Treatment of Early Hip Osteoarthritis: Ultrasound-Guided Platelet Rich Plasma versus Hyaluronic Acid Injections in a Randomized Clinical Trial Knee Osteoarthritis Injection Choices: Platelet- Rich Plasma (PRP) Versus Hyaluronic Acid (A one-year randomized clinical trial) Randomized controlled trial comparing hyaluronic acid, platelet-rich plasma and the combination of both in the treatment of mild and moderate osteoarthritis of the knee Is arthrocentesis plus platelet-rich plasma superior to arthrocentesis plus hyaluronic acid for the treatment of temporomandibular joint osteoarthritis: a randomized clinical trial. Effects of Platelet-Rich Plasma on Pain and Muscle Strength in Patients With Knee Osteoarthritis Does Intra Articular Platelet Rich Plasma Injection Improve Function, Pain and Quality of Life in Patients with Osteoarthritis of the Knee? A Randomized Clinical Trial Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options Comparison of hyaluronic acid and PRP intra-articular injection with combined intra-articular and intraosseous PRP injections to treat patients with knee osteoarthritis Effect of single injection of platelet-rich plasma in comparison with corticosteroid on knee osteoarthritis: a double-blind randomized clinical trial. Intra-articular hyaluronic acid vs platelet-rich plasma in the treatment of hip osteoarthritis. Efficacy of Intra-articular Injection of a Newly Developed Plasma Rich in Growth Factor (PRGF) Versus Hyaluronic Acid on Pain and Function of Patients with Knee Osteoarthritis: A Single-Blinded Randomized Clinical Trial Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial Efficacy of ultrasound-guided intra-articular injections of platelet-rich plasma versus hyaluronic acid for hip osteoarthritis. Does intraoperative application of leukocyte-poor platelet-rich plasma during arthroscopy for knee degeneration affect postoperative pain, function and quality of life? A 12-month randomized controlled double-blind trial Platelet-Rich Plasma Injection as an Effective Treatment for Temporomandibular Joint Osteoarthritis. Treatment of knee osteoarthritis with platelet-rich plasma in comparison with transcutaneous electrical nerve stimulation plus exercise: a randomized clinical trial Growth Factors Levels Determine Efficacy of Platelets Rich Plasma Injection in Knee Osteoarthritis: A Randomized Double Blind Noninferiority Trial Compared With Viscosupplementation. Treatment of Knee Joint Osteoarthritis with Autologous Platelet-Rich Plasma in Comparison with Hyaluronic Acid Leukocyte-poor platelet-rich plasma is more effective than the conventional therapy with acetaminophen for the treatment of early knee osteoarthritis A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Hyaluronic Acid Versus Platelet-Rich Plasma: A Prospective, Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for the Treatment of Knee Osteoarthritis Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus Durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a randomized controlled trial. Intra-articular Autologous Conditioned Plasma Injections Provide Safe and Efficacious Treatment for Knee Osteoarthritis Is Arthrocentesis Plus Platelet-Rich Plasma Superior to Arthrocentesis Alone in the Treatment of Temporomandibular Joint Osteoarthritis? A Randomized Clinical Trial. Treatment With Platelet-Rich Plasma Is More Effective Than Placebo for Knee Osteoarthritis
Purpose The aim of this study was to compare the clinical efficacy of ultrasound-guided intra-articular injections of autologous platelet rich plasma ( PRP ) versus hyaluronic acid ( HA ) for symptomatic early osteoarthritis ( OA ) of the hip . Methods A prospect i ve controlled double-blinded r and omized trial on 80 patients with hip OA was conducted . The patients were divided in two groups of 40 patients each : group 1 underwent three PRP intra-articular ultrasound-guided injections , whereas group 2 underwent three HA injections .  WOMAC , VAS , and Harris Hip Score were evaluated for both groups before and at 6 and 12 months after treatment . Results The two groups were comparable in age , sex , body mass index , and severity of hip OA . Both groups showed a significant improvement from baseline at 6-month and 12-month follow-ups for all the outcome measures . No major complications were observed during the treatment and at follow-ups in both the groups . Conclusion PRP did not offer significantly better results compared with HA in patients with moderate signs of OA , and thus it should not be considered as first-line treatment . Level of Evidence Level II , r and omized controlled trial Introduction Knee osteoarthritis ( OA ) is the most common articular disease . Different methods are used to alleviate the symptoms of patients with knee OA , including analgesics , physical therapy , exercise prescription , and intra-articular injections ( glucocorticoids , hyaluronic acid [ HA ] , etc ) . New studies have focused on modern therapeutic methods that stimulate cartilage healing process and improve the damage , including the use of platelet-rich plasma ( PRP ) as a complex of growth factors . Due to the high incidence of OA and its consequences , we decided to study the long-term effect of intraarticular injection of PRP and HA on clinical outcome and quality of life of patients with knee OA . Method This non-placebo-controlled r and omized clinical trial involved 160 patients affected by knee OA , grade 1–4 of Kellgren – Lawrence