The place of platelet rich plasma in traumatic and degenerative diseases of the foot and ankle. Literature review

Abstract

Platelet rich plasma (PRP) has been used for around ten years in degenerative and traumatic diseases of the locomotor apparatus by sports physicians, rheumatologists, radiologists and orthopaedic surgeons. Indications are currently increasing, unfortunately, however, there is a lack of evidence regarding the efficacy of PRP in these new indications. The aim of this article is to carry out a review of the literature, in order to state the level of evidence for the efficacy of PRP in five major diseases. For this literature review, the Pubmed and ScienceDirect search engines were used. The key words used for the search were [Platelet rich plasma], [Foot], [Ankle]. The articles selected were those that dealt with the benefit of PRP in tibiotalar arthritis, tendinopathies, ruptures of the Achilles tendon, plantar fasciitis and bone consolidation. Series of several cases were excluded. Articles needed to be from before 2010. Fifteen articles met the inclusion criteria. For arthritis of the ankle, the PRP injection was more effective than viscosupplementation or the injection of corticosteroids. The articles validate the data observed for gonarthrosis. For plantar fasciitis, PRP appeared to be as effective as corticosteroid injections. In ruptures of the Achilles tendon: there was no benefit seen for the injection of PRP into the rupture site. For chronic tendinopathy of the Achilles tendon: cases studies showed a benefit in terms of pain and function in the months following the injection. However, the only level 1 study did not find any significant difference compared with the placebo injection. PRP and bone consolidation: the number of articles was small. A single non-randomised study showed a benefit for talotibial arthrodesis. An assessment of the actual benefits of PRP is difficult, due to both the intra- and inter-individual variations of platelet levels. Unlike a pharmacological agent, the concentration of growth factors injected with PRP is not known. Literature regarding tibiotalar arthritis confirms the data for gonarthrosis. PRP is not validated for use in Achilles tendon rupture. In degenerative conditions of the Achilles tendon, studies are not consistent. However, there is considerable bias towards the injection site (intra or around the tendon). There is also bias regarding the “combing” effect linked to the intratendon injection. Regarding bone consolidation, only one series appeared to show a benefit in tibiotalar arthrodesis. The level of evidence regarding the place of PRP in arthrosis of the foot and ankle is equivalent to that for gonarthrosis. Regarding degenerative tendon conditions, the level of evidence is inadequate, with numerous bias and contradictory studies. The place of PRP in the consolidation of fractures and pseudoarthrosis of the foot has not been adequately studied.