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. 2017 Nov 6;3(1):e000237.
doi: 10.1136/bmjsem-2017-000237. eCollection 2017.

Efficacy of platelet-rich plasma injections for symptomatic tendinopathy: systematic review and meta-analysis of randomised injection-controlled trials

Larry E Miller  1 , William R Parrish  2 , Breana Roides  2 , Samir Bhattacharyya  2
Affiliations

Efficacy of platelet-rich plasma injections for symptomatic tendinopathy: systematic review and meta-analysis of randomised injection-controlled trials

Larry E Miller et al. BMJ Open Sport Exerc Med. .

Abstract

Aim: To determine the efficacy of platelet-rich plasma (PRP) injections for symptomatic tendinopathy.

Design: Systematic review of randomised, injection-controlled trials with meta-analysis.

Data sources: Systematic searches of MEDLINE and EMBASE, supplemented by manual searches.

Eligibility criteria for selecting studies: Randomised controlled trials with 3 months minimum follow-up that evaluated pain reduction with PRP versus control (saline, local anaesthetic, corticosteroid) injections in patients with symptomatic tendinopathy.

Results: A total of 16 randomised controlled trials (18 groups) of PRP versus control were included. Median sample size was 35 patients, a study size that would require an effect size ≥1.0 to achieve statistical significance. PRP was more efficacious than control in reducing tendinopathy pain, with an effect size of 0.47 (95% CI 0.22 to 0.72, p<0.001), signifying a moderate treatment effect. Heterogeneity among studies was moderate (I2=67%, p<0.001). In subgroup analysis and meta-regression, studies with a higher proportion of female patients were associated with greater treatment benefits with PRP.

Conclusions: Injection of PRP is more efficacious than control injections in patients with symptomatic tendinopathy.

Keywords: Autologous conditioned plasma; meta-analysis; platelet-rich plasma; systematic review; tendinopathy.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.
Figure 2
Figure 2
Forest plot of platelet-rich plasma (PRP) versus control on tendinopathy pain. Random effects meta-analysis using the standard mean difference statistic for PRP versus control. A pooled estimate of overall standard mean difference (diamond) and 95% CI (diamond width) summarises the effect size. Standard mean difference values of 0.2, 0.5, 0.8 and 1.0 are defined as small, medium, large and very large effect sizes, respectively. Effects to the left of 0 indicate greater efficacy with control; effects to the right of 0 indicate greater efficacy with PRP. When the horizontal bars of an individual study, or the pooled diamond width, cross 0, the effect is not significantly different. Heterogeneity: I2=67%, p<0.001. SMD, standard mean difference.
Figure 3
Figure 3
Funnel plot of standard mean difference in platelet-rich plasma efficacy across studies. Egger’s p value=0.66 for publication bias. SMD, standard mean difference.
Figure 4
Figure 4
Meta-regression of relationship between proportion of women in each study and platelet-rich plasma efficacy. Percentage of explained variance=34%, p<0.001. Markers are proportional to sample size. SMD, standard mean difference.
Figure 5
Figure 5
Forest plot for one-study removed sensitivity analysis of platelet-rich plasma (PRP) versus control on tendinopathy pain. Random effects meta-analysis using the standard mean difference statistic for PRP versus control. A pooled estimate of overall standard mean difference (diamond) and 95% CI (diamond width) summarises the effect size. Standard mean difference values of 0.2, 0.5, 0.8 and 1.0 are defined as small, medium, large and very large effect sizes, respectively. Effects to the left of 0 indicate greater efficacy with control; effects to the right of 0 indicate greater efficacy with PRP. When the horizontal bars of an individual study, or the pooled diamond width, cross 0, the effect is not significantly different. SMD, standard mean difference.
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