scale . In the PRP group ( n = 87 ) , two intra-articular injections at 4-week interval were applied , and in the HA group ( n = 73 ) , three doses of intra-articular injection at 1-week interval were applied . All patients were prospect ively evaluated before and at 12 months after the treatment by Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) and SF-36 question naires . The results were analyzed using SPSS 16.1 software ( RCT code : I RCT 2014012113442N5 ) . Results At the 12-month follow-up , WOMAC pain score and bodily pain significantly improved in both groups ; however , better results were determined in the PRP group compared to the HA group ( P < 0.001 ) . Other WOMAC and SF-36 parameters improved only in the PRP group . More improvement ( but not statistically significant ) was achieved in patients with grade 2 OA in both the groups . Conclusion This study suggests that PRP injection is more efficacious than HA injection in reducing symptoms and improving quality of life and is a therapeutic option in select patients with knee OA who have not responded to conventional treatment Objective : This study aims at evaluating the clinical effects of Platelet Rich Plasma ( PRP ) and Hyaluronic Acid ( HA ) as individual treatments for mild to moderate Osteoarthritis ( OA ) and it also examines the potential synergistic effects of PRP in combination with HA . Research continues to emerge examining the potential therapeutic efficacy of HA and PRP as autologous injectable treatments for joint arthritis . However , there is a paucity of research investigating the effects of combining HA and PRP on pain and functional status in patients with OA . Design : In this multi-center , r and omized , controlled , double blind , prospect i ve trial , 105 patients with mild to moderate knee osteoarthritis , who met the study criteria , were r and omly allocated to one of three interventions : HA ( n=36 ) , PRP ( n=36 ) , or HA+PRP ( n=33 ) . Each patient received 3 intra-articular knee injections of their assigned substance , with 2 week intervals between each injection . Clinical outcomes were evaluated using the Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) and Visual Analogue Scale ( VAS ) question naire at baseline and after 1,3,6 and 12 months . Results : The study showed that the PRP group have significant reduction in VAS scores at 1 ( p= 0.003 ) , 3 ( p= 0.0001 ) , 6 ( p= 0.0001 ) and 12 ( p= 0.000 ) months when compared to HA . In addition , the PRP group illustrated greater improvement in WOMAC physical activity scale at 12 months ( p= 0.008 ) when compared to the HA group . Combining HA and PRP result ed in a significant decreases in pain ( p=0.0001 ) and functional limitation ( p=0.0001 ) when compared to HA alone at 1 year post treatment ; and significantly increased physical function at 1 ( p=0.0004 ) and 3 ( p=.011 ) months when compared to PRP alone . Conclusion : The findings of the study support the use of autologous PRP as an effective treatment of mild to moderate knee osteoarthritis . It also shows that the combination of HA and PRP result ed to better outcomes than HA alone up to 1 year and PRP alone up to 3 months . Furthermore , the results suggest that combination of PRP and HA could potentially provide better functional outcomes in the first 30 days after treatment with both PRP and HA alone A r and omized clinical trial was implemented in adult patients with temporom and ibular joint osteoarthritis ( TMJ OA ) . The sample comprised 49 osteoarthritic joints in 31 consecutive patients . Patients were divided r and omly into two groups according to the treatment technique applied : the platelet-rich plasma ( PRP ) group patients underwent initial arthrocentesis plus PRP injection and then four consecutive PRP injections ; the hyaluronic acid ( HA ) group patients underwent one session of arthrocentesis plus HA injection . The predictor variable was the treatment technique . The outcome variables included visual analogue scale ( VAS ) evaluations and maximum inter-incisal opening ( MIO ) measurements . Outcome variables were recorded preoperatively and at 12 months postoperative . Descriptive and bivariate statistics were computed and significance was set at P<0.05 . The PRP group included 32 joints in 18 subjects , and the HA group included 17 joints in 13 subjects . No statistically significant difference was observed between the groups for any of the changes in VAS parameters or MIO measurements . Both treatment techniques result ed in significant clinical improvements in all VAS parameters and painless MIO . These findings suggest that arthrocentesis plus PRP injections is not superior to arthrocentesis plus a single HA injection ; thus PRP injection should not be considered as the first line treatment . Arthrocentesis plus HA injection would appear to be more acceptable for patients Objective No studies comparing the effects of platelet-rich plasma ( PRP ) injection and placebo injection in bilateral knee osteoarthritis in the same patient , or discussing muscle strength after PRP injection , have been published . Design Twenty patients with bilateral knee osteoarthritis were eligible , and 40 knees were r and omized into two groups : PRP ( knees [ right or left by a coin toss ] receiving a single intra-articular PRP injection ) and saline group ( the contralateral knee of the same patient , into which single 4-mL intra-articular injection of normal saline