Platelet-Rich Plasma, Mesenchymal Stem Cell, and Non-metallic Suture-Based Fixation Technique in a Patellar Fracture Nonunion: A Technical Note and Systematic Review

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Abstract

Backgroud

We performed a systematic review on the management of patellar fracture nonunion and report a novel suture-based non-metallic fixation technique associated with platelet-rich plasma and mesenchymal stem cell injections in the management of this injury.

Methods

A systematic search was performed up to August 2020 in PubMed and Scopus electronic databases of scholarly articles evaluating different surgical techniques used for nonunion of patellar fractures, with no restrictions on language or year of publication. Furthermore, we describe our novel non-metallic suture fixation technique and a patient in whom this technique was applied.

Results

A total of 9 articles were included in the systematic review. Tension band wiring was the most commonly used procedure (62.7%). Nonoperative procedures (8.1%) resulted in nonunion in all patients. The most common complication after open reduction and internal fixation was infection (7.8%). Our patient at the latest follow-up reported full functional recovery and full extension and flexion of the affected knee with no pain and subjectively normal strength.

Conclusions

The management of patella nonunions is still a challenge. The technique reported here can be used in patellar fracture nonunion, as well as in primary patellar fractures.

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Most cited references 26

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Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and publication bias.

Karsten Knobloch, Uzung Yoon, Peter Vogt (2011)

Publication bias is a major problem in evidence based medicine. As well as positive outcome studies being preferentially published or followed by full text publication authors are also more likely to publish positive results in English-language journals. This unequal distribution of trials leads to a selection bias in evidence l level studies, like systematic reviews, meta-analysis or health technology assessments followed by a systematic failure of interpretation and in clinical decisions. Publication bias in a systematic review occurs mostly during the selection process and a transparent selection process is necessary to avoid such bias. For systematic reviews/meta-analysis the PRISMA-statement (formerly known as QUOROM) is recommended, as it gives the reader for a better understanding of the selection process. In the future the use of trial registration for minimizing publication bias, mechanisms to allow easier access to the scientific literature and improvement in the peer review process are recommended to overcome publication bias. The use of checklists like PRISMA is likely to improve the reporting quality of a systematic review and provides substantial transparency in the selection process of papers in a systematic review. Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

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Current Clinical Recommendations for Use of Platelet-Rich Plasma

Adrian D. K. Le, Lawrence Enweze, Malcolm DeBaun … (2018)

Purpose of Review This review evaluates current clinical literature on the use of platelet-rich plasma (PRP), including leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP), in order to develop evidence-based recommendations for various musculoskeletal indications. Recent Findings Abundant high-quality evidence supports the use of LR-PRP injection for lateral epicondylitis and LP-PRP for osteoarthritis of the knee. Moderate high-quality evidence supports the use of LR-PRP injection for patellar tendinopathy and of PRP injection for plantar fasciitis and donor site pain in patellar tendon graft BTB ACL reconstruction. There is insufficient evidence to routinely recommend PRP for rotator cuff tendinopathy, osteoarthritis of the hip, or high ankle sprains. Current evidence demonstrates a lack of efficacy of PRP for Achilles tendinopathy, muscle injuries, acute fracture or nonunion, surgical augmentation in rotator cuff repair, Achilles tendon repair, and ACL reconstruction. Summary PRP is a promising treatment for some musculoskeletal diseases; however, evidence of its efficacy has been highly variable depending on the specific indication. Additional high-quality clinical trials with longer follow-up will be critical in shaping our perspective of this treatment option.

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The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials

Longxiang Shen, TING YUAN, Shengbao Chen … (2017)

Background Quite a few randomized controlled trials (RCTs) investigating the efficacy of platelet-rich plasma (PRP) for treatment of knee osteoarthritis (OA) have been recently published. Therefore, an updated systematic review was performed to evaluate the temporal effect of PRP on knee pain and physical function. Methods Pubmed, Embase, Cochrane library, and Scopus were searched for human RCTs comparing the efficacy and/or safety of PRP infiltration with other intra-articular injections. A descriptive summary and quality assessment were performed for all the studies finally included for analysis. For studies reporting outcomes concerning Western Ontario and McMaster Universities Arthritis Index (WOMAC) or adverse events, a random-effects model was used for data synthesis. Results Fourteen RCTs comprising 1423 participants were included. The control included saline placebo, HA, ozone, and corticosteroids. The follow-up ranged from 12 weeks to 12 months. Risk of bias assessment showed that 4 studies were considered as moderate risk of bias and 10 as high risk of bias. Compared with control, PRP injections significantly reduced WOMAC pain subscores at 3, 6, and 12 months follow-up (p = 0.02, 0.004, <0.001, respectively); PRP significantly improved WOMAC physical function subscores at 3, 6, and 12 months (p = 0.002, 0.01, <0.001, respectively); PRP also significantly improved total WOMAC scores at 3, 6 and 12 months (all p < 0.001); nonetheless, PRP did not significantly increased the risk of post-injection adverse events (RR, 1.40 [95% CI, 0.80 to 2.45], I 2 = 59%, p = 0.24). Conclusions Intra-articular PRP injections probably are more efficacious in the treatment of knee OA in terms of pain relief and self-reported function improvement at 3, 6 and 12 months follow-up, compared with other injections, including saline placebo, HA, ozone, and corticosteroids. Review registration PROSPERO CRD42016045410. Registered 8 August 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13018-017-0521-3) contains supplementary material, which is available to authorized users.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Orthop Surg

Journal ID (iso-abbrev): Clin Orthop Surg

Journal ID (publisher-id): CIOS

Title: Clinics in Orthopedic Surgery

Publisher: The Korean Orthopaedic Association

ISSN (Print): 2005-291X

ISSN (Electronic): 2005-4408

Publication date (Print): September 2021

Publication date (Electronic): 17 March 2020

Volume: 13

Issue: 3

Pages: 344-351

Affiliations

Department of Orthopaedics and Traumatology, San Francesco d'Assisi Hospital, Oliveto Citra, Italy.

[* ]Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.

[† ]Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy.

[‡ ]Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, England.

[§ ]School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Newcastle-under-Lyme, England.

Author notes

Correspondence to: Nicola Maffulli, MD. Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno 89100, Italy. Tel: +39-3201136248, n.maffulli@ 123456qmul.ac.uk

Author information

Giovanni Felice Trinchese https://orcid.org/0000-0002-2542-3822

Lucio Cipollaro https://orcid.org/0000-0001-7074-7597

Emanuele Calabrese https://orcid.org/0000-0003-2687-0867

Nicola Maffulli https://orcid.org/0000-0002-5327-3702

Article

DOI: 10.4055/cios20175

PMC ID: 8380518

PubMed ID: 34484627

SO-VID: 079775a8-c999-4ffe-a5d8-e7a0372d4efa

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Platelet-Rich Plasma, Mesenchymal Stem Cell, and Non-metallic Suture-Based Fixation Technique in a Patellar Fracture Nonunion: A Technical Note and Systematic Review

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Abstract

Backgroud

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Conclusions

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SICOT-J (Orthopedic surgery and traumatology)

Most cited references 26

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and publication bias.

Current Clinical Recommendations for Use of Platelet-Rich Plasma

The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials

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