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Objective: The present work aims to analyse the effectiveness of platelet-rich plasma (PRP) in degenerative knee pathology based on real-world data and to evaluate possible factors influencing the response to treatment. Methods: In total, 531 cases were analysed collecting data on gender, age, body mass index, pathology location, severity, number of cycles and route of administration. Clinical outcome was evaluated at 6 and 15 months after treatment, using the Knee injury and Osteoarthritis Outcome Score (KOOS) and obtaining percentages of Minimal Clinically Important Improvement (MCII). Blood and PRP samples were randomly tested as a quality control measure to ensure the correct properties. Comparative statistical tests and multivariate regression were performed for the analysis of the variables. Results: The PRP applied had a platelet concentration factor of 1.67, with no leukocytes or erythrocytes. The percentage of patients with MCII at 6 and 15 months after PRP application was 59.32% and 70.62%, respectively. Patients with MCII were younger ( p = 0.0246) and with lower body mass index ( p = 0.0450). The treatment had a better response in mild/moderate cases than in severe cases ( p = 0.0002). Intraosseous PRP application in severe cases improved the effect of intraarticular PRP ( p = 0.0358). The application of a second cycle of PRP only improved the response in patients without MCII at 6 months ( p = 0.0029), especially in mild/moderate cases ( p = 0.0357). Conclusion: The applications of PRP in degenerative knee pathologies is an effective treatment, but this effectiveness nonetheless depends on several variables. Real-world data can complement that from clinical trials to provide valuable information.

Platelet-Rich Plasma (PRP) is a biologic therapy that uses the patient's own blood to obtain products with a higher platelet concentration than in blood. This technology provides a controlled drug delivery system of growth factors suitable for regenerative medicine. The biological effects of PRP mimic and influence biological processes such as inflammation, analgesia, and cell stimulation, providing this therapy with promising therapeutic potential. All these processes participate in maintenance, correct function, and homeostasis of the joint, where all tissues are involved. Alterations in one joint element have impact on the rest, outstanding the cellular and molecular interaction between the cartilage and subchondral bone. Therefore, the joint is an optimal therapeutic target for PRP therapy, which favors biological environment for joint repair. This chapter collects the basic concepts of joint function and the biological processes that participate in its degeneration, the definition and obtention of PRP, as well as its therapeutic potential and clinical translation.

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Purpose To evaluate the eicacy of applying a combination of intrameniscal and intraarticular iniltrations of Platelet-Rich Plasma (PRP) in patients with meniscal tears, analyzing its failure rate and clinical evolution, as well as factors that may inluence the positive response to this treatment. Methods Three hundred and ninety-two cases out of 696 met the inclusion criteria and were included in this work. Survival and patient-reported outcome measure (PROM) were collected and analyzed. Survival rate was deined as the percentage of patients who did not undergo meniscus surgery during their follow-up time. Patients were asked to complete the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, 6 months and 18 months. Other patient-and pathology-related variables were collected. Blood and PRP samples were randomly tested as a quality control measure. Survival and comparative statistical tests, and multivariate regression were performed for the analysis of the variables. ResultsThe PRP applied had a platelet concentration factor of 1.9X in respect to blood levels, with no leukocytes or erythrocytes. Thirty-eight patients required surgical intervention after treatment reaching a survival rate of 90.3% with an estimated mean survival time of 54.4 months. The type of injury (P = 0.002) and the presence of chondropathy were risk factors for surgical intervention after PRP treatment (P = 0.043). All KOOS scores showed a signiicant statistical increase from baseline to 6 months (N = 93) and 18 months (N = 66) (P < 0.0001). The number of cases with minimal clinically important improvement (MCII) at 6 months and 18 months post-treatment was 65 (69.9%) and 43 (65.2%), respectively. Conclusion The combination of intrameniscal and intraarticular PRP iniltrations is a valid conservative treatment for meniscal injuries avoiding the need for surgical intervention. Its eicacy is higher in horizontal tears and decreases when joint degeneration is present. Level of evidence Level IV.