Electronic Thesis and Dissertation Repository

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Supervisor

Dr. Dianne Bryant

Abstract

Purpose: To evaluate the effectiveness of platelet rich plasma (PRP) in musculoskeletal injuries.

Methods: We completed a review of the literature on the use of PRP in tendon, muscle, bone, and intra-articular injuries (Chapter 2). We completed a systematic review and meta-analysis on the effectiveness of PRP in ultrasound guided versus palpation guided injections of PRP in non-operative treatment of tendon and muscle injuries using an indirect analysis method (Chapter 3). We conducted a randomized controlled trial to determine the effectiveness of PRP versus corticosteroid (CS) injections in patients with plantar fasciitis (Chapter 4).

Results: Most studies evaluating the effectiveness of PRP in musculoskeletal injuries are for the treatment of tendon and intra-articular injuries, with fewer studies assessing its effectiveness in muscle and bone healing. The published studies included in the review had a heterogenous summation of results that could not be used to conclusively determine the superiority of PRP over other treatments for musculoskeletal injuries. We included 26 studies in our systematic review to compare ultrasound versus palpation guided injections of PRP. We found no statistically significant difference between ultrasound versus palpation guided injections for failure rates and pain outcomes at two months, two to three months, and six months following injection (p > 0.05). The comparison of functional outcomes at six months showed a significant effect in favor of palpation guided injections (p = 0.01), but heterogeneity of the analysis was high (I2= 83.5%) and we were unable to make any definitive conclusions on the results. In our RCT, we found no statistically significant difference between PRP versus CS injections for our primary outcome of pain and function using the American Orthopaedic Foot and Ankle Society Ankle-hindfoot scale, at six months or one year. We also found no statistically significant difference for all other outcomes at six months and one year.

Conclusion: The results in all three of our studies does not provide supporting evidence for the superior effectiveness of PRP injections in musculoskeletal injuries. There are currently no clear indications for the clinical use of PRP injections in musculoskeletal injuries and further research is needed in this area.

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