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Effectiveness of platelet-rich plasma injection in patients with temporomandibular joint osteoarthritis: a systematic review and meta-analysis of randomized controlled trials

  • Pei-Yu Chung
    Affiliations
    School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
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  • Meng-Ting Lin
    Correspondence
    Reprint requests:Meng-Ting Lin,Departments of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, No.7, Zhongshan S. Road, Zhongzheng District, Taipei City 100, Taiwan.
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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  • Hsien-Po Chang
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Published:November 15, 2018DOI:https://doi.org/10.1016/j.oooo.2018.09.003

      Objective

      The aim of this study was to investigate the effectiveness of platelet-rich plasma (PRP) injection after arthrocentesis or arthroscopy in patients with temporomandibular joint osteoarthritis.

      Study Design

      Electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) were searched for reports up to July 30, 2018. We included all published or unpublished randomized controlled trials (RCTs). The primary outcome was pain reduction, and the secondary outcome was the improvement of maximal mouth opening. Weighted mean differences were utilized for random-effect meta-analysis.

      Results

      Five RCTs were enrolled in the meta-analysis, comparing PRP injection to placebo (hyaluronic acid [HA] injection, saline injection, or no injection). The results revealed that PRP injection was more effective than placebo in pain reduction, but no in the improvement of maximal mouth opening, in the long term. In the subgroup analysis, PRP injection yielded better outcome only in pain reduction comparing to HA injection (Weighted mean difference 1.34, 95% confidence interval [CI] 0.95–1.73).

      Conclusions

      This meta-analysis demonstrated that PRP injection provided adjuvant efficacy to arthrocentesis or arthroscopy in pain reduction for temporomandibular joint osteoarthritis in the long term. Furthermore, PRP injection significantly reduced pain better compared with HA injection, saline injection, or no injection.
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      Reference

