Abstract
Background: Platelet-rich plasma (PRP) has been suggested as an emerging treatment for bone defects. However, whether PRP could enhance the therapeutic efficacy of autologous bone grafting for long bone delayed union or non-union remains unknown. A meta-analysis of randomized and non-randomized controlled trials (RCT and NRCT) was performed to summarize current evidence.Methods: Relevant RCTs and NRCTs comparing the influences of autologous bone grafting on healing of long bone delayed union or non-union with and without PRP were obtained by searching PubMed, Embase, Cochrane's Library, China National Knowledge Infrastructure, and WanFang databases from inception to September 10, 2020. A random-effect model was applied to pool the results with the incorporation of the potential heterogeneity. Subgroup analysis according to study design was also performed.Results: Six RCTs and two NRCTs with 420 patients were included. Compared to patients allocated to autologous bone grafting alone, those allocated to combined treatment with PRP and autologous bone grafting were not associated with higher rates of radiographic bone healing [risk ratio (RR): 1.06, 95% confidence interval (CI): 0.99–1.13, P = 0.09; I2 = 24%] or excellent/good posttreatment limb function (RR: 1.14, 95% CI: 0.95–1.37, P = 0.37; I2 = 0%) but was associated with a shorter healing time (mean difference: −1.35 months, 95% CI: −1.86 to −0.84, P < 0.001; I2 = 58%). Subgroup analysis according to study design showed similar results for the above outcomes (P-values for subgroup difference all >0.10).Conclusions: Combined treatment with PRP and autologous bone grafting may be effective to accelerate the healing of long bone delayed union or non-union compared to autologous bone grafting alone.
Highlights
Delayed union and non-union of long bones after fracture are clinically challenging complications, which are observed in up to 40% of patients according to the severity of fracture, location of bones, and damages of vascular tissues, etc. [1,2,3]
The characteristics of the included randomized controlled trials (RCTs) and nonrandomized controlled trials (NRCTs) are summarized in Tables 1, 2
For patients allocated to the treatment group, combined treatment with Platelet-rich plasma (PRP) and autologous bone graft was applied; while for those allocated to the control group, autologous bone graft alone was performed
Summary
Delayed union and non-union of long bones after fracture are clinically challenging complications, which are observed in up to 40% of patients according to the severity of fracture, location of bones, and damages of vascular tissues, etc. [1,2,3]. Conventional treatment for delayed union and non-union included mechanical fixation and biological stimulation of bone repair, which always involves bone graft to accelerate the healing of the defect [4,5,6,7]. In view of the inconsistent results in previous pilot controlled studies [23,24,25,26,27,28,29,30], we aimed to perform a metaanalysis to systematically evaluate whether PRP could enhance the therapeutic efficacy of autologous bone grafting for long bone delayed union or non-union. A meta-analysis of randomized and non-randomized controlled trials (RCT and NRCT) was performed to summarize current evidence
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