Efficacy of Platelet-Rich Plasma and Plasma for Symptomatic Treatment of Knee Osteoarthritis: A Double-Blinded Placebo-Controlled Randomized Clinical Trial.

Abstract

Background: Platelet-rich plasma (PRP) has a still conflicting efficacy for knee osteoarthritis (KOA) and might be a minimally invasive and safe treatment alternative. The potential benefit of only plasma (non-enriched) has never been investigated. Our aim was to evaluate the efficacy of intra-articular platelet-rich plasma (PRP) and plasma to improve pain and function in participants with KOA over 24 weeks. Methods: Randomized, double-blind, placebo-controlled trial with 3 groups (n = 62): PRP (n = 20), plasma (n = 21) and saline (n = 21). Two ultrasound-guided knee injections were performed with a 2-week interval. The primary outcome was visual analog scale 0-10 cm (VAS) for overall pain at week 24, with intermediate assessments at weeks 6 and 12. Main secondary outcomes were: KOOS, OMERACT-OARSI criteria and TUGT. Results: At baseline, 92% of participants were female, with a mean age of 65 years, mean BMI of 28.0 Kg/m2and mean VAS pain of 6.2 cm. Change in pain from baseline at week 24 were -2.9 (SD 2.5), -2.4 (SD 2.5) and -3.5 cm (SD 3.3) for PRP, plasma and saline, respectively (p intergroup = 0.499). There were no differences between the three groups at weeks 6 and 12. Similarly, there were no differences between groups regarding secondary outcomes. The PRP group showed higher frequency of adverse events (65% versus 24% and 33% for plasma and saline, respectively, p = 0.02), mostly mild transitory increase in pain.Conclusions: PRP and plasma were not superior to placebo for pain and function improvement in KOA over 24 weeks. The PRP group had a higher frequency of mild transitory increase in pain.Trial registration: ClinicalTrials.gov, NCT03138317, 03/05/2017.

Platelet Rich Plasma in the Repair of Articular Cartilage Injury: A Narrative Review

“…While WOMAC scores for patients receiving the saline injection were relatively unchanged for up to 12 months. In contrast, Dorio et al 105 made a randomized controlled trial in which 62 patients were divided into 3 groups by injection of PRP, plasma, and saline. Pain and adverse effects were assessed at 6, 12, and 24 weeks, respectively.…”

“…Some scholars have observed that intra-articular injection of PRP can inhibit and produce local adverse reactions, including local swelling and pain, but it will be relieved after a short time, which may be related to the dose and method of PRP injection and the content of leukocytes in PRP. 105,[117][118][119] Most studies have proved that PRP injection has little adverse effect on patients and can be alleviated in a very short time. 111,120 In addition, there are the following problems in intra-articular injection of PRP: (1) lack of standard guidelines for PPP preparation and injection methods, (2) there is a certain bias in the research results, (3) the clinical application of PPP needs to be standardized, (4) lack of unified clinical efficacy evaluation method, (5) lack of clinical long-term follow-up study, and (6) expensive, and so on.…”

Age and synovitis affect the results of the treatment of knee osteoarthritis with Microfragmented Autologous Fat Tissue

“…Knee osteoarthritis (OA) is an extremely common chronic disease worldwide affecting cartilage [10,12,13], thus cell-based cartilage tissue engineering approaches have been used to treat focal articular cartilage defects, with varying degrees of success [2,5,9,15,20,23,24]. Particularly studied is the use of mesenchymal stem cells (MSCs), derived from different tissues, which showed properties of self-renewal, multi-lineage differentiation, immune-modulation, and activation of the microenvironment by secreting different growth factors and cytokines [11,19,25,27,28].…”