Intra‐articular platelet‐rich plasma injections for knee osteoarthritis: An overview of systematic reviews and risk of bias considerations

Xing, Dan; Wang, Bin; Zhang, Wei; Yang, Ziyi; Hou, Yunfei; Chen, Yaolong; Lin, Jianhao

doi:10.1111/1756-185x.13233

Cited by 35 publications

(26 citation statements)

References 42 publications

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“…If non‐surgical approaches are not successful, treatment options for advanced OA are limited to partial or total knee arthroplasty, while focal chondral defects can be treated with joint preserving options, including marrow stimulation with or without augmentation, osteochondral autografts and allografts, cell‐based therapy, scaffolds, osteotomy, and meniscal transplantation . In addition to traditional OA treatments, advanced biologic options have recently been used clinically with some success including platelet‐rich plasma, adipose‐derived stem cells, bone marrow‐derived cells, allogenic mesenchymal stem cells, and autologous protein solution (APS) . Furthermore, a pilot clinical study evaluating the safety profile of ASA was recently published by Vines et al confirming the safety of ASA for injection and suggesting a clinical benefit for up to 1 year based on patient‐reported outcomes.…”

Section: Discussionmentioning

confidence: 99%

Amniotic Suspension Allograft Modulates Inflammation in a Rat Pain Model of Osteoarthritis

Kimmerling

Gomoll

Farr

et al. 2019

Journal Orthopaedic Research

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Osteoarthritis (OA) affects over 301 million adults worldwide. Inflammation is a recognized component of the OA process; two potent pro-inflammatory cytokines involved in OA are interleukin-1β and tumor necrosis factor-α. Placental-derived tissues and fluids are known to contain anti-inflammatory and immunomodulatory cytokines and growth factors. The objective of this study was to evaluate the anti-inflammatory effects of amniotic suspension allograft (ASA) in an in vivo model of OA; we evaluated pain, function, and cytokine levels following ASA treatment in the rat monosodium iodoacetate (MIA) OA pain model. Rats were injected with 2 mg of MIA, which causes pain, cartilage degeneration, and inflammation, followed by treatment with saline, triamcinolone (positive control), or ASA 7 days following disease induction with MIA. Behavioral assays, including gait analysis, mechanical pain threshold, incapacitance, and swelling were evaluated, along with histology and serum and synovial fluid biomarkers. Treatment with ASA resulted in significant improvements in pain threshold, while weight bearing aversion and swelling were significantly decreased. There were no differences between groups in total joint score after histological grading. Serum biomarkers did not show differences, indicating a lack of systemic response; however, synovial fluid levels of IL-10 were significantly increased in animals treated with ASA. ASA treatment significantly reduced pain, weight-bearing aversion and swelling. This study provides mechanistic data regarding potential therapeutic effects of ASA in OA and preliminary evidence of the anti-inflammatory nature of ASA.

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Section: Discussionmentioning

confidence: 99%

Amniotic Suspension Allograft Modulates Inflammation in a Rat Pain Model of Osteoarthritis

Kimmerling

Gomoll

Farr

et al. 2019

Journal Orthopaedic Research

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“…Over a 7-year period, an estimated 13% of older adults (> 50 years) receive a diagnosis of OA with the knee joint implicated in 25% of the population (Jordan et al 2014). There is also an accompanying socioeconomic burden in terms of cost of medical care for both government and individuals (Xing et al 2017). It is a major public health problem worldwide (Pereira et al 2011) and is projected to rapidly increase as the population ages and rates of obesity escalate (Cross et al 2014).…”

Section: Introductionmentioning

confidence: 99%

The use of PRP injections in the management of knee osteoarthritis

2019

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Osteoarthritis (OA) is a degenerative disease involving joint damage, an inadequate healing response and progressive deterioration of the joint architecture that commonly affects the knee and/or hip joints. It is a major world public health problem and is predicted to increase rapidly with an ageing population and escalating rate of obesity. Autologous blood-derived products possess much promise in the repair and regeneration of tissue and have important roles in inflammation, angiogenesis, cell migration and metabolism in pathological conditions, including OA. Utilising platelet-rich plasma (PRP) to treat tendon, ligament and skeletal muscle has shown variable results across many studies with the current evidence base for the efficacy of PRP in treating sports injuries remaining inconclusive. More uniformly positive results have been observed by various studies for PRP in OA knee in comparison to hyaluronic acid, other intra-articular injections and placebo than in other musculoskeletal tissue. However, methodological concerns as well as satisfactory PRP product classification prevent the true characterisation of this treatment. Thus, further research is required to investigate how leukocyte inclusion, activation and platelet concentration affect therapeutic efficacy. Furthermore, the optimisation of timing, dosage, volume, frequency and rehabilitation strategies need to be ascertained. For knee OA management, these concerns must be addressed before this promising treatment can be widely implemented.

