Efficiency of Platelet-rich Plasma (PRP) Compared to Ozone Infiltrations on Patellofemoral Pain Syndrome and Chondromalacia: A Non- Randomized Parallel Controlled Trial

Abstract

Objective: 1) to determine the efficiency of PRP compared to Ozone Infiltrations on pain, function and quality of life (QoL) in patients with Patellofemoral Pain Syndrome (PFPS) and Chondromalacia. Material and methods:Prospective non-randomized controlled-trial, comparing two treatment protocols in parallel design, on 48 patients (24 in each group), with PFPS and Chondromalacia , who were treated at Santa Cristina's University Hospital, from January 2014 to May 2017. The PRP-protocol consisted of 3 sessions (1 session/week) of platelet-rich plasma (PRP), by an intra-articular infiltration of 3 ml. To obtain PRP, a kit device from EXACTECH (Accelerate Concentration System Device and Drucker Centrifuge was used.The Ozone-protocol consisted of 4 sessions (1 per week) of a medical mixture of Oxygen-Ozone (95%-5%) 20 ml, at a 20 ug/ml concentration, infiltrated intra-articularly. Pain, function, stiffness and Quality of Life were measured by Western Ontario and Mc Master Universities Index for Osteoarthritis (WOMAC) and Visual Analogical Scale (VAS) at baseline/end of treatment.Results: At baseline, age, sex, ratio male to female, clinical chondromalacia grades and symptom severity such as pain, stiffness and function were similar between groups of treatment. In both groups, the most common grade of chondromalacia was 2º grade (41.8% in PRP, 50% in Ozone), followed by 3º (37.6% in PRP, 33.4% in Ozone) and 4º (16.6% in both PRP and Ozone). When treatment protocols are analyzed separately, both PRP and Ozone were capable to produce pain relief (measured by VAS and WOMAC pain subscale), and improvement in function and rigidity (measured by WOMAC subscales), with a significant statistical level (p<0.05). In the case of pain, Ozone is even more effective than PRP (1.46 points on VAS scale and 2.95 points on WOMAC pain subscale) (p<0.05).Conclusion: PRP and ozone produce pain relief, function recovery and quality of life improvement in PFPS and chondromalacia, measured by WOMAC and VAS scores. In the case of pain severity, ozone produces even greater pain relief. PRP and Ozone are safe and effective modalities for the management of PFPS and chondromalacia.

Mid-Term Effectiveness of Ozone (O2-O3) Compared to Platelet-Rich Plasma (PRP) in the Management of Knee Osteoarthritis: A Randomized Parallel Controlled Trial

“…Recently, a study compared ozone (O 2 -O 3 ) to PRP in the management of chondromalacia, considered by many as a pre-stage of knee OA, and the results obtained were very promising (22). For this reason, the researchers hypothesized that ozone (O 2 -O 3 ) could also be as effective as PRP in the management of established knee OA (from mild to moderate and even severe stages), a fact that has been clearly demonstrated in the present study.…”

“…By doing this, a final 3-mL volume of PRP concentrate was obtained. This technique has been explained earlier by the study group (21,22).…”

Risk factors of the patellofemoral pain syndrome

“…When the patella has a different orientation, it will glide to one side of the patellar facies of the femur, which may cause overuse and overpressure on that part of the femur, resulting in pain, discomfort or irritation. 3 The prevalence of PFPS based on a systematic review conducted by Smith et al in the general population in the UK (2017) was 22.7%, in men as much as 15.5%, and in women, both adolescents and young adults, the highest prevalence of 29.2%. 4 A retrospective review of the orthopaedic database showed more than 30 million patients in the United States in 2007-2011; 1.75 million patients (about 6%) experienced PFPS, and women accounted for 55% of cases.…”