Talk:Platelet-rich plasma

Untitled

There has been criticism of this article in the Portuguese Wikipedia as follows (machine translation from http://pt.wikipedia.org/wiki/Wikipedia:P%C3%A1ginas_para_eliminar/Plasma_rico_em_plaquetas ):

Besides having noticed this, claims that the article is completely false and are used as "references", work on the subject that most authors claimed to have inconclusive results or even conclude that can cause unnecessary risks to the patient. The article stated that since the 1980s has been routinely used by dentists is a fallacy. I can say categorically no. In cases where there is bone problems (eg, pseudoarthrosis, necrosis, osteomyelitis, etc..) Is used in some cases bone graft, bone marrow transport (retires hematopoietic array of flat bones, eg the pelvic bone and injects in the affected area in an attempt to induce the activity of normal bone). In case of special needs shaving cutaneous (skin) graft is used in extreme cases. It makes sense to introduce a Platelet-Rich Plasma as the maximum that can be achieved with this is an inflammation (and thus the analysis of this tissue is already differentiated and recognized as foreign, thus bringing no benefit). In conclusion References contained in the pseudo-article are hostage to the will of whoever wrote the entry to show their vision. To quote his own words (contained in the article itself): "The author's personal experience (RTS) is also promising in this segment, and soon the work will be available in the medical literature. This treatment is in Brazil since 2005, and today their application is already supported by the existing medical literature. Rogerio Teixeira da Silva 20:29, 28 December 2009 (UTC). "Leandro Martinez msg 11:56, 31 December 2009 (UTC)

Follow up on this: [1]. Article is not neutral, has strong POV bias. --VanBurenen (talk) 12:29, 13 January 2010 (UTC)

Newer evidence

A more recent systematic review concluded that: The current clinical evidence suggests that PRGF intra-articular infiltrations in patients with knee osteoarthritis reduce pain and therefore are clinically efficacious in osteoarthritis treatment.

This seems like it is worth noting in the article: http://www.ncbi.nlm.nih.gov/pubmed/24996872 — Preceding unsigned comment added by Talgalili (talk • contribs) 20:46, 17 August 2014‎

I looked at the 2014 metaanalysis Talgalili quoted above, and think he could have certainly added it at that time, as it contains some (little) evidence of improvement. The caveat is, the authors could only include 5 studies for review, and even of those only 2 were RCT's, i.e. the majority were of poor quality.

As of today however, I would add , that newer trials have still not borne out this evidence of improvement. There is still lack of sounding, robust evidence to recommend PRT as a first line treatment, based on my review of the literature. If you search PubMed for PRT and osteoarthritis, you will find

• A 2015 systematic review (Lai LP, Stitik TP, Foye PM, Georgy JS, Patibanda V, Chen B. Use of Platelet-Rich Plasma in Intra-Articular Knee Injections for Osteoarthritis: A Systematic Review. PM R. 2015 Jun;7(6):637-48. doi: 10.1016/j.pmrj.2015.02.003.) stating PRT" may be an effective alternative treatment for knee OA. However, current studies are at best inconclusive regarding the efficacy of the PRP treatment. A large, multicenter randomized trial study is needed."
• a 2015 metaananlysis (Laudy AB, Bakker EW, Rekers M, et al. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br J Sports Med 2015;49:657–72. doi:10.1136/bjsports-2014-094036) which included 10 randomised and non-randomised controlled trials, found PRT improved pain and function, but has been criticized for inappropriately using a fixed-effects model, instead of a random-effects model. Analysing with the random-effects model showed no difference for pain or function.(Wang Z1, Liu Y1, Liu M2.Platelet-rich plasma injection is not more effective than hyaluronic acid to treat knee osteoarthritis when using a random-effects model.Br J Sports Med. 2016 Feb 25. pii: bjsports-2015-095512. doi: 10.1136/bjsports-2015-095512.)
• another 2015 metaanalysis of 6 randomized controlled trials (Riboh JC, Saltzman BM, Yanke AB, Fortier L, Cole BJ. Effect of leukocyte concentration on the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis. Am J Sports Med. 2015) suggested a particular form of PRP prepared using a leukocyte-poor technique produces improvements in self-reported symptoms.
• a 2016 RCT that found no difference in treatment groups (KL1,2, Nicholls M3, Bennell KL4, Bates D. Intra-articular injection of photo-activated platelet-rich plasma in patients with knee osteoarthritis: a double-blind, randomized controlled pilot study.BMC Musculoskelet Disord. 2016 Feb 9;17(1):67. doi: 10.1186/s12891-016-0920-3)
• and a 2016 expert opinion ?/editorial? summarizing the current evidence nicely (Matteo B1, Kon E1, Filardo G Intra-articular platelet-rich plasma for the treatment of osteoarthritis. Ann Transl Med. 2016 Feb;4(3):63. doi: 10.3978/j.issn.2305-5839.2016.01.18).--Wuerzele (talk) 20:00, 23 March 2016 (UTC)

