Efficacy of Platelet-Rich Plasma on Pain and Function in the Treatment of Knee Osteoarthritis: A Prospective Cohort Study

Abstract

Background Osteoarthritis (OA) is a degenerative disease commonly affecting the knee joints. It affects patients socially, psychologically and economically and rates of the disease have been increasing due to obesity and old age. Regardless of choosing a medically conservative approach, it is a challenge in the long term to provide OA patients efficient treatment with minimal side effects and long-term efficiency. Platelet-rich plasma (PRP) is a convenient, low-cost and affordable treatment technique used in treating knee OA with encouraging efficient and safe outcomes. In this study we will investigate the effect of PRP on knee OA. Methods This is a prospective cohort study involving 252 patients with different OA grades. The Kellgren and Lawrence (K&L) system was used in classifying the affected knee by degenerative cartilage lesions as well as early and severe OA. All patients with a diagnosis of knee OA were screened in every visit before the injection, the pain was assessed by the 0-10 Numeric Rating Scale (NRS), and knee range of motion including flexion and extension was assessed by goniometer. Follow-up appointments were done on three-month intervals for a total of three visits for evaluation. Injection of PRP was given to all the patients with a maximum of four injections. The results were evaluated statistically according to the total number of followup visits. Results In grade II patients, the pain improved with the visits and the maximum improvement in flexion degree was noticed in patients who came for a total of three follow-up visits. In grade III patients, the most improvement in pain was in patients who came for three follow-up visits, while the most improvement in flexion degree was in patients who came for a total of two follow-up visits. Patients with grade IV who came for three follow-up visits showed the most improvement in pain and degree of flexion. Conclusions Intra-articular injections gave significant pain and flexion improvement in grades II, III and IV in OA patients, especially with multiple injection in the short-term follow-up. As a result, recommendation of repeated multiple injections up to four times is efficient in providing long time relief in knee OA.

Comparative Efficacy of Intra-Articular Injection, Physical Therapy, and Combined Treatments on Pain, Function, and Sarcopenia Indices in Knee Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials

“…Treatment effects in response to IAI regimens are likely affected by the degree of cartilage degeneration. Numerus studies have conducted subgroup analyses stratified by KL grade to identify the efficacy of IAI agents in patients with KOA of varying severity, particularly PRP [ 53 , 84 , 90 , 125 , 126 , 127 , 128 ], HA [ 38 , 90 , 127 , 128 , 129 ], ACS [ 73 ], and MSCs [ 130 ]. These studies have obtained conclusive results indicating that patients who suffer minor cartilage loss or have a low KL grade generally respond well to such IAI agents compared with those that receive a placebo injection or comparative treatment, whereas those who experience more severe cartilage degeneration or have a high KL grade experience less improvement through treatment.…”

Pain Management Strategies in Osteoarthritis

“…Consequently, platelets play an active role in the healing mechanism through a diverse range of growth factors and other active molecules to the injured site. Several issues in relation to platelet-rich plasma (PRP) in a joint with OA remain debatable [79], along with the use of PRP in relation to decreased inflammation [80], pain alleviation [81], improved functionality [82], and potential cartilage redevelopment [83]. The main challenge lies in understanding the complex mechanisms concerning the potential therapeutic effects of platelet-rich plasma (PRP), primarily attributable to the diverse study methodologies which commonly imply a high risk of bias.…”

Intra-Articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Review of Their Current Molecular Mechanisms of Action and Their Degree of Efficacy

“…Intra-articular injections were found to provide significant pain relief and flexion improvement in patients with grades 2, 3, and 4 OA, especially with multiple injections in the short-term follow-up. Hegaze et al recommended repeated injections, up to four times, because they appeared efficient in providing long-term alleviation of knee OA [49].…”

“…In patients with knee OA, LR-PRP demonstrated effectiveness in meaningful end points for functional and patient-reported outcomes at early time points [51]. Table 2 summarizes the efficacy of intra-articular PRP injections in knee OA [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51].…”