The Effects of Platelet-Rich Plasma in Conjunction with Rehabilitation for Lower Extremity Musculoskeletal Pathologies

Abstract

Background: Platelet-rich plasma (PRP) has been considered for its role in facilitating the body’s own healing processes, with the potential to complement rehabilitation in the management of lower extremitymusculoskeletal pathologies.Methods: Eligible studies were randomized clinical trials and quasi-experimental trials with completed data analysis; published in English; recruited participants aged >18 years; had at least two groups, with one intervention group receiving PRP injection alone or PRP injection and rehabilitation, and the comparison group receiving either rehabilitation alone or a control group receiving saline and rehabilitation; included at least one outcome measure of pain, disability, quality of life, or return to play. An electronic search was conducted using PubMed, Embase, Cochrane, Pedro, and clinicaltrials.gov. Methodological quality was assessed using the Cochrane Collaboration Risk of Bias (RoB) tool. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the quality of evidence. Meta-analyses were conducted across outcomes in each pathology when possible.Results: Twenty-one studies assessed Achilles rupture, Achilles tendinopathy, lateral ankle sprain, high ankle sprain, hamstring injury, knee osteoarthritis, acute muscle injury, patellar tendinopathy, and plantar fasciitis, with an average RoB score of 9.9 out of 12. Meta-analyses for Achilles rupture (n = 270) revealed a nonsignificant effect on disability in the short and long term (high level of evidence) when comparing PRP, immobilization, and exercise/physical therapy to placebo, immobilization, and exercise/physical therapy. Meta-analyses for Achilles tendinopathy revealed a nonsignificant effect on pain (n = 64) in the short term, and disability in the short (n = 138) as well as long term (n = 192) (very low to low level of evidence) when comparing PRP and exercise to placebo and exercise.Conclusions: While individual studies demonstrated significant findings across outcomes, the non-significant pooled results and inability to perform further meta-analyses made it difficult to provide definitive recommendations for the addition of PRP to exercise for lower extremity musculoskeletal pathologies. Future studies should standardized PRP exercise rehabilitation protocols with better dosage parameters, consider larger sample sizes, and have short and long term follow-up periods consistent with the Cochrane Collaboration.