major edit in lede

I reverted an edit in the lede that changed a sentence to state the exact contrary of what is developed in the body under section Platelet-rich_plasma#Clinical_validity in detail, backed up with reviews and metaanalyses. If 90.197.193.51 wants to contest the revert, the place is here. The 2 refs he/she inserted are insufficient to back up the claims of "Large-scale randomized controlled trials have confirmed PRP to efficiently treat musculoskeletal injuries (including tendinitis, nerve injuries) and help in bone grafting", as they are outdated and they are primary sources. Also, the deletion of mentioning "use of PRP for hair regrowth isnt proven efficacious" was unwarranted.--Wuerzele (talk) 20:43, 10 April 2016 (UTC)

advert

This is departing more and more from WP:MEDMOS. The hype about potential uses in the medical use section (research does not belong there) is getting longer and more elaborate. Oddly, the adverse effects section is still a one sentence shrug. yep. Will try to put some time into this. 05:05, 30 April 2018 (UTC)

O shot

There is one decent reference and it says there is no evidence.[2]

Doc James (talk · contribs · email) 02:29, 1 June 2019 (UTC)

Agree it should be in then. Thanks for finding it. Ian Furst (talk) 13:10, 1 June 2019 (UTC)

There is a significant difference between saying "there is no evidence" and stating that the evidence is disputed because the studies have been few and relatively small. (I trust that you gentlemen, as physicians, appreciate the difference.)

I have put back the changes I previously made (albeit with a few, small changes), but with more and better citations to support what I said. As far as anecdotal evidence, it is abundant, as stated; but I only listed two because, as the weakest form of evidence, even 100 anecdotal reports of personal experience would not lend significant additional credence to the claims. There were a few studies that I was able to find to support the use of PRP for treating urogenital issues, and I cited a couple; they are small studies, as acknowledged. I believe that the weak evidence justifies those who question its effectiveness, and have left the book and business journal citations in place (although it's noteworthy that both of those were written before the publication of the two research studies i cited -- i.e they were accurate when written, but could not take into account yet-to-be-published evidence).

Honestly, the entire PRP page is a bloody mess, with citations dating back as much as a decade, a veritable eternity in a rapidly growing field of research (not all the old citations are wrong, but some clearly are); I've also come across a number of factual errors and biased verbiage. I wish I had time to devote to cleaning up the entire page (and I'll likely come back soon to clean up the opening section, at least), but the issues are too numerous for one busy professional to easily rectify. DoctorEric (talk) 19:38, 1 June 2019 (UTC)

Agree it's a good page for clean-up, but we've agreed that references have to be text-book, meta, cochrane, or review. Only two of the citations are scientific studies, and both declare themselves as pilots. Just too early right now. Wait for better evidence before. Ian Furst (talk) 00:52, 3 June 2019 (UTC)

Paraphrasing

"Limited evidence supports the conclusion that PRP is not superior to placebo treatment."

as

A 2019 meta-analysis found some evidence that PRP was not superior to placebo in Achilles tendinopthay.

