Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach Treatment of Knee Joint Osteoarthritis with Autologous Platelet-Rich Plasma in Comparison with Hyaluronic Acid A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Platelet-rich plasma injection is more effective than hyaluronic acid in the treatment of knee osteoarthritis. Treatment With Platelet-Rich Plasma Is More Effective Than Placebo for Knee Osteoarthritis
PURPOSE The aim of our study is to compare the efficacy of platelet-rich plasma ( PRP ) and viscosupplementation ( hyaluronic acid [ HA ] ) intra-articular injections for the treatment of knee cartilage degenerative lesions and osteoarthritis ( OA ) . METHODS The study involved 150 patients affected by cartilage degenerative lesions and early and severe OA . Fifty symptomatic patients were treated with 3 autologous PRP intra-articular injections and were evaluated prospect ively at enrollment and at 2- and 6-month follow-up . The results obtained were compared with 2 homogeneous groups of patients treated with HA injections . One group was treated with injections of high-molecular weight HA ; the other group was treated with low-molecular weight ( LW ) HA .  International Knee Documentation Committee and EQ VAS scores were used for clinical evaluation ; adverse events and patient satisfaction were also recorded . RESULTS At 2 months ' follow-up , the PRP and LW HA groups showed a similar improvement , with higher results compared with the high-molecular weight HA group ( P < .005 ) . At 6 months ' follow-up , better results were observed in the PRP group ( P < .005 ) . PRP and LW HA treatments offered similar results in patients aged over 50 years and in the treatment of advanced OA . PRP showed a better performance compared with HA in younger patients affected by cartilage lesions or early OA . CONCLUSIONS Autologous PRP injections showed more and longer efficacy than HA injections in reducing pain and symptoms and recovering articular function . Better results were achieved in younger and more active patients with a low degree of cartilage degeneration , whereas a worse outcome was obtained in more degenerated joints and in older patients , in whom results similar to those of viscosupplementation have been observed . LEVEL OF EVIDENCE Level II , prospect i ve comparative study Background Platelet Rich Plasma ( PRP ) , a blood-derived product rich in growth factors , is a promising treatment for cartilage defects but there is still a lack of clinical evidence . The aim of this study is to show , through a r and omized double blind prospect i ve trial , the efficacy of this procedure , by comparing PRP to Hyaluronic Acid ( HA ) injections for the treatment of knee chondropathy or osteoarthritis ( OA ) . Methods 109 patients ( 55 treated with HA and 54 with PRP )  were treated and evaluated at 12 months of follow-up . The patients were enrolled according to the following inclusion criteria : age > 18 years , history of chronic ( at least 4 months ) pain or swelling of the knee and imaging findings of degenerative changes of the joint ( Kellgren-Lawrence Score up to 3 ) . A cycle of 3 weekly injections was administered blindly . All patients were prospect ively evaluated before and at 2 , 6 , and 12 months after the treatment by : IKDC , EQ-VAS , TEGNER , and KOOS scores . Range of motion and knee circumference changes were measured over time . Adverse events and patient satisfaction were also recorded . Results Only minor adverse events were detected in some patients , such as mild pain and effusion after the injections , in particular in the PRP group , where a significantly higher post-injective pain reaction was observed ( p=0.039 ) . At the follow-up evaluations , both groups presented a clinical improvement but the comparison between the two groups showed a not statistically significant difference in all scores evaluated . A trend favorable for the PRP group was only found in patients with low grade articular degeneration ( Kellgren-Lawrence score up to 2 ) . Conclusions Results suggest that PRP injections offer a significant clinical improvement up to one year of follow-up . However , conversely to what was shown by the current literature , for middle-aged patients with moderate signs of OA , PRP results were not better than those obtained with HA injections , and thus it should not be considered as first line treatment . More promising results are shown for its use in low grade degeneration , but they still have to be confirmed Purpose To compare the safety and efficacy of two different approaches of platelet-rich plasma ( PRP ) production methods as intra-articular injection treatment for knee cartilage degenerative lesions and