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Am Fam Physician. 2022;105(4):online

Clinical Question

Are platelet-rich plasma injections effective for alleviating pain and improving function in adults with symptomatic ankle osteoarthritis?

Bottom Line

This study found no evidence that supports a benefit of platelet-rich plasma injections compared with saline placebo injections for improving function or reducing pain in adults with symptomatic ankle osteoarthritis. (Level of Evidence = 1b)

Synopsis

There have been no published randomized trials evaluating the effectiveness of platelet-rich plasma injections for ankle osteoarthritis. The investigators identified 100 adults, 18 years or older, who presented to orthopedic and sports medicine outpatient clinics with a score of at least 40 for ankle pain severity on a visual analog scale (range = 0 to 100, where 100 is the most severe pain) and definitive radiographic evidence of tibiotalar osteoarthritis. Patients randomly received (concealed allocation assignment) two ultrasound-guided intra-articular injections of platelet-rich plasma six weeks apart (leukocyte poor; prepared with a widely used standard system) or matched saline as placebo. The patients also received lifestyle and exercise counseling. The individuals who assessed outcomes using a standard validated scoring tool for ankle osteoarthritis remained masked to treatment group assignment. Complete follow-up occurred for 100% of patients at 26 weeks. Using intention-to-treat analysis, mean improvement scores were similar in the platelet-rich plasma and placebo groups (10 vs. 11 points, respectively, on the American Orthopaedic Foot and Ankle Society scale of 0 to 100, where higher scores indicate improved function and reduced pain). No significant differences between groups occurred in any of the multiple secondary outcomes reported.

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POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see https://www.essentialevidenceplus.com/Home/Loe?show=Sort.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Natasha J. Pyzocha, DO, contributing editor.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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