Thoughts? Doc James (talk · contribs · email) 15:33, 18 January 2020 (UTC)

Where they hedge, it is based on low quality evidence (e.g. only 2 studies followed up to 1 year). The key line was "In this study, the quantitative analysis of the 5 items of grade-I clinical evidence showed that the efficacy of PRP does not significantly differ from that of the placebo." Everything else is just low quality stuff that is ammo for future studies. E.g. tendon thickness; the meta could not prove anything because the studies were poor but it's an avenue to explore. I think we should change it to the quoted line. Ian Furst (talk) 15:08, 19 January 2020 (UTC)

User:Ian Furst how about "A 2019 meta-analysis found "limited evidence ... that PRP is not superior to placebo treatment"." Doc James (talk · contribs · email) 20:52, 20 January 2020 (UTC)

User:Doc James for some reason the not superior to placebo seems like a double negative. How about "A 2019 meta-analysis found that, for most outcomes of Achilles tendinopathy, PRP treatment did not differ from placebo treatment"? Ian Furst (talk) 14:04, 21 January 2020 (UTC)

That would be good. Agree I do not like the double negative. Doc James (talk · contribs · email) 07:30, 22 January 2020 (UTC)

References

2019 guideline

The article presently states, "Tentative evidence supports its use in osteoarthritis (OA) of the knee. A 2019 meta-analysis found that PRP might be more effective in reducing pain and improving function than hyaluronic acid in knee OA." However, the 2019 guideline from the American College of Rheumatology and Arthritis Foundation states, "Platelet-rich plasma treatment is strongly recommended against in patients with knee and/or hip OA. In contrast to intraarticular therapies discussed above, there is concern regarding the heterogeneity and lack of standardization in available preparations of platelet-rich plasma, as well as techniques used, making it difficult to identify exactly what is being injected. This treatment has not been evaluated in hand OA and, therefore, no recommendation is made with regard to OA of the hand." Can we resolve the conflict? ScienceFlyer (talk) 18:06, 16 February 2022 (UTC)

Noting "inconsistent evidence," The American Academy of Orthopaedic Surgeons 2021 guideline makes a "limited" strength recommendation, saying "Platelet-rich plasma (PRP) may reduce pain and improve function in patients with symptomatic osteoarthritis of the knee." However, this is listed in the same category as non-evidence-based treatments like Turmeric and Ginger extract. ScienceFlyer (talk) 18:24, 16 February 2022 (UTC)

Additional sources

Suggestions:

• Magruder ML, Caughey S, Gordon AM, Capotosto B S S, Rodeo SA. Trends in utilization, demographics, and costs of platelet-rich plasma injections: a ten-year nationwide investigation. Phys Sportsmed. 2023 Feb 17:1-9. doi: 10.1080/00913847.2023.2178816. Epub ahead of print. PMID: 36755520.Taylor SA, Hannafin JA. Evaluation and management of elbow tendinopathy. Sports Health. 2012 Sep;4(5):384-93. doi: 10.1177/1941738112454651. PMID: 23016111; PMCID: PMC3435941.

• Rodeo SA. Orthobiologics: Current Status in 2023 and Future Outlook. J Am Acad Orthop Surg. 2023 Jun 15;31(12):604-613. doi: 10.5435/JAAOS-D-22-00808. Epub 2023 May 1. PMID: 37130369.

-- John Broughton (♫♫) 18:45, 26 November 2023 (UTC)

Wiki Education assignment: Composition and Culture

This article was the subject of a Wiki Education Foundation-supported course assignment, between 16 January 2024 and 2 May 2024. Further details are available on the course page. Student editor(s): AMR2024 (article contribs).

— Assignment last updated by AMR2024 (talk) 15:42, 6 February 2024 (UTC)