Influence of platelet count on the clinical effectiveness of platelet-rich plasma in the treatment of knee osteoarthritis: A systematic review and meta-analysis.
Mario Simental-Mendía, Carlos A Acosta-Olivo, Daniela Ortega-Mata, Héctor Javier Salazar-Domínguez, Gabriela Cecilia Carrizales-Hernández, Ximena Fernanda Sierra-Morales, Luis Alejandro Rodríguez-Corpus, Víctor M Peña-Martínez, Félix Vilchez-Cavazos
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Abstract
Background: Clinical effectiveness of platelet-rich plasma (PRP) for knee osteoarthritis (OA) continues to be debated, largely due to inconsistencies in PRP preparation methods and the variability in platelet concentrations. The optimal therapeutic range for platelet concentration remains unclear, leading to inconsistent treatment protocols and outcomes across studies. This systematic review and meta-analysis aimed to evaluate whether platelet count in PRP influences clinical outcomes in patients with knee OA.
Materials and methods: A systematic search was conducted in MEDLINE, Scopus, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials through February 2024. Randomized controlled trials evaluating PRP injections in knee OA were included. Studies reporting platelet counts in whole blood and PRP, as well as baseline and follow-up pain and functional scores, were analyzed. Standardized mean differences (SMD) were computed, and subgroup analyses were conducted based on platelet fold increase in PRP preparation.
Results: Forty studies met the inclusion criteria. PRP improved both pain and function across all platelet concentration categories. However, lower platelet fold increases (0-2× and >2-4×) demonstrated greater clinical benefits (SMD 1.84, 95% CI [1.05, 2.04], p = 0.0004 and SMD 1.36, 95% CI [0.94, 1.79], p < 0.0001, respectively) compared to higher concentrations (>4-6× and >6-9×). Effect sizes for lower concentrations exceeded established minimal clinically important differences.
Discussion: Moderate platelet count increases (2-4×) in PRP appear optimal for knee OA treatment. Higher platelet concentrations may not provide additional benefit and could attenuate therapeutic effects. These findings highlight the importance of standardizing PRP formulations to optimize efficacy while minimizing variability.
背景：富血小板血浆（PRP）治疗膝关节骨性关节炎（OA）的临床疗效一直存在争议，主要是由于PRP制备方法的不一致性和血小板浓度的可变性。血小板浓度的最佳治疗范围尚不清楚，导致不同研究的治疗方案和结果不一致。本系统综述和荟萃分析旨在评估PRP中血小板计数是否影响膝关节OA患者的临床结局。材料和方法：系统检索MEDLINE、Scopus、EMBASE、Web of Science和Cochrane Central Register of Controlled Trials，检索时间截止到2024年2月。纳入评估PRP注射治疗膝关节OA的随机对照试验。研究报告了全血血小板计数和PRP，以及基线和随访疼痛和功能评分。计算标准化平均差异（SMD），并根据PRP制剂中血小板折叠数的增加进行亚组分析。结果：40项研究符合纳入标准。PRP改善了所有血小板浓度类别的疼痛和功能。然而，较低的血小板折叠增加（0-2倍和> -4倍）显示出更大的临床益处（SMD 1.84, 95% CI [1.05, 2.04], p = 0.0004; SMD 1.36, 95% CI [0.94, 1.79]， p 4-6倍和>6-9倍）。较低浓度的效应值超过了已确定的最小临床重要差异。讨论：中度血小板计数增加（2-4倍）对于膝关节OA治疗是最佳的。较高的血小板浓度可能不会提供额外的益处，并可能减弱治疗效果。这些发现强调了标准化PRP配方的重要性，以优化疗效，同时尽量减少可变性。证据等级：1。
期刊介绍：
Orthopaedics & Traumatology: Surgery & Research (OTSR) publishes original scientific work in English related to all domains of orthopaedics. Original articles, Reviews, Technical notes and Concise follow-up of a former OTSR study are published in English in electronic form only and indexed in the main international databases.
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