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Laver L, Filardo G, Sanchez M, Magalon J, Tischer T, Abat F, Bastos R, Cugat R, Iosifidis M, Kocaoglu B, Kon E, Marinescu R, Ostojic M, Beaufils P, de Girolamo L. The use of injectable orthobiologics for knee osteoarthritis: A European ESSKA-ORBIT consensus. Part 1-Blood-derived products (platelet-rich plasma). Knee Surg Sports Traumatol Arthrosc 2024; 32:783-797. [PMID: 38436492 DOI: 10.1002/ksa.12077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/15/2024] [Accepted: 01/24/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE The aim of this European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) consensus is to provide recommendations based on evidence and expert opinion to improve indications, decision-making and administration-related aspects when using blood-derived orthobiologics (for simplicity indicated as PRP-platelet-rich plasma-with PRP being the most common product) for the management of knee osteoarthritis (OA). METHODS Leading European expert clinicians and scientists were divided into a steering group, a rating group and a peer review group. The steering group prepared 28 question-statement sets divided into three sections: PRP rationale and indications, PRP preparation and characterisation and PRP protocol. The quality of the statements received grades of recommendation ranging from A (high-level scientific support) to B (scientific presumption), C (low-level scientific support) or D (expert opinion). The question-statement sets were then evaluated by the rating group, and the statements scored from 1 to 9 based on their degree of agreement with the statements produced by the steering group. Once a general consensus was reached between the steering and rating groups, the document was submitted to the peer review group who evaluated the geographic adaptability and approved the document. A final combined meeting of all the members of the consensus was held to produce the official document. RESULTS The literature review on the use of blood-derived products for knee OA revealed that 9 of 28 questions/statements had the support of high-level scientific literature, while the other 19 were supported by a medium-low scientific quality. Three of the 28 recommendations were grade A recommendations: (1) There is enough preclinical and clinical evidence to support the use of PRP in knee OA. This recommendation was considered appropriate with a strong agreement (mean: 8). (2) Clinical evidence has shown the effectiveness of PRP in patients for mild to moderate degrees of knee OA (KL ≤ 3). This recommendation was considered appropriate with a strong agreement (mean: 8.1). (3) PRP injections have been shown to provide a longer effect in comparison to the short-term effect of CS injections. They also seem to provide a safer use profile with less potential related complications. This recommendation was considered appropriate with a very strong agreement (mean: 8.7). Six statements were grade B recommendations, 7 were grade C and 12 were grade D. The mean rating score was 8.2 ± 0.3. CONCLUSIONS The consensus group reached a high level of agreement on all the questions/statements despite the lack of clear evidence for some questions. According to the results from this consensus group, given the large body of existing literature and expert opinions, PRP was regarded as a valid treatment option for knee OA and as a possible first-line injectable treatment option for nonoperative management of knee OA, mainly for KL grades 1-3. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Lior Laver
- Department of Orthopaedics, Hillel Yaffe Medical Center (HYMC), Hadera, Israel
- Rappaport Faculty of Medicine, Technion University Hospital (Israel Institute of Technology), Haifa, Israel
- Arthrosport Clinic, Tel-Aviv, Israel
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mikel Sanchez
- Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain
| | - Jeremy Magalon
- Cell Therapy Laboratory, Hôpital de la Conception, AP-HM, Marseille, France
- INSERM, INRA, C2VN, Aix Marseille Univ, Marseille, France
- SAS Remedex, Marseille, France
| | - Thomas Tischer
- Department of Orthopaedic Surgery, University of Rostock, Rostock, Germany
| | - Ferran Abat
- Department of Sports Orthopaedic, ReSport Clinic, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Ricardo Bastos
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence and Dom Henrique Research Centre, Porto, Portugal
- Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Ramon Cugat
- Instituto Cugat, Hospital Quironsalud Barcelona, Barcelona, Spain
- Fundación García Cugat, Mutualidad de Futbolistas Españoles-Delegació Catalana, Barcelona, Spain
| | - Micahel Iosifidis
- OrthoBiology Surgery Center, Thessaloniki, Greece
- 3rd Orthopaedic Department, European Interbalkan Medical Center, Thessaloniki, Greece