osteoarthritis ( OA ) . Methods The study involved 144 symptomatic patients affected by cartilage degenerative lesions and OA . Seventy-two patients were treated with 3  injections of platelet concentrate prepared with a single-spinning procedure ( PRGF ) , the other 72 with 3 injections of PRP obtained with a double-spinning approach . The patients were evaluated prospect ively at the enrollment and at 2 , 6 , and 12 months ’ follow-up with IKDC , EQ-VAS and Tegner scores ; adverse events and patient satisfaction were also recorded . Results Both treatment groups presented a statistically significant improvement in all the scores evaluated at all the follow-up times . Better results were achieved in both groups in younger patients with a lower degree of cartilage degeneration . The comparative analysis showed similar improvements with the two procedures : in particular , IKDC subjective evaluation increased from 45.0 ± 10.1 to 59.0 ± 16.2 , 61.3 ± 16.3 , and 61.6 ± 16.2 at 2 , 6 , and 12 months in the PRGF group , and from 42.1 ± 13.5 to 60.8 ± 16.6 , 62.5 ± 19.9 , and 59.9 ± 20.0 at 2 , 6 , and 12 months in the PRP group , respectively . Concerning adverse events , more swelling ( P = 0.03 ) and pain reaction ( P = 0.0005 ) , were found after PRP injections . Conclusions Although PRP injections produced more pain and swelling reaction with respect to that produced by PRGF , similar results were found at the follow-up times , with a significant clinical improvement with respect to the basal level . Better results were achieved in younger patients with a low degree of cartilage degeneration . Level of evidence II Objective This study aim ed to find a simple , cost-effective , and time-efficient method for the preparation of platelet-rich plasma ( PRP ) , so the acquired benefits will be readily available for multiple procedures in smaller outpatient clinics and to explore the safety and efficacy of the application of PRP in the treatment of degenerative lesions of articular cartilage of the knee . Design The study was design ed as a prospect i ve , cohort study with a control group . A total of 120 patients with Grade 1 , 2 , or 3 osteoarthritis according to the Kellgren and Lawrence grading scale were enrolled in the study . One group of patients was treated using three intra-articular applications of PRP , and the second group of patients was given three injections of hyaluronic acid . Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index and the 11-point pain intensity Numeric Rating Scale . Results On average , a 4.5-fold increase in platelet concentration was obtained in the PRP group . No severe adverse events were observed . Statistically significantly better results in the Western Ontario and McMaster Universities Osteoarthritis Index and Numeric Rating Scale scores were recorded in a group of patients who received PRP injections after a 3- and 6-mo follow-up . Conclusions Our preliminary findings support the application of autologous PRP as an effective and safe method in the treatment of the initial stages of knee osteoarthritis . Further studies are needed to confirm these results and to investigate the persistence of the beneficial effects observed PURPOSE This multicenter , double-blind clinical trial evaluated and compared the efficacy and safety of PRGF-Endoret ( BTI Biotechnology Institute , Vitoria-Gasteiz , Spain ) , an autologous biological therapy for regenerative purpose s , versus hyaluronic acid ( HA ) as a short-term treatment for knee pain from osteoarthritis . METHODS We r and omly assigned 176 patients with symptomatic knee osteoarthritis to receive infiltrations with PRGF-Endoret or with HA ( 3 injections on a weekly basis ) . The primary outcome measure was a 50 % decrease in knee pain from baseline to week 24 . As secondary outcomes , we also assessed pain , stiffness , and physical function using the Western Ontario and McMaster Universities Osteoarthritis Index ; the rate of response using the criteria of the Outcome Measures for Rheumatology Committee and Osteoarthritis Research Society International St and ing Committee for Clinical Trials Response Criteria Initiative ( OMERACT-OARSI ) ; and safety . RESULTS The mean age of the patients was 59.8 years , and 52 % were women . Compared with the rate of response to HA , the rate of response to PRGF-Endoret was 14.1 percentage points higher ( 95 % confidence interval , 0.5 to 27.6 ; P = .044 ) . Regarding the secondary outcome measures , the rate of response to PRGF-Endoret was higher in all cases , although no significant differences were reached . Adverse events were mild and evenly distributed between the groups . CONCLUSIONS Plasma rich in growth factors showed