was administered ) . The primary outcome measure was Western Ontario and McMaster 's Universities Osteoarthritis Index and the secondary included isokinetic test results . The evaluation was at baseline and at 2 wks , 1 , 3 , and 6 mos after injection . Results The PRP group showed a significant reduction in the Western Ontario and McMaster 's Universities Osteoarthritis Index pain and total scores compared with normal saline group ( P < 0.05 ) . Although a significantly greater percentage of knee strength ( extensor > flexor ) was found in the PRP group during a longer follow-up period , PRP treatment result ed in insignificant differences in muscle strength compared with normal saline . Conclusions Platelet-rich plasma treatment significantly improves pain , stiffness , and disability in patients with knee osteoarthritis compared with normal saline treatment . Additional strength training is recommended to enhance muscle strength recovery We design ed a r and omized clinical trial with control group , to investigate the effects of platelet rich plasma ( PRP ) on pain , stiffness , function and quality of life in patients with knee osteoarthritis . Patients were r and omly divided in two groups . For both groups of participants , therapeutic exercise was prescribed . In the PRP group , two courses of leukocyte rich PRP ( 5.6 fold higher platelet concentration ) with a 4-week interval was injected . For each participant , Western Ontario and McMaster University ’s Arthritis Index ( WOMAC ) and the SF-36 question naire ( Farsi version ) were filled at the baseline and 6 months after treatments . Thirty-one patients in the PRP group and 31 patients in the control group were studied .  Mean changes of total WOMAC , physical component summery and mental component summery of Short Form-36 in PRP group showed better improvement than control group ( P<0.05 ) . This study showed that intra articular PRP knee injection combined with therapeutic exercise can be more effective in pain reduction and improvement of stiffness and quality of life , compared with therapeutic exercise alone Purpose This study was performed to compare the efficacy of treatment in three groups of patients with knee osteoarthritis ( OA ) given an intra-articular injection of platelet-rich plasma ( PRP ) , hyaluronic acid ( HA ) or ozone gas . Methods A total of 102 patients with mild – moderate and moderate knee OA who presented at the polyclinic with at least a 1-year history of knee pain and VAS score ≥4 were r and omly separated into three groups . Group 1 ( PRP group ) received intra-articular injection of PRP × 2 doses , Group 2 ( HA group ) received a single dose of HA , and Group 3 ( Ozone group ) received ozone × four doses . Weight-bearing anteroposterior – lateral and Merchant ’s radiographs of both knees were evaluated . WOMAC and VAS scores were applied to all patients on first presentation and at 1 , 3 , 6 and 12 months . Results At the end of the 1st month after injection , significant improvements were seen in all groups . In the 3rd month , the improvements in WOMAC and VAS scores were similar in Groups 1 and 2 , while those in Group 3 were lower ( p < 0.001 ) . At the 6th month , while the clinical efficacies  of PRP and HA were similar and continued , the clinical effect of ozone had disappeared ( p < 0.001 ) . At the end of the 12th month , PRP was determined to be both statistically and clinical ly superior to HA ( p < 0.001 ) . Conclusion In the treatment of mild – moderate knee OA , PRP was more successful than HA and ozone injections , as the application alone was sufficient to provide at least 12 months of pain-free daily living activities . Level of evidence Therapeutic study , Level The aim of this study was to evaluate the benefit provided by intraosseous infiltration combined with intra-articular injection of platelet-rich plasma to treat mild and moderate stages of knee joint degeneration ( Kellgren-Lawrence score II – III ) compared with other treatments , specifically intra-articular injection of PRP and of HA .  Eighty-six patients with grade II to grade III knee OA according to the Kellgren-Lawrence classification were r and omly assigned to intra-articular combined with intraosseous injection of PRP ( group A ) , intra-articular PRP ( group B ) , or intra-articular HA ( group C ) . Patients in group A received intra-articular combined with intraosseous injection of PRP ( administered twice , 2 weeks apart ) . Patients in group B received intra-articular injection of PRP every 14 days . Patients in group C received a series of five intra-articular injections of HA every 7 days . All patients were evaluated using the Visual Analogue Scale ( VAS ) and Western Ontario and McMaster Universities ( WOMAC ) score before the treatment and at 1 , 3 , 6 , 12 , and 18 months after treatment . There were significant improvements at the end of the 1st month . Notably , group A patients had significantly superior VAS and WOMAC scores than were observed in groups B and C. The VAS scores were similar in groups B and group C after the 6th month . Regarding the WOMAC scores , groups B and C differed at the 1st , 3rd , 6th , and 12th months ; however , no significant difference was observed at the 18th month . The combination of intraosseous with intra-articular injections of PRP result ed in a significantly superior clinical outcome , with sustained lower VAS and WOMAC scores and improvement in quality of life within 18 months BACKGROUND Evidence on the effect of platelet-rich plasma ( PRP ) in treating osteoarthritis ( OA ) is insufficient . Therefore , the present study compares the effects of a one-time injection of PRP and corticosteroid ( CS ) . METHODS In the present r and omized double blind clinical trial , the participants who suffered from knee osteoarthritis ( Grade s II/III ) , were r and omly divided into two groups : intra articular injection of PRP and CS .  