| | - Baris Kocaoglu
- Acibadem Altunizade Sports Therapy and Health Unit, Department of Orthopedics and Traumatology, Acibadem MAA University Faculty of Medicine, Istanbul, Turkey
| | - Elizaveta Kon
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Rodica Marinescu
- Department of Orthopaedics, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Marko Ostojic
- Department of Orthopaedics, University Hospital Mostar, Mostar, Bosnia and Herzegovina
- Osteon Clinic, Mostar, Bosnia and Herzegovina
| | | | - Laura de Girolamo
- Orthopaedic Biotechnology Laboratory, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milano, Italy
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Tel A, Parodi PC, Robiony M, Zanotti B, Zingaretti N. Letter to the Editor: Could ChatGPT Improve Knowledge in Surgery? Ann Surg Oncol 2023:10.1245/s10434-023-13518-z. [PMID: 37071236 DOI: 10.1245/s10434-023-13518-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/05/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Alessandro Tel
- Department of Medical Area (DAME), Clinic of Maxillo-facial Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Pier Camillo Parodi
- Department of Medical Area (DAME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Massimo Robiony
- Department of Medical Area (DAME), Clinic of Maxillo-facial Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Bruno Zanotti
- Department of Neuroscience, Neurology with Neurosurgical Activity, C. Poma Hospital, ASST di Mantova, Mantua, Italy
| | - Nicola Zingaretti
- Department of Medical Area (DAME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy.
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Indrayan A, Vishwakarma G, Malhotra RK, Gupta P, Sachdev HPS, Karande S, Asthana S, Labani S. The development of QERM scoring system for comprehensive assessment of the Quality of Empirical Research in Medicine - Part 1. J Postgrad Med 2022; 68:221-230. [PMID: 36348606 PMCID: PMC9841535 DOI: 10.4103/jpgm.jpgm_460_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Whereas a large number of features are mentioned to connote the quality of medical research, no tool is available to comprehensively measure it objectively across different types of studies. Also, all the available tools are for reporting, and none includes quality of the inputs and the process of research. The present paper is aimed to initiate a discussion on the need to develop such a comprehensive scoring system (in the first place), to show that it is feasible, and to describe the process of developing a credible system. Method An expert group comprising researchers, reviewers, and editors of medical journals extensively reviewed the literature on the quality of medical research and held detailed discussions to parse quality at all stages of medical research into specific domains and items that can be assigned scores on the pattern of quality-of-life score. Results Besides identifying the domains of the quality of medical research, a comprehensive tool for scoring emerged that can be possibly used to objectively measure the quality of empirical research comprising surveys, trials, and observational studies. Thus, this can be used as a tool to assess Quality of Empirical Research in Medicine (QERM). The expert group confirmed its face and content validity. The tool can be used by the researchers for self-assessment and improvement before submission of a paper for publication, and the reviewers and editors can use this for assessing the submissions. Published papers can also be rated such as those included in a meta-analysis. Conclusion It is feasible to devise a comprehensive scoring system comprising domains and items for assessing the quality of medical research end-to-end from choosing a problem to publication. The proposed scoring system needs to be reviewed by the researchers and needs to be validated.
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Affiliation(s)
| | - A Indrayan
- Clinical Research, Max Healthcare, New Delhi, India,Address for correspondence: Dr. Indrayan A, E-mail:
| | - G Vishwakarma
- Biostatistics, Indian Spinal Injuries Centre, New Delhi, India
| | - RK Malhotra
- Surgical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - P Gupta
- Pediatrics, University College of Medical Sciences, Delhi, India
| | - HPS Sachdev
- Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Sciences and Research, New Delhi, India
| | - S Karande
- Pediatrics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S Asthana
- Epidemiology and Biostatistics, National Institute of Cancer Prevention and Research (Indian Council of Medical Research), Noida, Uttar Pradesh, India
| | - S Labani
- Epidemiology and Biostatistics, National Institute of Cancer Prevention and Research (Indian Council of Medical Research), Noida, Uttar Pradesh, India
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