm膝关节评分量表以及重返工作和运动/活动调查工具，均通过电话或邮件亲自完成。在病历审查中，从电子病历中收集活动度数据。根据可用的数字，事后功效计算表明，如果我们治疗153例PRP患者和219例未治疗PRP患者，假设α率为5%，功效超过80%，我们预计能够使用IKDC辨别差异。使用Lysholm评分作为结果测量，事后功效估计为0.523，效应量为-1.1在p = 0.05和把握度= 80%时，12名患者需要PRP治疗，17名患者未接受PRP治疗，差异具有统计学意义（-2.1至-0.05）。PRP组中接受再次手术的患者比例无差异（27% [4/15]）与非PRP组（25% [5/20]; p = 0.89）相比。根据所用指标，两组之间的功能结局指标无差异（平均IKDC评分，69;标准差，PRP组26分，未使用PRP组76分;标准差，未使用PRP组17分; p = 0.288;平均Tegner Lysholm膝关节评分量表，66分;标准差，PRP组32分，未使用PRP组89分;标准差，未使用PRP组10分; p = 0.065）。根据现有数据，PRP组中重返工作岗位的患者比例没有差异（100% [6/6]）与非PRP组相比（100% [9/9]）或PRP组中恢复常规运动/活动的患者（71% [5/7]）与非PRP组（78% [7/9]; p = 0.75）相比。在我们有限的研究组中，采用和不采用PRP的半月板修复后的结果在再手术率方面相似。然而，由于研究的效力和性质不足，可能未检测到结局的适度大小差异。未来需要进行更大规模的前瞻性研究，以明确确定PRP是否应用于尿道修复。此外，还需要进行研究以确定PRP和其他生物制剂是否对复杂泪液类型有益。III级，治疗性研究。
Increased contact stresses after meniscectomy have led to an increased focus on meniscal preservation strategies to prevent articular cartilage degeneration. Platelet-rich plasma (PRP) has received attention as a promising strategy to help induce healing and has been shown to do so both in vitro and in vivo. Although PRP has been used in clinical practice for some time, to date, few clinical studies support its use in meniscal repair.We sought to (1) evaluate whether PRP augmentation at the time of index meniscal repair decreases the likelihood that subsequent meniscectomy will be performed; (2) determine if PRP augmentation in arthroscopic meniscus repair influenced functional outcome measures; and (3) examine whether PRP augmentation altered clinical and patient-reported outcomes.Between 2008 and 2011, three surgeons performed 35 isolated arthroscopic meniscus repairs. Of those, 15 (43%) were augmented with PRP, and 20 (57%) were performed without PRP augmentation. During the study period, PRP was used for patients with meniscus tears in the setting of no ACL reconstruction. Complete followup at a minimum of 2 years (mean, 4 years; range, 2-6 years) was available on 11 (73%) of the PRP-augmented knees and 15 (75%) of the nonaugmented knees. Clinical outcome measures including the International Knee Documentation Committee (IKDC) score, Tegner Lysholm Knee Scoring Scale, and return to work and sports/activities survey tools were completed in person, over the phone, or through the mail. Range of motion data were collected from electronic patient charts in chart review. With the numbers available, a post hoc power calculation demonstrated that we would have expected to be able to discern a difference using IKDC if we treated 153 patients with PRP and 219 without PRP assuming an alpha rate of 5% and power exceeding 80%. Using the Lysholm score as an outcome measure, post hoc power estimate was 0.523 and effect size was -1.1 (-2.1 to -0.05) requiring 12 patients treated with PRP and 17 without to find statistically significant differences at p = 0.05 and power = 80%.There was no difference in the proportion of patients who underwent reoperation in the PRP group (27% [four of 15]) compared with the non-PRP group (25% [five of 20]; p = 0.89). Functional outcome measures were not different between the two groups based on the measures used (mean IKDC score, 69; SD, 26 with PRP and 76; SD, 17 without PRP; p = 0.288; mean, Tegner Lysholm Knee Scoring Scale, 66, SD, 32 with PRP and 89; SD, 10 without PRP; p = 0.065). With the numbers available there was no difference in the proportion of patients who returned to work in the PRP group (100% [six of six]) compared with the non-PRP group (100% [nine of nine]) or in the patients who returned to their regular sports/activities in the PRP group (71% [five of seven]) compared with the non-PRP group (78% [seven of nine]; p = 0.75).Patients who sustain meniscus injuries should be counseled at the time of injury about the outcomes after meniscus repair. With our limited study group, outcomes after meniscus repair with and without PRP appear similar in terms of reoperation rate. However, given the lack of power and nature of the study, modest size differences in outcome may not have been detected. Future larger prospective studies are needed to definitively determine whether PRP should be used with meniscal repair. Additionally, studies are needed to determine if PRP and other biologics may benefit complex tear types.Level III, therapeutic study.