superior short-term results when compared with HA in a r and omized controlled trial , with a comparable safety profile , in alleviating symptoms of mild to moderate osteoarthritis of the knee . LEVEL OF EVIDENCE Level I , r and omized controlled multicenter trial PURPOSE OF THE STUDY There is increasing use of platelet-rich plasma ( PRP ) in orthopaedics as it is a simple , cheap and minimally invasive technique . This study aim ed to compare the effects of the use of PRP and hyaluronic acid ( HA ) injections in the knee of patients diagnosed with and being followed-up for degenerative arthritis . MATERIAL S AND METHODS This prospect i ve study included 90 patients with complaints of knee pain with findings of mild or moderate degenerative arthritis . In the PRP group ( n=45 ) , one intra-articular injection was applied and in the HA group ( n=45 ) , three doses of intra-articular injection were applied . Clinical evaluation was made by Knee Injury and Osteoarthritis Outcome Score ( KOOS ) and a visual pain scale . RESULTS No severe adverse events was observed . Statistically significant better results in the KOOS score and visual pain scale was determined in PRP group than HA group at 3 months and 6 months follow up . The cost of the application for the PRP group was lower than that of the HA group . CONCLUSION The results of this study have shown the application of single dose PRP to be a safe , effective and low-cost method for treating OA . However , further studies are required for a more clear result Background : Specific growth factors have been proposed as therapeutic proteins for cartilage repair . Hypothesis : Platelet-rich plasma ( PRP ) provides symptomatic relief in early osteoarthritis ( OA ) of the knee . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : A total of 78 patients ( 156 knees ) with bilateral OA were divided r and omly into 3 groups . Group A ( 52 knees ) received a single injection of PRP , group B ( 50 knees ) received 2 injections of PRP 3 weeks apart , and group C ( 46 knees ) received a single injection of normal saline . White blood cell (WBC)–filtered PRP with a platelet count 3 times that of baseline ( PRP type 4B ) was administered in all . All the groups were homogeneous and comparable in baseline characteristics . Clinical outcome was evaluated using the Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) question naire before treatment and at 6 weeks , 3 months , and 6 months after treatment . They were also evaluated for pain by a visual analog scale , and overall satisfaction with the procedure and complications were noted . Results : Statistically significant improvement in all WOMAC parameters was noted in groups A and B within 2 to 3 weeks and lasting until the final follow-up at 6 months , with slight worsening at the 6-month follow-up . The mean WOMAC scores ( pain , stiffness , physical function , and total score ) for group A at baseline were 10.18 , 3.12 , 36.56 , and 49.86 , respectively , and at final follow-up were 5.00 , 2.10 , 20.08 , and 27.18 , respectively , showing significant improvement . Similar improvement was noted in group B ( mean WOMAC scores at baseline : 10.62 , 3.50 , 39.10 , and 53.20 , respectively ; mean WOMAC scores at final follow-up : 6.18 , 1.88 , 22.40 , and 30.48 , respectively ) . In group C , the mean WOMAC scores deteriorated from baseline ( 9.04 , 2.70 , 33.80 , and 45.54 , respectively ) to final follow-up ( 10.87 , 2.76 , 39.46 , and 53.09 , respectively ) . The 3 groups were compared with each other , and no improvement was noted in group C as compared with groups A and B ( P < .001 ) . There was no difference between groups A and B , and there was no influence of age , sex , weight , or body mass index on the outcome . Knees with Ahlback grade 1 fared better than those with grade 2 . Mild complications such as nausea and dizziness , which were of short duration , were observed in 6 patients ( 22.2 % ) in group A and 11 patients ( 44 % ) in group B. Conclusion : A single dose of WBC-filtered PRP in concentrations of 10 times the normal amount is as effective as 2 injections to alleviate symptoms in early knee OA . The results , however , deteriorate after 6 months . Both groups treated with PRP had better results than did the group injected with saline only
Dear Editor : We read with interest the network meta- analysis by Riboh and colleagues titled ‘ ‘ Effect of Leukocyte Concentration on the Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis , ’ ’ which compared intra-articular injection of leukocyte-rich platelet-rich plasma ( LR-PRP ) , leukocyte-poor platelet-rich plasma ( LP-PRP ) , and hyaluronic acid ( HA ) for treatment of knee osteoarthritis ( OA ) .