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“…13 Results showed significantly better pain relief with PRP injected into the intra-articular space compared to saline injections at 6-and 12-month follow-ups. 13 To our knowledge, there are no published studies yet investigating the efficacy of PRP injections targeting the meniscus. An additional RCT investigated the efficacy of dextrose prolotherapy injected into the periarticular space compared to the intra-articular space in decreasing pain and increasing function for individuals with symptomatic knee OA.…”

Section: Discussionmentioning

confidence: 88%

“…A 2017 systematic review examined the role PRP plays in regenerative cartilage healing in various musculoskeletal disorders, particularly in knee OA, as it is becoming an accepted, effective alternative to steroid injections . With PRP's demonstrated regenerative and anti‐inflammatory effects, a systematic review including 10 RCTs investigated the efficacy of PRP injections into the intra‐articular space for knee OA . Results showed significantly better pain relief with PRP injected into the intra‐articular space compared to saline injections at 6‐ and 12‐month follow‐ups .…”

Section: Discussionmentioning

confidence: 99%

“…13 With PRP's demonstrated regenerative and anti-inflammatory effects, a systematic review including 10 RCTs investigated the efficacy of PRP injections into the intra-articular space for knee OA. 13 Results showed significantly better pain relief with PRP injected into the intra-articular space compared to saline injections at 6-and 12-month follow-ups. 13 To our knowledge, there are no published studies yet investigating the efficacy of PRP injections targeting the meniscus.…”

Section: Discussionmentioning

confidence: 99%

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Meniscus‐Targeted Injections for Chronic Knee Pain Due to Meniscal Tears or Degenerative Fraying: A Retrospective Study

Wilderman

Berkovich

Meaney

et al. 2019

J of Ultrasound Medicine

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Objectives Meniscal tears caused by acute trauma or degenerative fraying affect a wide array of individuals. An effective, long‐lasting treatment has widely been sought after. Intra‐articular corticosteroid injections have been among the methods of controlling pain for more than 60 years. However, such injections tend to produce short‐lasting results, with profound effects lasting an average of up to 4 weeks. The purpose of this study was to determine the average duration and magnitude of pain relief after meniscal‐targeted injections. Methods The electronic medical records of 135 patients were accessed for this retrospective chart review. Patients who had meniscal tears or degenerative fraying and were treated with meniscal‐targeted injections were selected. Patients’ visual analog scale (VAS) pain scores (before and after treatment) were recorded, along with the percentage of pain relief and duration of pain relief. Results Ultrasound‐guided meniscus‐targeted corticosteroid injections for meniscal tears or degenerative fraying produced 5.68 (SD, 5.28) weeks of pain relief on average, with a decrease in pain from initial to follow‐up visits of 2.14 (P < .0001) as per the visual analog scale score, and an Integral of Pain Relief score of 3.98. Conclusions Our findings indicate a substantial benefit from 20‐ or 40‐mg meniscus‐targeted triamcinolone injections, granted the limitations of chart review research and no control group comparison. Results highlight the need for future prospective research comparing meniscus‐targeted injections with intra‐articular injections to identify a better modality for treating patients with chronic knee pain caused by meniscal tears or degenerative fraying.

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Intra‐articular platelet‐rich plasma injections for knee osteoarthritis: An overview of systematic reviews and risk of bias considerations

Abstract: The present overview demonstrates that PRP is an effective intervention in treating knee OA without increased risk of adverse events. Therefore, the present conclusions may help decision makers interpret and choose PRP with more confidence.

Cited by 35 publications

References 42 publications

Amniotic Suspension Allograft Modulates Inflammation in a Rat Pain Model of Osteoarthritis

Amniotic Suspension Allograft Modulates Inflammation in a Rat Pain Model of Osteoarthritis

The use of PRP injections in the management of knee osteoarthritis

Meniscus‐Targeted Injections for Chronic Knee Pain Due to Meniscal Tears or Degenerative Fraying: A Retrospective Study

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