PRP For the Treatment of Cartilage Pathology Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions Treatment of Knee Joint Osteoarthritis with Autologous Platelet-Rich Plasma in Comparison with Hyaluronic Acid [Therapeutic effectiveness of intra-knee-articular injection of platelet-rich plasma on knee articular cartilage degeneration]. Platelet-rich plasma (PRP) injections as an effective treatment for early osteoarthritis Clinical and MRI outcomes after platelet-rich plasma treatment for knee osteoarthritis. Autologous matrix-induced chondrogenesis combined with platelet-rich plasma gel: technical description and a five pilot patients report Intra-articular injection of an autologous preparation rich in growth factors for the treatment of knee OA: a retrospective cohort study. A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Injection of Platelet-Rich Plasma in Patients with Primary and Secondary Knee Osteoarthritis: A Pilot Study Treatment With Platelet-Rich Plasma Is More Effective Than Placebo for Knee Osteoarthritis
In recent years biological strategies are being more widely used to treat cartilage lesions . One of the most exploited novel treatments is Platelet-rich Plasma ( PRP ) , whose high content of growth factors is supposed to determine a regenerative stimulus to cartilaginous tissue . Despite many promising in vitro and in vivo studies , when discussing clinical application a clear indication for the use of PRP can not be assessed . There are initial encouraging clinical data , but only a few r and omized controlled trials have been published , so it is not possible to fully endorse this kind of approach for the treatment of cartilage pathology . Furthermore , study comparison is very difficult due to the great variability in PRP preparation methods , cell content and concentration , storage modalities , activation methods and even application protocol s. These factors partially explain the lack of high quality controlled trials up to now . This paper discusses the main aspects concerning the basic biology of PRP , the principal sources of variability , and summarizes the available literature on PRP use , both in surgical and conservative treatments . Based on current evidence , PRP treatment should only be indicated for low- grade cartilage degeneration and in case of failure of more traditional conservative approaches 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 Platelet-rich plasma ( PRP ) is a natural concentrate of autologous blood growth factors experimented in different fields of medicine in order to test its potential to enhance tissue regeneration . The aim of our study is to explore this novel approach to treat degenerative lesions of articular cartilage of the knee . One hundred consecutive patients , affected by chronic degenerative condition of the knee , were treated with PRP intra-articular injections ( 115 knees treated ) . The procedure consisted of 150-ml of venous blood collected and twice centrifugated : 3 PRP units of 5 ml each were used for the injections . Patients were clinical ly prospect ively evaluated before and at the end of the treatment , and at 6 and 12 months follow-up . IKDC , objective and subjective , and EQ VAS were used for clinical evaluation . Statistical analysis was performed to evaluate the significance of sex , age , grade of OA and BMI . A statistically significant improvement of all clinical scores was obtained from the basal evaluation to the end of the therapy and at 6–12 months follow-up ( P < 0.0005 ) . The results remained stable from the end of the therapy to 6 months follow up , whereas they became significantly worse at 12 months follow up ( P = 0.02 ) , even if still significantly higher respect to the basal level ( P < 0.0005 ) . The preliminary results indicate that the treatment with PRP injections is safe and has the potential to reduce pain and improve knee function and quality of live in younger patients with low degree of articular degeneration 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 OBJECTIVE Platelet-rich plasma ( PRP ) can enhance the chondrocyte proliferation and repair of cartilage defects . To explore the safety and efficacy of intra-knee-articular injection of PRP to treat knee articular cartilage degeneration by comparing with injecting sodium hyaluronate ( SH ) . METHODS Thirty consecutive patients ( 30 knees ) with knee articular cartilage degeneration were selected between January 2010 and June 2010 . According to different injections , 30 patients were r and omly divided into PRP group ( test group , n = 15 ) and SH group ( control group , n = 15 ) . There was no significant difference in gender , age , body mass index , and Kellgren-Lawrence grade between 2 groups ( P > 0.05 ) . Test group received 3.5 mL of PRP intra-knee-articular injections while control group received 2 mL of SH during the same time period . Both treatments were administered in series of 3 intra-knee-articular injections at 3-week intervals . Then , adverse reactions were recorded . International Knee Documentation Committee ( IKDC ) score , Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) score , and Lequesne index were used for evaluation of treatment results . RESULTS The patients of 2 groups were followed up 6 months . There were significant differences in IKDC score , WOMAC score , and Lequesne index between pre- and post-injection in 2 groups ( P < 0.05 ) ; no significant difference was found between different time points ( 3 , 4 , and 6 months ) in test group ( P > 0.05 ) , while significant differences were found between the postoperative 6th month and the postoperative 3rd and 4th months in control group ( P < 0.05 ) . There was no significant difference in IKDC score , WOMAC score , and Lequesne index between 2 groups within 4 months ( P > 0.05 ) , but the effectiveness of test group was significantly better than that of control group at 6 months after injection ( P < 0.05 ) . Adverse reactions occurred in 12 patients ( 31 injections ) of test group and in 12 patients ( 30 injections ) of control group . No significant difference in onset time , termination time , and duration of adverse reactions were found between 2 groups ( P > 0.05 ) . CONCLUSION Intra-knee-articular injection of PRP to treat knee articular cartilage degeneration is safe , which can alleviate symptoms of pain and swelling and improve the quality of life of patients ; however , further data of large sample s and long-term follow-up are needed to confirm the safety and effectiveness The aims of this study were to analyze the range of cartilage damage and patellofemoral joint ( PFJ ) degeneration in degenerative osteoarthritis ( OA ) and determine the duration for the positive effects of platelet-rich plasma ( PRP ) injection . This study included 65 patients suffering from OA that were treated with intra-articular PRP injection .  The patients were prospect ively evaluated at 1 , 3 , 6 , 9 , and 12 months after the procedure using a visual analogue scale ( VAS ) score and an International Knee Documentation Committee ( IKDC ) score . Clinical improvement in the average VAS score from 7.4 before the procedure to 4.2 at 6 months post-procedure had been reported , but the symptoms tended to deteriorate to 5.0 1 year after injection . The IKDC score also showed statistical significance ( P < 0.05 ) . Patients reported relapsed pain 8.8 months after the procedure . Developing degeneration according to the Kellgren – Lawrence grade reduced the clinical effects of PRP ( P < 0.05 ) and also accelerated the time for feeling relapsed pain ( P < 0.05 ) . There was a statistically significant negative correlation between patient age and the PRP potential in the VAS score ( slope = 0.1667 ) and IKDC score ( slope = 1.3333 ) . The presence of PFJ degeneration is expected to produce a worse outcome ( P < 0.05 ) . While intra-articular PRP injection can be used for the treatment of early OA , increasing age , and developing degeneration result in a decreased potential for PRP injection therapy The purpose of this study was to investigate whether platelet-rich plasma therapy for early knee osteoarthritis is associated with good clinical outcomes and a change in magnetic resonance imaging ( MRI ) structural appearances . The design was a prospect i ve cohort study following patients 1 year after platelet-rich plasma therapy for knee osteoarthritis . Twenty-two patients were treated with platelet-rich plasma for early osteoarthritis , confirmed with a baseline MRI . Inclusion criteria were Kellgren grade 0-II with knee pain in patients aged 30 to 70 years . All the patients received a 6-mL platelet-rich plasma injection using the Cascade system .  Fifteen subjects underwent clinical assessment s at baseline , 1 week , and 1 , 3 , 6 , and 12 months , and MRIs at 1 year . Pain scores significantly decreased , whereas functional and clinical scores increased at 6 months and 1 year from baseline . Qualitative MRIs demonstrated no change per compartment in at least 73 % of cases at 1 year Purpose This pilot study was design ed to describe the technical details and to present the preliminary outcome of autologous matrix-induced chondrogenesis ( AMIC ) combined with platelet-rich plasma gel , the so called AMIC plus technique , for the treatment of patellar cartilage defects in the knee . Methods The AMIC plus technique was used for the treatment of ( osteo ) chondral patellar lesions in the knee . The surgical technique is extensively described . Five patients were clinical ly prospect ively evaluated during 2 years .  