Intra-articular Platelet-Rich Plasma vs Placebo Injection and Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis—Reply

Bennell, Kim L; Paterson, K.; Hunter, David J.

doi:10.1001/jama.2022.1315

Cited by 22 publications

(48 citation statements)

References 5 publications

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“…These findings emphasize the importance of comparing interventions with placebos in trials of injection therapies. The placebo effect of intra-articular injection on a 0- to 10-point visual analog scale for pain was estimated previously at 1.8 points, consistent with the findings documented in the trial by Bennell et al for knee OA.…”

supporting

confidence: 87%

“…With this background, the rigorous RCT of PRP for knee OA reported in this issue of JAMA , along with the RCTs of PRP for ankle OA and for midportion Achilles tendinopathy reported in recent issues, represent important new evidence . These 3 clinical trials were randomized and placebo controlled and included blinding of patients, assessors, and treating clinicians.…”

mentioning

confidence: 99%

“…In each study, both the participants randomized to the active treatment and those randomized to the placebo improved substantially, and there was no significantly greater benefit in the active treatment group, compared with placebo. For example, in the trial of 288 adults aged 50 years or older with knee OA, Bennell et al reported that participants who were randomized to receive 3 PRP injections improved by 2.1 points on a 1- to 10-point pain scale over 12 months, whereas participants randomized to placebo improved by 1.8 points. Thus, mean improvement in participants randomized to the intervention and placebo, respectively, was at least as great as the minimum clinically important difference of 1.8 points, but the mean difference in pain relief between the PRP and placebo groups of 0.4 points was neither clinically meaningful nor statistically significant …”

mentioning

confidence: 99%

“…Bennell et al also assessed knee cartilage volume on magnetic resonance imaging at baseline and at 12 months and reported that both the PRP and placebo groups lost approximately 1% of cartilage volume over 12 months of follow-up, with no meaningful difference between PRP and placebo. These findings do not support the hypothesis that PRP arrests or reverses structural joint damage.…”

mentioning

confidence: 99%

“…The findings of Kearney et al regarding PRP for Achilles tendinitis are consistent with several prior trials, suggesting that PRP may simply be ineffective for Achilles tendinitis . Paget et al reported that among patients with ankle OA, intra-articular PRP injections, compared with placebo injections, did not significantly improve ankle symptoms and function over 26 weeks, and suggested that their findings “do not support the use of PRP injections for ankle osteoarthritis.” Bennell et al reported that PRP treatment, compared with saline injection, did not significantly improve the 2 primary outcomes, changes in knee pain and joint structure (ie, medial tibial cartilage volume). However, the suggestion of possible benefit for some of the secondary outcomes (self-reported improvement in pain and function), as well as the mixed results of prior studies, support caution before dismissing PRP entirely for knee OA.…”

mentioning

confidence: 99%

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Platelet-Rich Plasma for Osteoarthritis and Achilles Tendinitis

Katz

2021

JAMA

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supporting

confidence: 87%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Platelet-Rich Plasma for Osteoarthritis and Achilles Tendinitis

Katz

2021

JAMA

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Intra-Articular Platelet-Rich Plasma Injection After Anterior Cruciate Ligament Reconstruction

