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Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial.

ABSTRACT: The purpose of this study is to evaluate the efficiency of local platelet-rich plasma (PRP) injection as an adjuvant treatment after carpal ligament release. We conducted a prospective randomized, triple-blinded, controlled trial. Fifty participants with mild to extreme carpal tunnel syndrome (CTS) were randomly assigned either to the PRP (n?=?25) or the platelet-poor plasma (PPP, n?=?25) group. After performing open surgical release of the carpal ligament, the inside of the carpal tunnel was irrigated with 3?mL of PRP or PPP according to each participant's group allocation. The primary outcome was hand grip strength (HGS). Secondary outcomes were the time taken off work after surgery (in days) and scores on the Wong-Baker Faces Scale, Boston Carpal Tunnel Questionnaire, and Southampton Wound Assessment Scale. We evaluated patients before treatment and at 6-weeks. As expected, the pain levels, symptom severity, and functional status improved in all the patients after surgery. However, intragroup analysis revealed that only the participants in the PRP group had regained their pre-operative HGS levels at 6-weeks follow-up. These findings indicate that PRP is an effective adjuvant treatment in patients with mild to severe CTS who require surgery.

SUBMITTER: Trull-Ahuir C

PROVIDER: S-EPMC7005701 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial.

Trull-Ahuir Carmen C Sala Diego D Chismol-Abad Joaquín J Vila-Caballer Marian M Lisón Juan Francisco JF

Scientific reports 20200207 1

The purpose of this study is to evaluate the efficiency of local platelet-rich plasma (PRP) injection as an adjuvant treatment after carpal ligament release. We conducted a prospective randomized, triple-blinded, controlled trial. Fifty participants with mild to extreme carpal tunnel syndrome (CTS) were randomly assigned either to the PRP (n = 25) or the platelet-poor plasma (PPP, n = 25) group. After performing open surgical release of the carpal ligament, the inside of the carpal tunnel was ir ...[more]

PMID: 32034241

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Project description:BACKGROUND:There has been a surge in high-level studies investigating platelet-rich plasma (PRP) for tendon and ligament injuries. A number of meta-analyses have been published, but few studies have focused exclusively on tendon and ligament injuries. PURPOSE:To perform a meta-analysis assessing the ability of PRP to reduce pain in patients with tendon and ligament injuries. STUDY DESIGN:Systematic review and meta-analysis. METHODS:This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search of the literature was carried out in April 2017 using electronic databases PubMed, MEDLINE, and the Cochrane Library. Only level 1 studies were included. Platelet and leukocyte count, injection volume, kit used, participant age/sex, comparator, and activating agent used were recorded. The short-term and long-term efficacy of PRP was assessed using the visual analog scale (VAS) to measure pain intensity. Injury subgroups (rotator cuff, tendinopathy, anterior cruciate ligament, and lateral epicondylitis) were evaluated. Funnel plots and the Egger test were used to screen for publication bias, and sensitivity analysis was performed to evaluate the effect of potential outliers by removing studies one at a time. RESULTS:Thirty-seven articles were included in this review, 21 (1031 participants) of which could be included in the quantitative analysis. The majority of studies published investigated rotator cuff injuries (38.1%) or lateral epicondylitis (38.1%). Seventeen studies (844 participants) reported short-term VAS data, and 14 studies (771 participants) reported long-term VAS data. Overall, long-term follow-up results showed significantly less pain in the PRP group compared with the control group (weighted mean difference [WMD], -0.84; 95% CI, -1.23 to -0.44; P < .01). Patients treated with PRP for rotator cuff injuries (WMD, -0.53; 95% CI, -0.98 to -0.09; P = .02) and lateral epicondylitis (WMD, -1.39; 95% CI, -2.49 to -0.29; P = .01) reported significantly less pain in the long term. Substantial heterogeneity was reported at baseline ( I2 = 72.0%; P < .01), short-term follow-up ( I2 = 72.5%; P < .01), long-term follow-up ( I2 = 76.1%; P < .01), and overall ( I2 = 75.8%; P < .01). The funnel plot appeared to be asymmetric, with some missingness at the lower right portion of the plot suggesting possible publication bias. CONCLUSION:This review shows that PRP may reduce pain associated with lateral epicondylitis and rotator cuff injuries.

Project description:IntroductionPlatelet-rich plasma (PRP) has been shown to be effective in treating partial tears of the ulnar collateral ligament (UCL) of the elbow in overhead throwing athletes, but it is still unknown whether it has a role in complete tears. The aim of this study was to assess the effectiveness of PRP in treating complete as well as partial UCL tears. We hypothesized that trephination of the injured UCL followed by injection with PRP can promote healing of both partial and complete tears.MethodsThirty-four baseball players with partial or complete UCL tears confirmed by magnetic resonance imaging (MRI) were included in the study. They were all recalcitrant to more than two months of rest and physical therapy. Under ultrasound guidance, trephination of the UCL was performed using an 18-gauge needle, followed by PRP injection. Visual analog scale (VAS) scores, Disabilities of the Arm, Shoulder, and Hand (DASH) sports module scores, and sonographic ulnohumeral joint space measurements with valgus stress were all obtained prior to the procedure and six months after.ResultsTwenty-six of 30 athletes were able to return to sport with pre-injury level of play within six months after the procedure, at an average time of 12.4 weeks (range: 10-18). Four subjects needed surgical treatment for persistent UCL insufficiency. The average follow-up was 54.2 weeks (range: 26-148). The average VAS and DASH scores improved from 53.5 to 17.2 (p < 0.0001) and from 81.7 to 24.2 (p < 0.0001), respectively. The average ulnohumeral joint space opening with valgus stress decreased from 3.81 mm to 3.45 mm (p = 0.018). Subgroup analysis by injury location revealed that the average VAS score improved from 48.2 to 8.6 (p < 0.0001) and from 64.0 to 34.5 (p = 0.0023) in proximal and distal tears, respectively. The average DASH score improved from 83.8 to 17.8 (p = 0.0001) and from 77.5 to 36.7 (p < 0.0001) in proximal and distal tears, respectively. The average ulnohumeral joint space opening with valgus stress decreased from 3.64 to 3.21 mm (p = 0.003) and from 4.14 to 3.92 mm (p = 0.0023) in proximal and distal tears, respectively. There was one case with a proximal tear that needed surgical management for failure of treatment, while there were three cases needing surgery in those with distal tears.ConclusionUltrasound-guided PRP injection following trephination can be an effective treatment option for both partial and complete UCL tears of the elbow, especially proximal tears. The use of this technique for complete UCL tears may allow more athletes to avoid surgery and enable them to return to play faster.

Dataset Information

Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial.

Publications

Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial.

Similar Datasets

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