GENERAL ORTHOPAEDICS
Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial
この研究はハイインパクトの可能性があります。
OEのAI駆動型ハイインパクト指標は、論文が掲載されたジャーナルと論文自体の科学的内容の両方からのシグナルを統合することで、論文が持つ可能性の高い影響力を推定します。
最先端の自然言語処理を用いて開発されたOEハイインパクトモデルは、ジャーナルのインパクトファクターのみよりも、研究の将来の引用実績をより正確に予測します。
これにより、臨床的に意義のある研究をより早く認識することが可能になり、読者は将来の診療を形成する可能性が最も高い論文に集中することができます。
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(4):20 BMC Musculoskelet Disord. 2012 Nov 23;13:229. doi: 10.1186/1471-2474-13-229109 patients with degenerative knee cartilage were randomized to determine the efficacy of platelet-rich plasma (PRP) compared to viscosupplementation via hyaluronic acid (HA) as a treatment method. Patients were allocated to three injections of either solution, and were followed up for 12 months. Results revealed that there were no differences between groups in clinical outcome for the duration of the study. Interestingly, a sub-group analysis of patients with lower degenerative status (Kellgren-Lawrence grade 0-II) indicated a trend of improved outcome with PRP, but did not reach statistical significance.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
3/4
Randomização
3/4
Medidas de resultado
1/4
Inclusão/Exclusão
3/4
Descrição do tratamento
3/4
Estatística
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
While participation in sports activity continues to grow among the entire population as a means of maintaining a healthy lifestyle, so to does the incidence of knee cartilage pathologies. As a result, numerous treatment methods have been suggested in the management of these conditions, although the efficacy of these treatments is often limited in both time and satisfaction. A developing treatment option is in platelet-rich plasma (PRP), which has shown a potential beneficial effect in the regeneration of damaged tissue through the release of concentrated growth factors. While promising findings have been reported, high level evidence in support of PRP remains lacking.
主な研究課題は何ですか？
Was the application of PRP more efficacious than viscosupplementation with hyaluronic acid (HA) after 12 months as a method of treatment for knee cartilage pathologies?
重要な知見は？
- IKDC subjective score in the PRP group was increased from 50.2 (SD 15.7) at baseline to 62.8 (SD 17.6) at 2 months, 64.3 (SD 16.4) at 6 months and 64.9 (SD 16.8) at 12 months. Corresponding values in the HA group were 47.4 (SD 15.7), 61.4 (SD 16.2), 61.0 (SD 18.2), and 61.7 (SD 19.0), respectively. Although intra-group improvements were significant, there was no statistically significant difference observed between groups.
- No significant differences were observed between groups in EQ-VAS scores, nor in overall KOOS score or in individual KOOS subcategories (pain, activity of daily life, sport, quality of life), despite significant intra-group improvements.
- Activity level on the Tegner scale in the PRP group was improved from 2.9 (SD 1.4) at baseline to 3.8 (SD 1.3) at 12 months, and in the HA group from 2.6 (SD 1.2) at baseline to 3.4 (SD 1.6) at 12 months.
- Sub-analysis of IKDC subjective score in patients with Kellgren Lawrence 0-II revealed a trend of improved outcomes at 6 and 12 months in those with low grade degeneration, although statistical significance was not reached (p=0.08 at 6 months, p=0.07 at 12 months).
- Injections of PRP were associated with higher post-injection pain reaction compared to HA injections (p=0.039); reaction was self-limiting within a few days and did not impact overall outcome.
最も覚えておくべきことは？
Both treatments resulted in significant improvements in clinical scores. Clinical outcome of platelet-rich plasma injections for knee cartilage pathologies was not superior to viscosupplementation with hyaluronic acid injections, as similar IKDC, KOOS, EQ-VAS and Tegner activity scores were observed between treatment methods. Outcome in patients with lower graded degeneration (Kellgren-Lawrence 0-II) showed a trend of improved outcome, albeit without significance.
それが私の患者ケアにどのように影響するか？
The findings of this research suggest that treatment of knee cartilage pathologies is not better with PRP injection compared to HA injection, and does not support the use of PRP as first line treatment in this population. However, due to the trend observed in a sub-analysis of this study, future research should be considered for evaluating the efficacy of PRP exclusively in patients with lower degenerative status.
免責事項
このページに記載されている内容は、情報提供のみを目的としたものであり、専門的な医療アドバイス、診断、治療の代わりとなるものではありません。治療が必要な場合は、必ず医師の診断を仰ぐか、最寄りの救急外来を受診してください。このページに記載されている内容に関して個人が表明した意見、信念、見解は、OrthoEvidenceの意見、信念、見解を反映するものではありません。
0の4 月間無料記事のロック解除
