Platelet Rich Plasma for knee osteoarthritis research

In the medical journal Arthroscopy, doctors at Rush University in Chicago combined research data from multiple studies in order to evaluate platelet-rich plasma (PRP) injections in the treatment of knee joint cartilage degenerative pathology and to provide a framework for analysis and interpretation of the best available evidence to provide recommendations for or against use of PRP for knee osteoarthritis.

The bullet points of their findings:

  • Studies were examined in which  PRP injections for knee osteoarthritis were compared to corticosteroids, hyaluronic acid, oral nonsteroidal anti-inflammatory drugs, or placebo.
  • Use of PRP led to significant improvements in patient outcomes at 6 months after injection, and these improvements were seen starting at 2 months and were maintained for up to 12 months.
  • Patients with less radiographic evidence of arthritis benefit more from PRP treatment.
  • PRP injections are a viable treatment for knee osteoarthritis and has the potential to lead to symptomatic relief for up to 12 months.1

Similar findings were noted by two independent studies from China

In the first study doctors from the Chongqing Medical University in China, also published in the medical journal Arthroscopy that:

  • Analysis showed that at 6 months postinjection, PRP and hyaluronic acid (HA) had similar effects with respect to pain relief and functional improvement
    At 12 months postinjection, however, PRP was associated with significantly better pain relief and functional improvement
  • Compared with saline, PRP was more effective for pain relief and functional improvement at 6 months and 12 months postinjection 2

In the second study from doctors at Shanghai Jiaotong University School of Medicine, writing in the Journal of orthopaedic surgery and research, that current evidence indicates that, compared with Hyaluronic Acid and saline, intra-articular PRP injection may have more benefit in pain relief and functional improvement in patients with symptomatic knee osteoarthritis at 1 year postinjection.3

Doctors in Turkey say “In the treatment of mild-moderate knee knee osteoarthritis, PRP was more successful than Hyaluronic Acid and ozone injections, as the application alone was sufficient to provide at least 12 months of pain-free daily living activities.”4

Doctors in Pakistan looked at soldiers who had internal derangements of knee, (torn, ruptured or deranged meniscus of the knee, or a partial or complete cruciate rupture, with or without injury to the capsular ligament of the knee, resulting in ongoing or intermittent signs and symptoms such as pain, instability, or abnormal mobility of that knee.

In their paper, the doctors said: “Platelet Rich Plasma (PRP) is an emerging biotechnology which uses patient’s own blood components to create healing effect to their own injured tissues. . . Intraarticular PRP injection is safe and effective method in the conservative treatment of internal knee derangements.

Rearchers in Spain sought to make recommendations on Platelet Rich Plasma Therapy dosages and knee osteoarthritis patient selection in their paper appearing in the medical journal “cirugia y cirujanos” Eng. “Surgery and Surgeons”

Here is what they said: The biological changes that commonly cause degenerative articular cartilage injuries in the knee are primarily associated to misalignment of the joint and metabolic changes related to age, as occurs in osteoarthritis.

Furthermore, the capacity for cartilage self-regeneration is quite limited due to the lack of vascularity (blood supply) of the tissue.

To date there is no ideal treatment capable to stimulate cartilage regeneration; thus there is a need to seek alternative therapies for the treatment of such conditions.

The number of publications demonstrating the therapeutic and regenerative benefits of using platelet-rich plasma as a treatment for knee osteoarthritis has been increasing in recent years.

In spite of encouraging results, there are still only a few randomised control studies with strong clinical evidence, lacking clarity on points such as the optimum formulation or the mechanism of action of platelet-rich plasma. Up to this point and based on the results of clinical studies, not all patients can benefit from this therapy. It is important to consider aspects such as the age and grade of cartilage degeneration.1

 

Material from this article was adapted from Platelet Rich Plasma Therapy for Knee Osteoarthritis by Ross Hauser, MD


1 Campbell KA, Saltzman BM, Mascarenhas R, Khair MM, Verma NN, Bach BR, Cole BJ. 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: The Journal of Arthroscopic & Related Surgery. 2015 Nov 30;31(11):2213-21. [Pubmed] [Google Scholar]

2 Dai WL, Zhou AG, Zhang H, Zhang J. Efficacy of platelet-rich plasma in the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2017 Mar 31;33(3):659-70. [Pubmed] [Google Scholar]

3 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. Journal of orthopaedic surgery and research. 2017 Jan 23;12(1):16. [Pubmed] [Google Scholar]

4 Duymus TM, Mutlu S, Dernek B, Komur B, Aydogmus S, Kesiktas FN. Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options. Knee Surg Sports Traumatol Arthrosc. 2016 Apr 7. [Pubmed]

5 Razaq S, Ejaz A, Rao SE, Yasmeen R, Arshad MA. The Role of Intraarticular Platelet Rich Plasma (PRP) Injection in Patients with Internal Knee Derangements. J Coll Physicians Surg Pak. 2015 Sep;25(9):699-701. [Pubmed]