Effects of Platelet-Rich Plasma on Clinical Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

Abstract

Background: Many studies have documented the use of platelet-rich plasma (PRP) alongside anterior cruciate ligament (ACL) reconstruction (ACLR) in the management of ACL injury, but evidence on the benefits of PRP in improving the clinical outcomes of ACLR is inconsistent. Purpose: To help in our understanding, we undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) that evaluated the effects of PRP on patient-reported functional scores, the clinical assessments of knee function and structure, and complications. Study Design: Systematic review; Level of evidence, 1. Methods: We searched 9 online databases for RCTs published in English or Chinese that examined the effects of PRP on ACLR. The primary outcome measures were visual analog scale (VAS) for pain and International Knee Documentation Committee (IKDC) scores. The secondary outcomes included KT-1000 arthrometer, pivot-shift test, Lysholm and Tegner scores, tunnel widening, graft characterization, and complications. Subgroup analyses were performed according to time of assessments. Fixed- and random-effects models were selected for data analysis. Results: A total of 14 studies were included. When PRP was injected to graft tunnels, the pooled VAS scores of the 2 groups were similar ( P = .31), and the subgroup analysis found that VAS and IKDC only improved at 3 months postoperatively ( P = .0003 and P < .00001, respectively). When PRP was used at the bone–patellar tendon–bone harvest sites, VAS was decreased in the first 6 months postoperatively ( P < .00001), whereas IKDC score was not remarkably different ( P = .07). After PRP injection, Lysholm scores at 3 months postoperatively was different between the 2 groups ( P < .00001), but the Tegner scores ( P = .86), KT-1000 measurements ( P = .12), the positive rate of pivot-shift test ( P = .64), the enlargement of tunnels (femoral, P = .91; tibial, P = .80), and the characterization of grafts ( P = .05) were not different. No difference in complications was found in either group. Conclusion: PRP applied alongside ACLR could reduce postoperative pain and improve knee function in the short and medium terms but is ineffective in the long term. PRP does not improve knee stability and the enlargement of tunnels and does not accelerate the healing of grafts. Further studies would be required.