Intra-articular Injection of Platelet-Rich Plasma Is Superior to Hyaluronic Acid or Saline Solution in the Treatment of Mild to Moderate Knee Osteoarthritis: A Randomized, Double-Blind, Triple-Parallel, Placebo-Controlled Clinical Trial

Lin, Kuan Yu; Yang, Chia Chi; Hsu, Chien Jen; Yeh, Ming Long; Renn, Jenn Huei

doi:10.1016/j.arthro.2018.06.035

Cited by 142 publications

(159 citation statements)

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“…The positive effect of intraarticular applications in treatment of symptomatic knee OA was well documented in the literature [7,8,22]. The results of this study showed signi cant decrease in WOMAC pain score and overall WOMAC score in the PRP group at follow-ups, which is consistent with the literature [27,28]. This, in combination with the results of T2 mapping, seems to be in favour of improving cartilage properties (5,6).…”

Section: Discussionsupporting

confidence: 89%

T2 mapping evaluation of changes in cartilage matrix after PRP and HA injection therapy in knee osteoarthritis: a prospective, randomized, double blind, placebo controlled study

Vogrin¹,

Naranda²,

Gorenjak³

et al. 2020

Preprint

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BackgroundIn this study we focused on evaluating the effect of intra-articular platelet-rich plasma (PRP) and hyaluronic acid (HA) on the qualitative and quantitative properties of the articular cartilage in patients with knee osteoarthritis (OA).MethodsWe evaluated 264 patients undergoing treatment of moderate knee OA. Patients aged between 40 and 70 years were included with articular K-L stage ≤ 2. Patients were randomized into three groups and treated with three doses of intra-articular PRP, HA, or placebo injection. Patients were evaluated clinically and by using T2 mapping.ResultsBoth PRP (619.05 ± 243 ms; p = 2.7 × 10− 5) and HA (637.12 ± 273 ms; p = 1.×10− 4) group showed statistically significant lower post-application T2 relaxation times in comparison to the placebo group (859.80 ± 406 ms).Cartilage thickness increased significantly after PRP (2.41±0.87 vs. 2.58±0.97 mm, p=0.033) and HA (2.28±0.81 vs. 2.80±1.00 mm, p=1.8×10) applications. There was a significant decrease in WOMAC pain score by 30% (p=0,001) and the overall WOMAC score by 27 p=1.9×10-4%) in PRP group. The decrease in WOMAC pain score and the overall WOMAC score in the placebo group was similar to the results observed in the PRP group. In the HA group a significant decrease in WOMAC pain score by 14% (p=0,005) was observed only at the first follow-up, whereas no difference was observed at the second follow-up. ConclusionsT2 mapping of cartilage tissue may aid to monitor its properties after the intra-articular therapies in knee OA. However, there is a discrepancy between clinical findings and the results of T2 mapping, suggesting questionable grounds for applying intra-articular therapy.

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Section: Discussionsupporting

confidence: 89%

T2 mapping evaluation of changes in cartilage matrix after PRP and HA injection therapy in knee osteoarthritis: a prospective, randomized, double blind, placebo controlled study

Vogrin¹,

Naranda²,

Gorenjak³

et al. 2020

Preprint

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“…PRP was first shown to be more effective in reducing pain than HA injections at six months follow-up in a randomized controlled trial by Sánchez et al [30] in 2012. e same results were confirmed in the same year by Cerza et al [31] in a large randomized controlled trial on 120 patients. In the following years, a recent review [24] and several other trials confirmed these findings [12,14,17,32] showing, besides no increased risk of adverse events, a significant improvement in short-term exceeding what is considered a minimum clinically important difference. However, the literature currently lacks evidence on the potential of PRP for the treatment of knee OA in sport-active patients.…”

Section: Discussionmentioning

confidence: 78%

“…e use of PRP to treat knee OA is being supported by increasing evidence. Its safety and efficacy were proved in randomized controlled trials versus placebo, proving the effects of PRP, with pain reduction and improvement in function and clinical scores at short-term follow-up [12,14,15,[26][27][28][29]. However, in terms of efficacy in addressing OA joints, the evidence about any possible superiority of PRP versus hyaluronic acid (HA) is more controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Intra-articular injective treatments emerged as an alternative minimally invasive option to provide a clinical benefit and delay more sacrificing procedures while avoiding the impact and risks of surgical treatments in these active patients. In the past few years, platelet-rich plasma (PRP) has been proposed for the treatment of knee OA and its use is now supported by increasing evidence [12][13][14][15][16][17]. Its rational lays on its anabolic and anti-inflammatory properties due to growth factors and cytokines released by platelets [18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