MRI data were analysed based on the original MOCART ( Magnetic Resonance Observation of Cartilage Repair Tissue ) and modified MOCART scoring system . Results A clinical improvement became apparent after 24 months of follow-up . Both MOCART scoring systems revealed no significant deterioration or improvement of the repair tissue between one and 2 years of follow-up . However , all cases showed subchondral lamina and bone changes . The formation of intralesional osteophytes was observed in 3 of the 5 patients during the 2 years of follow-up . Conclusions AMIC plus is feasible for the treatment of symptomatic patellar cartilage defects and result ed in a clinical improvement in all patients . The favourable clinical outcome of the AMIC plus technique was not confirmed by the MRI findings .Level of evidence IV OBJECTIVE To obtain preliminary information about the effectiveness of intra-articular injections of an autologous preparation rich in growth factors ( PRGF ) for knee OA treatment to be explored further in future studies . METHODS We have characterized PRGF treatment by platelet count and concentration of relevant growth factors ( TGF-Beta1 , PDGF-AB , VEGF-A ; HGF and IGF-I ) involved in healing mechanisms . We have performed an observational retrospective cohort study using hyaluronan injections as a control . Each group included 30 patients with OA of the knee , matched according to age , sex , body mass index and radiographic severity . Both treatments were based on three weekly injections . Clinical outcome was examined using the WOMAC question naires prior to treatment and at 5 weeks after treatment . RESULTS The observed success rates by week 5 for the pain subscale reached 33.4 % for the PRGF group and 10 % for the hyaluronan group . The difference was attributed exclusively to the treatment modality , p = 0.004 . The percent reductions in the physical function subscale and overall WOMAC at 5 weeks were also associated solely with treatment modality in favour of PRGF , p = 0.043 and p = 0.010 respectively . CONCLUSIONS Although these preliminary results need to be evaluated in a r and omized clinical trial , they provide useful infomration about the safety of PRGF and open new perspectives on autologous treatments for joint diseases 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 Sampson S , Reed M , Silvers H , Meng M , M and elbaum B : Injection of platelet-rich plasma in patients with primary and secondary knee osteoarthritis : A pilot study . Objective : To evaluate the clinical effects of intraarticular platelet-rich plasma ( PRP ) injections in a small group of patients with primary and secondary osteoarthritis . Most of the current treatments for osteoarthritis are palliative and attack the symptoms rather than influencing the biochemical environment of the joint . Autologous platelet-rich plasma has emerged as a treatment option for tendinopathies and chronic wounds . In addition to release of growth factors , platelet-rich plasma also promotes concentrated anti-inflammatory signals including interleukin-1ra , which has been a focus of emerging treatments for osteoarthritis . Design : In this single-center , uncontrolled , prospect i ve preliminary study , 14 patients with primary and secondary knee osteoarthritis who met the study criteria received three platelet-rich plasma injections in the affected knee at ∼4-wk intervals . Outcome measures included the Brittberg-Peterson Visual Pain ( Visual Analog Scale [ VAS ] ) , Activities , and Expectations score and the Knee Injury and Osteoarthritis Outcome Scores at preinjection visit at 2- , 5- , 11- , 18- , and 52-wk follow-up visits . Musculoskeletal ultrasound was used to measure cartilage thickness . Results : There were no adverse events reported . The study demonstrated significant and almost linear improvements in Knee Injury and Osteoarthritis Outcome Scores , including pain and symptom relief . Brittberg-Peterson VAS showed many improvements including reduced pain after knee movement and at rest . Cartilage assessment was limited because of the small sample size . The majority of the patients expressed a favorable outcome at 12 mos after treatment . Conclusions : The positive trends and safety profile demonstrated could potentially be used to inspire a larger , blinded , and r and omized clinical trial to determine whether platelet-rich plasma is safe and effective for the treatment of knee osteoarthritis 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
OBJECTIVE To explore the effectiveness of platelet-rich plasma ( PRP ) in treating cartilage degenerative pathology in knee joints .