Current concepts in intraosseous Platelet-Rich Plasma injections for knee osteoarthritis

Abstract

Knee osteoarthritis (OA) is a degenerative process that slowly destroys the joints producing pain and loss of function, and diminishes the quality of life. Current treatments alleviate this symptomatology but do not stop the disease, being total knee arthroplasty the only definitive solution. Among the emerging treatments, Platelet-Rich Plasma (PRP) has shown promising results in the treatment of OA. However, to improve its effectiveness, it is necessary to approach this pathology targeting the whole joint, not only the cartilage, but including other tissues such as subchondral bone. The pathological processes that occur in the subchondral bone have influence of the cartilage loss, aggravating the disease. The combination of intraarticular infiltrations with intraosseous infiltrations regulates the biological processes of the tissues, reducing the inflammatory environment and modulating the overexpression of biomolecules that generate an aberrant cellular behavior. Although the first clinical results using this technique are promising, further research and developing adequate protocols are necessary to achieve good clinical results.

Every new technique either conservative or surgical is good?

“…Preliminary clinical results are promising, while further research and developing adequate protocols are necessary. [4] Due to the limitations of conventional treatments for focal chondral defects of the knee, orthobiologics have recently become an area of interest. Orthobiologics used for cartilage defects include bone marrow aspirate concentrate, adipose-derived mesenchymal stem cells, PRP, and micronized allogeneic cartilage.…”

Isolation, Activation, and Mechanism of Action of Platelet-Rich Plasma and Its Applications for Joint Repair

“…Pathological levels of these molecules also interfere in physiological repairing responses. For instance, the action of MSCs from the bone marrow is altered by high levels of transforming growth factor beta (TGF-β), compromising their modulating and repairing functions [22].…”

“…One of the characteristics of the subchondral bone in patients with knee OA is the presence of fibroneurovascular proliferation. Although the PRP contains proangiogenic and profibrotic molecules, no basic or clinical study showed the uncontrolled induction of this effect after the application of intraosseous PRP [22].…”

Ultrasound-Assisted Intraosseous Injection of Platelet-Rich Plasma for a Patient With Tibial Plateau Subchondral Bone Marrow Lesion: A Case Presentation and Technical Illustration

“…Articular cartilage lesions are usually accompanied by subchondral bone alteration or bone marrow lesions (BMLs) which are diagnosed using magnetic resonance imaging (MRI) with high signal intensity on fluid-sensitive sequences with or without low T1-weighted signals [ 1 ]. The presence of BML has been strongly associated with osteoarthritis pathogenesis and pain in knee osteoarthritis [ 2 ]. Therefore, the subchondral BMLs have been considered as one of the treatment targets in knee osteoarthritis patients and recent studies have shown a positive therapeutic effect with intraosseous platelet-rich plasma (PRP) or bone marrow aspirate concentrate injections [ 1 , 3 ].…”

“…The traditional intraosseous injection is performed by using a large caliber trocar under fluoroscopy. However, radiation exposure can be a limitation for this procedure [ 2 ]. Also, using a trocar to break into the subchondral bone can be destructive for the overlying cortical bone and the patient is usually sedated prior to the procedure.…”