        • LeResche L.
        Epidemiology of temporomandibular disorders: implications for the investigation of etiologic factors.
        Crit Rev Oral Biol Med. 1997; 8: 291-305
        • Maixner W.
        • Diatchenko L.
        • Dubner R.
        • et al.
        Orofacial pain prospective evaluation and risk assessment study—the OPPERA study.
        J Pain. 2011; 12 (e1-2): T4-T11
        • Ferrando M.
        • Andreu Y.
        • Galdón M.J.
        • Durá E.
        • Poveda R.
        • Bagán J.V.
        Psychological variables and temporomandibular disorders: distress, coping, and personality.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 98: 153-160
        • Wilkes C.H.
        Internal derangements of the temporomandibular joint. Pathological variations.
        Arch Otolaryngol Head Neck Surg. 1989; 115: 469-477
        • Campos M.I.
        • Campos P.S.
        • Cangussu M.C.
        • Guimarães R.C.
        • Line S.R.
        Analysis of magnetic resonance imaging characteristics and pain in temporomandibular joints with and without degenerative changes of the condyle.
        Int J Oral Maxillofac Surg. 2008; 37: 529-534
        • de Souza R.F.
        • Lovato da Silva C.H.
        • Nasser M.
        • Fedorowicz Z.
        • Al-Muharraqi M.A.
        Interventions for the management of temporomandibular joint osteoarthritis.
        Cochrane Database Syst Rev. 2012; 4CD007261
        • Mujakperuo H.R.
        • Watson M.
        • Morrison R.
        • Macfarlane T.V.
        Pharmacological interventions for pain in patients with temporomandibular disorders.
        Cochrane Database Syst Rev. 2010; 10CD004715
        • Monje-Gil F.
        • Nitzan D.
        • González-Garcia R.
        Temporomandibular joint arthrocentesis. Review of the literature.
        Med Oral Patol Oral Cir Bucal. 2012; 17: e575-e581
        • Dolwick M.F.
        The role of temporomandibular joint surgery in the treatment of patients with internal derangement.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 83: 150-155
        • Zhang S.Y.
        • Liu X.M.
        • Yang C.
        • et al.
        New arthroscopic disc repositioning and suturing technique for treating internal derangement of the temporomandibular joint: part II—magnetic resonance imaging evaluation.
        J Oral Maxillofac Surg. 2010; 68: 1813-1817
        • Foster T.E.
        • Puskas B.L.
        • Mandelbaum B.R.
        • Gerhardt M.B.
        • Rodeo S.A.
        Platelet-rich plasma: from basic science to clinical applications.
        Am J Sports Med. 2009; 37: 2259-2272
        • Dai W.L.
        • Zhou A.G.
        • Zhang H.
        • Zhang J.
        Efficacy of platelet-rich plasma in the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials.
        Arthroscopy. 2017; 33: 659-670
        • Fitzpatrick J.
        • Bulsara M.
        • Zheng M.H.
        The effectiveness of platelet-rich plasma in the treatment of tendinopathy: a meta-analysis of randomized controlled clinical trials.
        Am J Sports Med. 2017; 45: 226-233
        • Kütük N.
        • Baş B.
        • Soylu E.
        • et al.
        Effect of platelet-rich plasma on fibrocartilage, cartilage, and bone repair in temporomandibular joint.
        J Oral Maxillofac Surg. 2014; 72: 277-284
        • Pihut M.
        • Szuta M.
        • Ferendiuk E.
        • Zeńczak-Więckiewicz D.
        Evaluation of pain regression in patients with temporomandibular dysfunction treated by intra-articular platelet-rich plasma injections: a preliminary report.
        Biomed Res Int. 2014; 2014132369
        • Hegab A.F.
        • Ali H.E.
        • Elmasry M.
        • Khallaf M.G.
        Platelet-rich plasma injection as an effective treatment for temporomandibular joint osteoarthritis.
        J Oral Maxillofac Surg. 2015; 73: 1706-1713
        • Cömert Kiliç S.
        • Güngörmüş M.
        • Sümbüllü M.A.
        Is arthrocentesis plus platelet-rich plasma superior to arthrocentesis alone in the treatment of temporomandibular joint osteoarthritis? A randomized clinical trial.
        J Oral Maxillofac Surg. 2015; 73: 1473-1483
        • Cömert Kiliç S.
        • Güngörmüş M.
        Is arthrocentesis plus platelet-rich plasma superior to arthrocentesis plus hyaluronic acid for the treatment of temporomandibular joint osteoarthritis: a randomized clinical trial.
        Int J Oral Maxillofac Surg. 2016; 45: 1538-1544
        • Fernández Sanromán J.
        • Fernández Ferro M.
        • Costas López A.
        • Arenaz Bua J.
        • López A.
        Does injection of plasma rich in growth factors after temporomandibular joint arthroscopy improve outcomes in patients with Wilkes stage IV internal derangement? A randomized prospective clinical study.
        Int J Oral Maxillofac Surg. 2016; 45: 828-835
        • Fernández-Ferro M.
        • Fernández-Sanromán J.
        • Blanco-Carrión A.
        • et al.
        Comparison of intra-articular injection of plasma rich in growth factors versus hyaluronic acid following arthroscopy in the treatment of temporomandibular dysfunction: a randomised prospective study.
        J Craniomaxillofac Surg. 2017; 45: 449-454
        • Bousnaki M.
        • Bakopoulou A.
        • Koidis P.
        Platelet-rich plasma for the therapeutic management of temporomandibular joint disorders: a systematic review.
        Int J Oral Maxillofac Surg. 2018; 47: 188-198
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • et al.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Ann Intern Med. 2009; 151: 264-269
      1. Higgins JPT Green S Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration, London, UK2011
        • Lin M.T.
        • Chiang C.F.
        • Wu C.H.
        • Hsu H.H.
        • Tu Y.K.
        Meta-analysis comparing autologous blood-derived products (including platelet-rich plasma) injection versus placebo in patients with Achilles tendinopathy.
        Arthroscopy. 2018; 34 (e5): 1966-1975
        • Fleiss J.L.
        The statistical basis of meta-analysis.
        Stat Methods Med Res. 1993; 2: 121-145
        • Machon V.
        • Levorova J.
        • Hirjak D.
        • et al.
        A prospective assessment of outcomes following the use of autologous blood for the management of recurrent temporomandibular joint dislocation.