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Platelet‐Rich Plasma for Sport‐Active Patients with Knee Osteoarthritis: Limited Return to Sport

Altamura

Martino

Andriolo

et al. 2020

BioMed Research International

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Objective. To evaluate a cohort of sport-active patients suffering from cartilage degeneration and OA, in terms of clinical outcome and return to sport (RTS) after platelet-rich plasma (PRP) injective treatment. Design. is study included forty-seven sport-active patients ≤50 years old with unilateral symptomatic knee cartilage degeneration or OA. Patients received 3 PRP injections and were prospectively evaluated at baseline and then at 2, 6, 12, and 24 months follow-up by IKDC subjective EQ-VAS, and Tegner scores. Furthermore, patients were asked about their RTS, in terms of return to any sport level or to their activity level before symptoms onset. Results. IKDC subjective score improved significantly at all follow-ups, changing from 59.2 ± 13.6 to 70.6 ± 13 at 12 months and to 76.7 ± 12.5 at 24 months (p < 0.0005). A similar outcome was observed with the EQ-VAS score. Tegner score improved from 3.6 ± 1.4 to 4.8 ± 0.9 at 24 months (p < 0.0005), but only 76.6% of patients returned to some sport activity and 48.9% to the same activity level. A lower presymptoms Tegner score was associated with a higher RTS rate, both at any level (p � 0.024) and at the same presymptoms level (p < 0.0005). Conclusions. Sport-active patients affected by knee OA can benefit from PRP injections, with pain and function improvement over time. However, results are less satisfactory in terms of RTS since only half can achieve the same sport level as before the onset of symptoms. Patients undergoing PRP treatment should be made aware of their low chances to go back to high-impact sport activities.

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“…The study by Lin, Yang, Hsu, Yeh, and Renn, entitled "Intra-articular Injection of Platelet-Rich Plasma Is Superior to Hyaluronic Acid or Saline in the Treatment of Mild to Moderate Knee Osteoarthritis: A Randomized, Double-Blind, Triple-Paralleled, Placebo-Controlled Clinical Trial," seeks to compare the effectiveness of platelet-rich plasma (PRP) and hyaluronic acid (HA) with a normal saline (control group) in a randomized (dose-controlled), doubleblind, clinical trial for knee osteoarthritis. 10 The authors should be commended on this work as it represents a well-designed randomized clinical trial that helps build the body of literature of an approach that is readily available and that can impact a patient's quality of life in a positive way.…”

Section: See Related Article On Page 106mentioning

confidence: 99%

Editorial Commentary: Platelet-Rich Plasma for Knee Osteoarthritis: A “Novel” and Effective Symptomatic Approach

Chahla

Cole

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Osteoarthritis (OA) constitutes a significant cause of disability, and it is now recognized as a source of increased mortality. Thus, several therapeutic approaches have been reported in the literature in an attempt to mitigate the symptoms of OA with varying degrees of success. Platelet-rich plasma (PRP) is being increasingly accepted as one of the most efficacious approaches for the symptomatic treatment of mild to moderate OA. Several confounding factors can affect the outcome of PRP such as age, grade of OA, PRP processing technique, and number and timing of these injections. However, numerous reports in the literature derived from PRP randomized clinical trials (compared with saline, hyaluronic acid, and other nonsurgical methods) suggest that successful outcomes can be achieved at least at 1-year postinjection with minimal complications.

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Intra-articular Injection of Platelet-Rich Plasma Is Superior to Hyaluronic Acid or Saline Solution in the Treatment of Mild to Moderate Knee Osteoarthritis: A Randomized, Double-Blind, Triple-Parallel, Placebo-Controlled Clinical Trial

Cited by 142 publications

References 44 publications

T2 mapping evaluation of changes in cartilage matrix after PRP and HA injection therapy in knee osteoarthritis: a prospective, randomized, double blind, placebo controlled study

T2 mapping evaluation of changes in cartilage matrix after PRP and HA injection therapy in knee osteoarthritis: a prospective, randomized, double blind, placebo controlled study

Platelet‐Rich Plasma for Sport‐Active Patients with Knee Osteoarthritis: Limited Return to Sport

Editorial Commentary: Platelet-Rich Plasma for Knee Osteoarthritis: A “Novel” and Effective Symptomatic Approach

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