Knee injury and osteoarthritis outcome score ( KOOS ) , the 20-Meter-Walk Test ( 20MW ) , active and passive ranges of motions ( ROM ) , flexion contracture , and pain intensity based on Visual Analog Scale ( VAS ) were assessed before , 2-months , and 6-months after interventions . RESULTS Forty-one participants ( 48 knees ) were involved in the research ( 66.7 % women ; average age of 61.1±7.0 years old ) . Compared to the group treated with corticosteroid  , pain relief ( df : 6 , 35 ; F=11.0 ; P=0.007 ) , symptom free ( df:6 , 35 ; F=23.0 ; P<0.001 ) , activities of daily living ( ADL ) ( df:6 , 35 ; F=10.7 ; P=0.005 ) and quality of life ( df:6 , 35 ; F=5.2 ; P=0.02 ) in the RPR group were significantly higher , but sporting ability was not different between the two groups ( df : 6 , 35 ; F=0.6 ; P=0.55 ) . PRP was significantly more helpful for relieving patients ' pain ( VAS ) compared to corticosteroids ( df : 6 , 35 ; F=32.0 ; P=0.001 ) . It is also notable that using PRP was more helpful in improving the 20MW test than corticosteroid treatment ( df : 6 , 35 ; F=7.4 ; P=0.04 ) but none of the treatments had any impact on active flexion ROM ، passive flexion ROM and flexion contracture ( P>0.05 ) . CONCLUSIONS Our study demonstrated that one shot of PRP injection , decreased joint pain more and longer-term , alleviated the symptoms , and enhanced the activity of daily living and quality of life in short-term duration in comparison with CS AIM To compare the efficacy of ultrasound-guided intra-articular ( IA ) treatment with platelet-rich plasma ( PRP ) versus viscosupplementation ( hyaluronic acid HA ) in hip osteoarthritis . METHODS : A total of 43 patients affected by monolateral severe hip osteoarthritis ( OA ) were included in the study . Patients were r and omized to receive either intra-articular PRP ( 3 ml ) or HA ( 30 mg/2 ml ; 1,000 - 2,900 kDa ) , 3 injections in total - 1/week . Clinical assessment s for each patient were made at baseline ( T0 ) , 4 ( T1 ) , and 16 weeks ( T2 ) of follow-up . The primary efficacy outcome was pain reduction as measured by VAS and by WOMAC pain subscale . RESULTS Data analysis revealed that , compared to T0 , in the PRP-treated group VAS scores significantly decreased at T1 but not at T2 , thereby indicating an early effect on pain which was not maintained at a longer term follow-up . In the HA group a significant decrease of both VAS and WOMAC values was registered only between T0 and T2 . CONCLUSIONS Intra-articular PRP had an immediate effect on pain that was not maintained at longer term follow-up when , on the contrary , the effects of intra-articular HA were evident Background and objectives : Knee osteoarthritis is the most common joint disease . We aim ed to compare the efficacy and safety of intra-articular injection of a newly developed plasma rich in growth factor ( PRGF ) versus hyaluronic acid ( HA ) on pain and function of patients with knee osteoarthritis . Methods : In this single-blinded r and omized clinical trial , patients with symptomatic osteoarthritis of knee were assigned to receive 2 intra-articular injections of our newly developed PRGF in 3 weeks or 3 weekly injections of HA . Our primary outcome was the mean change from baseline until 2 and 6 months post intervention in scores of visual analog scale , Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , and Lequesne index . We used analysis of variance for repeated- measures statistical test . Results : A total of 69 patients entered final analysis . The mean age of patients was 58.2 ± 7.41 years and 81.2 % were women . In particular , total WOMAC index decreased from 42.9 ± 13.51 to 26.8 ± 13.45 and 24.4 ± 16.54 at 2 and 6 months in the newly developed PRGF group ( within subjects P = .001 ) , and from 38.8 ± 12.62 to 27.8 ± 11.01 and 27.4 ± 11.38 at 2 and 6 months in the HA group ( within subjects P = .001 ) , respectively ( between subjects P = .631 ) . There was no significant difference between PRGF and HA groups in patients ’ satisfaction and minor complications of injection , whereas patients in HA group reported significantly lower injection-induced pain . Conclusions : In 6 months follow up , our newly developed PRGF and HA , both are effective options to decrease pain and improvement of function in patients with symptomatic mild to moderate knee osteoarthritis Purpose To compare the effectiveness of intraarticular ( IA ) multiple and single platelet-rich plasma ( PRP ) injections as well as hyaluronic acid ( HA ) injections in different stages of osteoarthritis ( OA ) of the knee . Methods A total of 162 patients with different stages of knee OA were r and omly divided into four groups receiving 3 IA doses of PRP , one dose of PRP , one dose of HA or a saline injection ( control ) . Then , each group was subdivided into two groups : early OA ( Kellgren – Lawrence grade 0 with cartilage degeneration or grade I – III ) and advanced OA ( Kellgren – Lawrence grade IV ) . The patients were