Current state of systematic reviews for platelet-rich plasma use in knee osteoarthritis

Gurjovan Sahi; Jin Tong Du; Aazad Abbas; Herman S Dhotar

doi:10.1016/j.otsr.2023.103735

Current state of systematic reviews for platelet-rich plasma use in knee osteoarthritis

Orthop Traumatol Surg Res. 2024 Feb;110(1):103735. doi: 10.1016/j.otsr.2023.103735. Epub 2023 Oct 27.

Authors

Gurjovan Sahi¹, Jin Tong Du², Aazad Abbas², Herman S Dhotar³

Affiliations

¹ Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
² Division of Orthopaedic Surgery, University of Toronto, 149 College Street Room 508-A, Toronto, ON, M5T 1P5, Canada.
³ Department of Orthopaedic Surgery, North York General Hospital, University of Toronto, 4001 Leslie Street, North York, ON, M2K, Canada; Department of Surgery, University of Toronto, 149 College Street 5th Floor, Toronto, ON, M5T 1P5, Canada. Electronic address: herman.dhotar@mail.utoronto.ca.

PMID: 37890526
DOI: 10.1016/j.otsr.2023.103735

Abstract

Background: Knee osteoarthritis (KOA) is a highly prevalent musculoskeletal disorder affecting millions of people. To date, there is no curative treatment for KOA other than joint arthroplasty. However, treatments such as platelet-rich plasma (PRP) have been proposed as a possible therapy, with increasing interest over the last decade. To date, there are no evidence-based guidelines in the use of PRP therapy for KOA, but there are numerous studies and systematic reviews (SRs) evaluating the usage of PRP in KOA. Since SRs are of great importance for clinical decision-making, it is necessary to access their methodological quality before any valid conclusions can be made. This study will evaluate the methodological quality of SRs on PRP therapy for KOA using a validated assessment tool known as AMSTAR 2, "A MeaSurement Tool to Assess systematic Reviews".

Hypothesis: It is hypothesized that the methodological quality of SRs will be moderate, whereby most of the SRs will provide an accurate summary of the results but will include more than one critical weakness as defined by the AMSTAR 2 checklist.

Patients and methods: The MEDLINE, EMBASE, PubMed and Cochrane databases were searched from inception to May 2023. Two independent reviewers selected SRs that investigated the use of injection therapies for KOA. Descriptive statistical analysis was performed. AMSTAR 2 assessment was completed independently by the same reviewers. Cohen's kappa was calculated to measure interrater reliability. The quality of the studies was rated as "high", "moderate", "low", and "critically low". The overall confidence assessment was tabulated.

Results: Forty-one SRs were included in the analysis. The Cohen kappa was 0.88, indicating high interrater reliability. There were no "high" quality SRs identified. Seven SRs (17%) were of "low" quality, while the remainder (34 SRs, 83%) were rated as "critically low".

Conclusion: The methodological quality of the selected SRs was suboptimal. Clinicians should critically appraise the SRs and interpret their conclusions with caution before making clinical decisions. This study supports future work of high-quality SRs regarding the use of PRP injections for KOA.

Level of evidence: II.

Keywords: AMSTAR; Knee; Osteoarthritis; Platelet-rich plasma.

Publication types

Review

MeSH terms

Arthroplasty
Humans
Osteoarthritis, Knee* / therapy
Platelet-Rich Plasma*
Reproducibility of Results
Systematic Reviews as Topic