        Oral Maxillofac Surg. 2018; 22: 53-57
        • Daif E.T.
        Autologous blood injection as a new treatment modality for chronic recurrent temporomandibular joint dislocation.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109: 31-36
        • Lin S.L.
        • Tsai C.C.
        • Wu S.L.
        • Ko S.Y.
        • Chiang W.F.
        • Yang J.W.
        Effect of arthrocentesis plus platelet-rich plasma and platelet-rich plasma alone in the treatment of temporomandibular joint osteoarthritis: a retrospective matched cohort study (A STROBE-compliant article).
        Medicine (Baltimore). 2018; 97: e0477
        • Hancı M.
        • Karamese M.
        • Tosun Z.
        • Aktan T.M.
        • Duman S.
        • Savaci N.
        Intra-articular platelet-rich plasma injection for the treatment of temporomandibular disorders and a comparison with arthrocentesis.
        J Craniomaxillofac Surg. 2015; 43: 162-166
        • Schiffman E.
        • Ohrbach R.
        • Truelove E.
        • et al.
        Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group.
        J Oral Facial Pain Headache. 2014; 28: 6-27
        • Lin M.T.
        • Chiang C.F.
        • Wu C.H.
        • Huang Y.T.
        • Tu Y.K.
        • Wang T.G.
        Comparative effectiveness of injection therapies in rotator cuff tendinopathy: a systematic review, pairwise and network meta-analysis of randomized controlled trials.
        Arch Phys Med Rehabil. 2018; (pii: S0003-9993(18)30920-1[Epub ahead of print])https://doi.org/10.1016/j.apmr.2018.06.028
        • Marx R.E.
        Platelet-rich plasma: evidence to support its use.
        J Oral Maxillofac Surg. 2004; 62: 489-496
        • Nikolidakis D.
        • Jansen J.A.
        The biology of platelet-rich plasma and its application in oral surgery: literature review.
        Tissue Eng Part B Rev. 2008; 14: 249-258
        • Cole B.J.
        • Seroyer S.T.
        • Filardo G.
        • Bajaj S.
        • Fortier L.A.
        Platelet-rich plasma: where are we now and where are we going.
        Sports Health. 2010; 2: 203-210
        • Smyth N.A.
        • Murawski C.D.
        • Fortier L.A.
        • Cole B.J.
        • Kennedy J.G.
        Platelet-rich plasma in the pathologic processes of cartilage: review of basic science evidence.
        Arthroscopy. 2013; 29: 1399-1409
        • Anitua E.
        • Andia I.
        • Ardanza B.
        • Nurden P.
        • Nurden A.T.
        Autologous platelets as a source of proteins for healing and tissue regeneration.
        Thromb Haemost. 2004; 91: 4-15
        • Laudy A.B.
        • Bakker E.W.
        • Rekers M.
        • Moen M.H.
        Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis.
        Br J Sports Med. 2015; 49: 657-672
        • Campbell K.A.
        • Saltzman B.M.
        • Mascarenhas R.
        • et al.
        Does intra-articular platelet-rich plasma injection provide clinically superior outcomes compared with other therapies in the treatment of knee osteoarthritis? A systematic review of overlapping meta-analyses.
        Arthroscopy. 2015; 31: 2213-2221
        • Zarb G.A.
        • Carlsson G.E.
        Temporomandibular disorders: osteoarthritis.
        J Orofac Pain. 1999; 13: 295-306
        • Candirli C.
        • Yüce S.
        • Cavus U.Y.
        • Akin K.
        • Cakir B.
        Autologous blood injection to the temporomandibular joint: magnetic resonance imaging findings.
        Imaging Sci Dent. 2012; 42: 13-18
        • Patel J.
        • Nilesh K.
        • Parkar M.I.
        • Vaghasiya A.
        Clinical and radiological outcome of arthrocentesis followed by autologous blood injection for treatment of chronic recurrent temporomandibular joint dislocation.
        J Clin Exp Dent. 2017; 9: e962-e969
        • Braun H.J.
        • Kim H.J.
        • Chu C.R.
        • Dragoo J.L.
        The effect of platelet-rich plasma formulations and blood products on human synoviocytes: implications for intra-articular injury and therapy.
        Am J Sports Med. 2014; 42: 1204-1210
        • Riboh J.C.
        • Saltzman B.M.
        • Yanke A.B.
        • Fortier L.
        • Cole B.J.
        Effect of leukocyte concentration on the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis.
        Am J Sports Med. 2016; 44: 792-800
        • Dohan Ehrenfest D.M.
        • Andia I.
        • Zumstein M.A.
        • Zhang C.Q.
        • Pinto N.R.
        • Bielecki T.
        Classification of platelet concentrates (platelet-rich plasma-PRP, platelet-rich fibrin-PRF) for topical and infiltrative use in orthopedic and sports medicine: current consensus, clinical implications and perspectives.
        Muscles Ligaments Tendons J. 2014; 4: 3-9
        • Chahla J.
        • Cinque M.E.
        • Piuzzi N.S.
        • et al.
        A call for standardization in platelet-rich plasma preparation protocols and composition reporting: a systematic review of the clinical orthopaedic literature.
        J Bone Joint Surg Am. 2017; 99: 1769-1779
        • Moreland L.W..
        Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action.
        Arthritis Res Ther. 2003; 5: 54-67
        • Goiato M.C.
        • da Silva E.V.
        • de Medeiros R.A.
        • Túrcio K.H.
        • Dos Santos D.M.
        Are intra-articular injections of hyaluronic acid effective for the treatment of temporomandibular disorders? A systematic review.
        Int J Oral Maxillofac Surg. 2016; 45: 1531-1537
        • Moldez M.A.
        • Camones V.R.
        • Ramos G.E.
        • Padilla M.
        • Enciso R.
        Effectiveness of intra-articular injections of sodium hyaluronate or corticosteroids for intracapsular temporomandibular disorders: a systematic review and meta-analysis.
        j oral facial pain headache. 2018; 32: 53-66
        • Shen L.
        • Yuan T.
        • Chen S.
        • Xie X.
        • Zhang C.
        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.
        J Orthop Surg Res. 2017; 12: 16
        • Sundman E.A.
        • Cole B.J.
        • Karas V.
        • et al.
        The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis.
        Am J Sports Med. 2014; 42: 35-41