evaluated before the injection and at the 6-month follow-ups using the EuroQol visual analogue scale ( EQ-VAS ) and International Knee Documentation Committee ( IKDC ) subjective scores . Adverse events and patient satisfaction were recorded . Results There was a statistically significant improvement in the IKDC and EQ-VAS scores in all the treatment groups compared with the control group . The knee scores of patients treated with three PRP injections were significantly better than those patients of the other groups . There was no significant difference in the scores of patients injected with one dose of PRP or HA . In the early OA subgroups , significantly better clinical results were achieved in the patients treated with three PRP injections , but there was no significant difference in the clinical results of patients with advanced OA among the treatment groups . Conclusion The clinical results of this study suggest IA PRP and HA treatment for all stages of knee OA . For patients with early OA , multiple ( 3 ) PRP injections are useful in achieving better clinical results . For patients with advanced OA , multiple injections do not significantly improve the results of patients in any group . Level of evidence Intra-articular injections of platelet-rich plasma ( PRP ) and hyaluronic acid ( HA ) represent efficacious medical treatments for osteoarthritis ( OA ) , although no comparative study on long-term efficacy in hip OA exists . The goals of the current study were to compare the clinical efficacy of PRP vs HA at 12 months of follow-up in patients with hip OA and evaluate the influence of the type of infiltration and patient age , sex , body mass index , and degree of OA on temporal clinical evolution . One hundred patients with chronic unilateral symptomatic hip OA were consecutively enrolled and r and omly assigned to 1 of 2 groups : group A received PRP and group B received HA administered via intra-articular ultrasound-guided injections . Patients were evaluated at baseline and after 1 , 3 , 6 , and 12 months using the Harris Hip Score ( HHS ) and visual analog scale ( VAS ) . An overall improvement was detected in both groups between 1- and 3-month follow-up . Despite a slightly progressive worsening between 6- and 12-month follow-up , the final clinical scores remained higher compared with baseline ( P<.0005 ) , with no significant differences between PRP and HA . Regarding clinical temporal evolution , multivariate analysis showed that HHS was not influenced by the type of infiltration , patient age , sex , body mass index , or degree of OA , whereas a significant association was detected between OA grade IV and VAS evolution ( P<.0005 ) . Intra-articular injections of PRP are efficacious in terms of functional improvement and pain reduction but are not superior to HA in patients with symptomatic hip OA at 12-month follow-up Introduction We aim ed to identify the effects of intraoperative applied leukocyte-poor platelet-rich plasma ( LP-PRP ) during knee arthroscopy for degenerative lesions involving pain , function and quality of life . Methods We performed a r and omized controlled , double-blind trial ( RCT ) including 58 patients for arthroscopic knee surgery for cartilage or meniscal degeneration with allocation into the LP-PRP ( n = 24 ) or control group ( n = 34 ) . During arthroscopy , LP-PRP was injected intra-articular in the intervention group . At baseline , 6 weeks , 6 months and 12 months pain , function , and life quality were assessed . Results 91 % of enrolled patients were available for 12 months follow-up . Pain was significantly lower in the LP-PRP group ( VAS 0.9 . vs. 2.3 ) at 6 ( p = 0.008 ) but not at 12 months ( VAS 1.0 vs. 1.6 , p = 0.063 ) . LP-PRP application improved the Lysholm Score at 6 ( 77.5 vs. 65.6 , p = 0.033 ) and 12 months ( 83.2 vs.70.0 , p = 0.007 ) . Assessment of life quality ( SF-36 ) concerning the physical component summary was significantly higher at 6 weeks ( 33.9 vs. 25.6 , p = 0.001 ) and 6 months ( 29.9 vs. 27.1 , p = 0.027 ) in the LP-PRP group but equal at 1 year ( 31.4 vs. 30.1 , p = 0.438 ) . Conclusions Intraoperative application of LP-PRP may enhance pain reduction and gain of knee function within 6–12 months compared to arthroscopy alone . Level of evidence II , r and omized controlled clinical trial with reduced power . Clinical Trials.gov identifierNCT02189408 PURPOSE Emerging evidence has suggested that platelet-rich plasma ( PRP ) might be of assistance in the treatment of degenerative conditions of the joints . The aim of the present study was to compare the use of PRP and hyaluronic acid ( HA ) in the treatment of temporom and ibular joint ( TMJ ) osteoarthritis ( OA ) with long-term follow-up data . PATIENTS AND METHODS Patients meeting the Research Diagnostic Criteria for TMJ-OA were r and omly assigned to 1 of 2 study groups that received either PRP or HA . The outcome variables were maximum nonassisted ( voluntary ) mouth opening ( MVMO ) , joint sounds , and pain index scores . Other variables , including patient age and gender , were evaluated in relation to the outcomes . Descriptive and bivariate statistics were computed , and the P value was set at .05 . RESULTS A total of 50 patients with TMJ-OA were enrolled in the study ( 29 women and 21 men , age range 31 to 49 years , mean age 38.6 ) . In group I , 25 patients received 3 injections of 1 mL of PRP . In group II , 25 patients received 3 injections of 1 