Ye,

Chen,

Qiao

et al. 2024

JAMA Netw Open

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ImportancePlatelet-rich plasma (PRP) has been considered a promising treatment for musculoskeletal disorders. The effects of PRP on clinical outcomes of anterior cruciate ligament reconstruction (ACLR) are controversial.ObjectiveTo compare subjective outcomes and graft maturity in patients undergoing ACLR with and without postoperative intra-articular PRP injection.Design, Setting, and ParticipantsThis surgeon- and investigator-masked randomized clinical trial included patients treated at a national medical center in China who were aged 16 to 45 years and scheduled to undergo ACLR. Participants were enrolled between March 21, 2021, and August 18, 2022, and followed up for 12 months, with the last participant completing follow-up on August 28, 2023.InterventionsParticipants were randomized 1:1 to the PRP group (n = 60), which received 3 doses of postoperative intra-articular PRP injection at monthly intervals, or to the control group (n = 60), which did not receive postoperative PRP injection. Both groups had the same follow-up schedule.Main Outcomes and MeasuresThe primary outcome was the mean score for 4 subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS4) (range, 0-100, with higher scores indicating better knee function and fewer symptoms) at 12 months postoperatively. Secondary outcomes were patient-reported outcomes, graft maturity (on magnetic resonance imaging), and physical examinations at 3, 6, and 12 months.ResultsAmong the 120 randomized participants (mean [SD] age, 29.0 [8.0] years; 84 males [70%]), 114 (95%) were available for the primary outcome analysis. The mean KOOS4 scores at 12 months were 78.3 (SD, 12.0; 95% CI, 75.2-81.4) in the PRP group and 76.8 (SD, 11.9; 95% CI, 73.7-79.9) in the control group (adjusted mean between-group difference, 2.0; 95% CI, −2.3 to 6.3; P = .36). Secondary outcomes were not statistically significantly different between the 2 groups except for sports and recreation level and graft maturity at 6 months. Intervention-related adverse events included pain at the injection site and knee swelling after injection.Conclusions and RelevanceIn this randomized clinical trial among patients undergoing ACLR, the addition of postoperative intra-articular PRP injection did not result in superior improvement of knee symptoms and function at 12 months compared with no postoperative injection. Further studies are required to determine appropriate indications for PRP in musculoskeletal disorders.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2000040262

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Selection of Knees With Subsequent Cartilage Thickness Loss Based on Magnetic Resonance Imaging Semiquantitative Grading: Data From the Osteoarthritis Initiative Foundation for the National Institutes of Health Biomarker Cohort

Wirth

Maschek

Wisser

et al. 2023

Arthritis Care & Research

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Objective To investigate which magnetic resonance imaging (MRI)–based articular pathologies are predictive of subsequent medial femorotibial compartment quantitative cartilage thickness loss and therefore suitable for enrichment of clinical trials with participants showing a high likelihood for structural progression. Methods Semiquantitative MRI Osteoarthritis Knee Score (MOAKS) assessments at baseline and quantitative cartilage thickness measurements at baseline and year‐2 follow‐up were performed in 599 participants (age 62 years; body mass index 31 kg/m2; 59% female) from the Osteoarthritis Initiative–based Foundation for the National Institutes of Health Osteoarthritis Biomarkers Consortium. Knees were classified as medial femorotibial compartment (MFTC) progressors or nonprogressors based on MFTC cartilage thickness change (smallest detectable change threshold −111 μm). Logistic regression was used to investigate the association between baseline presence and severity of MFTC MOAKS pathologies with subsequent MFTC progression. The standardized response mean (SRM) was computed to estimate the sensitivity to change that can be achieved when selecting knees based on MOAKS pathologies. Results Presence of MFTC MOAKS cartilage damage (odds ratio [OR] 2.77 [95% confidence interval (95% CI) 1.76, 4.36]), MFTC bone marrow lesions (OR 2.69 [95% CI 1.89, 3.83]), medial meniscus extrusion or damage (OR 2.21 [95% CI 1.37, 3.55]), as well as MOAKS severity subscales for cartilage and meniscus damage were associated with subsequent progression. The SRM was greater in knees with than in knees without the presence of these pathologies and was associated with the severity of those pathologies. Conclusion MRI‐based grading of articular pathologies makes it possible to specifically select progressor knees suitable for inclusion in clinical trials but also to identify knees in which treatment is not indicated (e.g., knees without cartilage damage despite presence of radiographic osteoarthritis).

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Intra-articular Platelet-Rich Plasma vs Placebo Injection and Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis—Reply

Abstract: Differences in treatment strategies in the management of acute appendicitis in a county hospital in Guatemala and an academic teaching institution in the United States.

Cited by 22 publications

References 5 publications

Platelet-Rich Plasma for Osteoarthritis and Achilles Tendinitis

Platelet-Rich Plasma for Osteoarthritis and Achilles Tendinitis

Intra-Articular Platelet-Rich Plasma Injection After Anterior Cruciate Ligament Reconstruction

Selection of Knees With Subsequent Cartilage Thickness Loss Based on Magnetic Resonance Imaging Semiquantitative Grading: Data From the Osteoarthritis Initiative Foundation for the National Institutes of Health Biomarker Cohort

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