CME OnDemand: 2022 AOFAS Annual Meeting-The Statistical Fragility of Platelet-Rich Plasma as Treatment for Chronic Noninsertional Achilles Tendinopathy: A Systematic Review and Meta-analysis

The Statistical Fragility of Platelet-Rich Plasma as Treatment for Chronic Noninsertional Achilles Tendinopathy: A Systematic Review and Meta-analysis

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This systematic review and meta-analysis evaluated the statistical robustness of randomized controlled trials (RCTs) evaluating the use of platelet-rich plasma (PRP) for the treatment of chronic non-insertional Achilles tendinopathy (AT). The study aimed to determine the fragility index (FI) and fragility quotient (FQ) of these trials and assess their statistical findings.<br /><br />The researchers conducted a systematic search of various online databases and included 8 RCTs in the final analysis. The mean sample size of the included studies was 63.1 patients, with a mean follow-up duration of 39.8 weeks. Out of the 52 total outcome events, 23.1% were dichotomous and 76.9% were continuous.<br /><br />The study found that the RCTs evaluating PRP for chronic non-insertional AT were lacking in statistical robustness. The median FI for dichotomous outcomes was 4.5, while the median FQ was 0.111. For continuous outcomes, the median FI was 5 and the median FQ was 0.154. This indicates that a small change in the number of patients or outcome events could alter the statistical significance.<br /><br />Furthermore, 23.1% of the outcome events would have had a reversal of significance if follow-up had been maintained. This highlights the importance of designing future RCTs with consideration of sample size to ensure protocol robustness.<br /><br />The study recommends reporting fragility indices alongside p-values to provide a more comprehensive understanding of the strength of statistical findings. In conclusion, limited conclusions can be drawn about the true therapeutic effect of PRP for chronic non-insertional AT based on the current evidence.<br /><br />Overall, this study emphasizes the need for more rigorous and well-designed RCTs to evaluate the efficacy of PRP in treating chronic non-insertional AT.

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Amy L. Xu, BS, Carlos Ortiz-Babilonia, BS, Arjun Gupta, BS, Davis Rogers, MD, Amiethab A. Aiyer, MD, Ettore Vulcano, MD

Keywords

systematic review

meta-analysis

randomized controlled trials

platelet-rich plasma

chronic non-insertional Achilles tendinopathy

fragility index

fragility quotient

statistical robustness

sample size

outcome events