mL of low-molecular-weight HA . Between-group comparisons of the outcome variables over time revealed significant improvements in group II at 1 and 3 months . At 6 and 12 months , the PRP group exhibited better performance compared with the HA group in terms of the recurrence of pain and joint sounds . The improvements obtained with the PRP injections in group I were maintained during the follow-up period . At the end of the follow-up period , the median MVMO in group I was 41.0 mm . In group II , the median MVMO was 39.0 mm . CONCLUSION PRP performed better than HA acid in the treatment of TMJ-OA during long-term follow-up in terms of pain reduction and increased interincisal distance . Future studies will focus on the synergistic actions of HA and PRP in the treatment of TMJ-OA Background : Osteoarthritis is a disabling musculoskeletal disease with no definite treatment . This study compared the effect of Platelet-rich plasma ( PRP ) and Transcutaneous Electrical Nerve Stimulation ( TENS ) plus exercise in the treatment of patients with knee joint osteoarthritis . Methods : 54 eligible patients with knee osteoarthritis were r and omly allocated into two groups . ( I RCT 2012110611382N ) Group A ( 27 patients ) received 2 injections of PRP ( 4 weeks apart ) and group B ( 27 patients ) received 10 sessions of TENS as well as exercise during the study period . Clinical outcome was evaluated using the Knee injury and Osteoarthritis Outcome Scores ( KOOS ) question naire before the treatment , 4 weeks , and 8 weeks after that the treatment . Pain was also assessed using a visual analog scale ( VAS ) . Time to an intolerable knee pain during treadmill workout was also evaluated using an objective test . Results : In the PRP group , the mean KOOS symptom score improved significantly from baseline to the end of study , while the change was not significant over this period for the group B. In both groups , significant reductions were observed in VAS scores from baseline till the end of study . The mean time to feel intolerable knee pain during treadmill work out of PRP group increased significantly from baseline to week 4 , but no significant changes were found in this parameter over the time of study in the group B. Conclusion : Intraarticular injection of PRP is an effective , safe method for short-term treatment of patients with knee joint osteoarthritis PURPOSE To assess the noninferiority of a single platelet-rich plasma ( PRP ) injection compared with hyaluronic acid ( HA ) , to alleviate pain and enhance functional capacity in knee osteoarthritis , and identify biological characteristics of PRP that may affect their efficacy . METHODS Fifty-four patients with symptomatic knee osteoarthritis received a single injection of either PRP ( 26 patients ) or HA ( 28 patients ) . They were assessed at baseline and at 1 , 3 , and 6 months . The primary endpoint was the change in Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) score at 3 months , and secondary endpoints were responders ' rate ( improvement of at least 5 points or 40 % of WOMAC total score at 3 months ) of pain evaluation and patient 's subjective satisfaction . Cell counts and the contents of vascular endothelial growth factor ( VEGF ) , platelet-derived growth factor-AB ( PDGF-AB ) , transforming growth factor beta 1 ( TGF-β1 ) content of injected PRP were assessed to analyze their relationship with clinical outcome . RESULTS Both treatments proved their improvement in knee functional status and symptom relief , with a significant decrease observed at 1 month on all scores except for pain VAS in PRP group and WOMAC function score in the HA group . No difference between groups regarding WOMAC and VAS scores was observed . A higher percentage of responders was observed in the PRP group ( 72.7 % ) than in the HA group ( 45.8 % ) without significance ( P = .064 ) . The quantity of injected PDGF-AB and TGF-β1 correlated with the change in WOMAC scores at 3 months and was lower in responders than in nonresponders ( P = .009 and P = .003 , respectively ) . CONCLUSIONS Current results indicated that a single injection of very pure PRP offers a significant clinical improvement in the management of knee osteoarthritis , equivalent to a single HA injection in this patient population . Moreover , a significant correlation between the doses of TGF-β1 and PDGF-AB and the worsening of WOMAC score 3 months after the procedure was found . LEVEL OF EVIDENCE Level II , r and omized double blind controlled trial 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 Introduction Knee osteoarthritis ( OA ) is a degenerative and progressive articular cartilage disease . Infiltration of autologous platelet-rich plasma ( PRP ) has been proposed as a therapeutic alternative due to the content of biologically active cytokines in PRP . We aim ed to compare the clinical response of acetaminophen and intra-articular leukocyte-poor PRP ( LP-PRP ) in early knee OA . Material s and methods A total of 65 patients with clinical ly and radiographically documented knee OA ( grade 1–2 ) were analyzed . Patients were r and omized into two groups : 32 were treated with acetaminophen ( 500 mg/8 h ) over 6 weeks , and 33 received three intra-articular injections of autologous LP-PRP ( once every 2 weeks ) . All patients were evaluated by the Visual Analogue Scale ( VAS ) , the Western Ontario and McMaster Universities ( WOMAC ) score , and the SF-12 health survey at baseline and 6 , 12 , and 24 weeks of follow-up . All LP-PRP preparations were analyzed for the platelet , leukocyte , IL-1ra , and TGF-β concentrations . Results The decrease in the VAS pain level in the LP-PRP group was greater than that in the acetaminophen group ( p < 0.05 ) . Patients treated with LP-PRP showed a sustained improvement in knee function at week 24 ( p < 0.01 ) . The SF-12 results only indicated an improvement in quality -of-life in the LP-PRP group at 6 , 12 , and 24 weeks of follow-up ( p < 0.01 ) . Both IL-1ra and TGF-β were detected in the LP-PRP sample s ( 313.8 ± 231.6 and 21,183.8 ± 8556.3 pg/mL , respectively ) . Conclusions Treatment with LP-PRP injections result ed in a significantly better clinical outcome than did treatment with acetaminophen , with sustained lower EVA and WOMAC scores and improvement in quality -of-life ( higher SF-12 score ) . Therapy with LP-PRP may positively modify the inflammatory joint environment by counteracting IL-1β action 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 Background : The use of platelet-rich plasma ( PRP ) for the treatment of osteoarthritis ( OA ) has demonstrated mixed clinical outcomes in r and omized controlled trials when compared with hyaluronic acid ( HA ) , an accepted nonsurgical treatment for symptomatic OA . Biological analysis of PRP has demonstrated an anti-inflammatory effect on the intra-articular environment . Purpose : To compare the clinical and biological effects of an intra-articular injection of PRP with those of an intra-articular injection of HA in patients with mild to moderate knee OA . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : A total of 111 patients with symptomatic unilateral knee OA received a series of either leukocyte-poor PRP or HA injections under ultrasound guidance . Clinical data were collected before treatment and at 4 time points across a 1-year period . Synovial fluid was also collected for analysis of proinflammatory and anti-inflammatory markers before treatment and at 12 and 24 weeks after treatment . Several measures were used to assess results : ( 1 ) Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) pain subscale ; ( 2 ) International Knee Documentation Committee ( IKDC ) subjective knee evaluation , visual analog scale ( VAS ) for pain , and Lysholm knee score ; and ( 3 ) difference in intra-articular biochemical marker concentrations . Results : There were 49 patients r and omized to treatment with PRP and 50 r and omized to treatment with  HA . No difference was seen between the groups in the primary outcome measure ( WOMAC pain score ) . In the secondary outcome measure , linear contrasts identified a significantly higher IKDC score in the PRP group compared with the HA group at 24 weeks ( mean ± st and ard error [ SE ] , 65.5 ± 3.6 vs 55.8 ± 3.8 , respectively ; P = .013 ) and at final follow-up ( 52 weeks ) ( 57.6 ± 3.37 vs 46.6 ± 3.76 , respectively ; P = .003 ) . Linear contrasts also identified a statistically lower VAS score in the PRP group versus the HA group at 24 weeks ( mean ± SE , 34.6 ± 3.24 vs 48.6 ± 3.7 , respectively ; P = .0096 ) and 52 weeks ( 44 ± 4.6 vs 57.3 ± 3.8 , respectively ; P = .0039 ) . An examination of fixed effects showed that patients with mild OA and a lower body mass index had a statistically significant improvement in outcomes . In the biochemical analysis , differences between groups approached significance for interleukin-1β ( mean ± SE , 0.14 ± 0.05 pg/mL [ PRP ] vs 0.34 ± 0.16 pg/mL [ HA ] ; P = .06 ) and tumor necrosis factor α ( 0.08 ± 0.01 pg/mL [ PRP ] vs 0.2 ± 0.18 pg/mL [ HA ] ; P = .068 ) at 12-week follow-up . Conclusion : We found no difference between HA and PRP at any time point in the primary outcome measure : the patient-reported WOMAC pain score . Significant improvements were seen in other patient-reported outcome measures , with results favoring PRP over HA . Preceding a significant difference in subjective outcomes favoring PRP , there was a trend toward a decrease in 2 proinflammatory cytokines , which suggest that the anti-inflammatory properties of PRP may contribute to an improvement of symptoms . Registration : Clinical Trials.gov ( Identifier : NCT02588872 ) PURPOSE The purpose of this study was to compare the efficacy and safety in a r and omized , clinical trial of 3 injections of PRGF-Endoret ( BTI Biotechnology Institute , Vitoria , Spain ) versus one single intra-articular injection of Durolane hyaluronic acid ( HA ) ( Q-MED AB , Uppsala , Sweden ) as a treatment for reducing symptoms in patients with knee osteoarthritis ( OA ) . METHODS Ninety-six patients with symptomatic knee OA were r and omly assigned to receive PRGF-Endoret ( 3 injections on a weekly basis ) or one infiltration with Durolane HA . The primary outcome measures were a 30 % decrease and a 50 % decrease in the summed score for the pain , physical function , and stiffness subscales of the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) and Lequesne scores from baseline to weeks 24 and 48 . The percentage of OMERACT-OARSI ( Outcome Measures for Rheumatology Committee and Osteoarthritis Research Society International St and ing Committee for Clinical Trials Response Criteria Initiative ) responders was also documented . As secondary outcomes , pain , stiffness , and physical function by use of the WOMAC and the Lequesne score were considered and overall safety of the injection themselves . RESULTS The mean age of the patients was 63.6 years . Treatment with PRGF-Endoret was significantly more efficient than treatment with Durolane HA in reducing knee pain and stiffness and improving physical function in patients with knee OA . The rate of response to PRGF-Endoret was significantly higher than the rate of response to HA for all the scores including pain , stiffness , and physical function on the WOMAC , Lequesne index , and OMERACT-OARSI responders at 24 and 48 weeks . Adverse events were mild and evenly distributed between the groups . CONCLUSIONS Our findings show that PRGF-Endoret is safe and significantly superior to Durolane HA in primary and secondary efficacy analysis both at 24 and 48 weeks ; provides a significant clinical improvement , reducing patients ' pain and improving joint stiffness and physical function with respect to basal levels in patients with knee OA ; and should be considered in the treatment of patients with knee OA Background : Platelet-rich plasma ( PRP ) injections have become an intriguing treatment option for osteoarthritis ( OA ) , particularly OA of the knee . Despite the plethora of PRP-related citations , there is a paucity of high-level evidence that is comparable , cohort specific , dose controlled , injection protocol controlled , and double-blinded . Purpose : To determine the safety and efficacy of leukocyte-poor PRP autologous conditioned plasma ( ACP ) for knee OA treatment through a feasibility trial regulated by the US Food and Drug Administration ( FDA ) . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : In accordance with FDA protocol , patient selection was based on strict inclusion /exclusion criteria ; 114 patients were screened , and 30 were ultimately included in the study . These patients were r and omized to receive either ACP ( n = 15 ) or saline placebo ( n = 15 ) for a series of 3 weekly injections . Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) scores served as the primary efficacy outcome measure . Patients were followed for 1 year . Results : No adverse events were reported for ACP administration . Furthermore , the results demonstrated no statistically significant difference in baseline WOMAC scores between the 2 groups . However , in the ACP group , WOMAC scores at 1 week were significantly decreased compared with baseline scores , and the scores for this group remained significantly lower throughout the study duration . At the study conclusion ( 12 months ) , subjects in the ACP group had improved their overall WOMAC scores by 78 % from their baseline score , compared with 7 % for the placebo group . Conclusion : ACP is safe and provides quantifiable benefits for pain relief and functional improvement with regard to knee OA . No adverse events were reported for ACP administration . After 1 year , WOMAC scores for the ACP subjects had improved by 78 % from their baseline score , whereas scores for the placebo control group had improved by only 7 % . Other joints affected with OA may also benefit from this treatment PURPOSE To compare the long-term clinical and radiologic outcomes of temporom and ibular joint osteoarthritis ( TMJ-OA ) treated with arthrocentesis plus platelet-rich plasma ( PRP ) versus arthrocentesis alone . MATERIAL S AND METHODS A r and omized clinical trial in adult patients with TMJ-OA referred to the authors ' clinic from May 2012 through July 2013 was implemented . The sample was composed of 30 consecutive patients with TMJ-OA treated r and omly with arthrocentesis alone ( control group ) or initial arthrocentesis plus PRP injection and then 4 consecutive PRP injections  ( study group ) . The predictor variable was treatment technique . The outcome variables were visual analog scale evaluations ( masticatory efficiency , joint sounds , and pain complaints ) , maximal interincisal opening , and cone-beam computed tomographic ( CBCT ) findings . Outcome variables were recorded preoperatively and 12 months postoperatively . Descriptive and bivariate statistics were computed , and significance was set at a P value less than .05 . The paired t and Student t tests were used for intragroup and intergroup comparisons , respectively . RESULTS The sample was composed of 47 joints of 30 patients with OA ( control group : 15 joints of 12 patients ; mean age , 35.08 ± 14.84 yr ; study group : 32 joints of 18 patients ; mean age , 32.22 ± 14.32 yr ) . Joint sounds and general pain complaints decreased statistically in the 2 groups , whereas masticatory efficiency , painless interincisal opening , and lateral motion increased statistically only in the study group . However , only masticatory efficiency showed statistically greater improvement in the study group compared with the control group . CBCT evaluations showed that reparative remodeling of the osseous abnormalities occurred at rates of 87.5 and 46.6 % in the study and control groups , respectively . CONCLUSIONS These findings suggested that arthrocentesis and PRP injections constitute a safe and promising method for the treatment of TMJ-OA that is superior to arthrocentesis alone 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 The magnitude of the therapeutic effects of intra-articular injection of platelet-rich plasma ( PRP ) on osteoarthritis ( OA ) is still under debate .
The goal of this study that was a systematic review of r and omised controlled trials of PRP injections for the treatment of OA was to eluci date the therapeutic efficacy of PRP .