Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial

Filardo, Giuseppe; Kon, Elizaveta; Martino, Alessandro Di; Matteo, Berardo Di; Merli, M.; Cenacchi, Annarita; Fornasari, Pier Maria; Marcacci, Maurilio

doi:10.1186/1471-2474-13-229

Cited by 350 publications

(351 citation statements)

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“…Nine RCTs were included in the results, 15,16,[21][22][23][33][34][35]38 3 of which were double blinded ( Table 2). Hyaluronic acid was used for the control groups in 7 RCTs, saline was used in 1 study, and an exercise program was used in another.…”

Section: Randomized Controlled Trialsmentioning

confidence: 99%

PRP for Degenerative Cartilage Disease: A Systematic Review of Clinical Studies

et al. 2016

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Objective: To explore the utilization of platelet-rich plasma (PRP) for degenerative cartilage processes and evaluate whether there is sufficient evidence to better define its potential effects. Design: Systematic literature reviews were conducted in PubMed/MEDLINE and Cochrane electronic databases till May 2015, using the keywords "platelet-rich plasma OR PRP OR autologous conditioned plasma OR ACP AND cartilage OR chondrocyte OR chondrogenesis OR osteoarthritis (OA) OR arthritis." Results: The final result yielded 29 articles. Twenty-six studies examined PRP administration for knee OA and 3 involved PRP administration for hip OA. The results included 9 prospective randomized controlled trials (RCTs) (8 knee and 1 hip), 4 prospective comparative studies, 14 case series, and 2 retrospective comparative studies. Hyaluronic acid (HA) was used as a control in 11 studies (7 RCTs, 2 prospective comparative studies, and 2 retrospective cohort). Overall, all RCTs reported on improved symptoms compared to baseline scores. Only 2 RCTs-one for knee and one for hip-did not report significant superiority of PRP compared to the control group (HA). Nine out of 11 HA controlled studies showed significant better results in the PRP groups. A trend toward better results for PRP injections in patients with early knee OA and young age was observed; however, lack of uniformity was evident in terms of indications, inclusion criteria, and pathology definitions in the different studies. Conclusion: Current clinical evidence supports the benefit in PRP treatment for knee and hip OA, proven to temporarily relieve pain and improve function of the involved joint with superior results compared with several alternative treatments. Further research to establish the optimal preparation protocol and characteristics of PRP injections for OA is needed.

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Section: Randomized Controlled Trialsmentioning

confidence: 99%

PRP for Degenerative Cartilage Disease: A Systematic Review of Clinical Studies

et al. 2016

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“…Of the three comparative studies included in this assessment, two used hyaluronic acid, an inappropriate comparator for the Australian setting. 21,22 No comparative studies were identified that compared the use of PRP to NSAIDs, the current treatment option for osteoarthritis of the knee in Australia.…”

Section: Resultsmentioning

confidence: 99%

Platelet-rich plasma: a case study for the identification of disinvestment opportunities using horizon scanning

Mundy

2017

Aust. Health Review

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Objective. This paper discusses the potential for horizon scanning to identify low-value, inappropriate clinical practices that deliver minimal benefit to patients and represent a considerable financial burden on the health system.Methods. Platelet-rich plasma (PRP) was identified by routine horizon scanning as a potentially innovative treatment alternative for osteoarthritis of the knee. A rapid, non-systematic assessment of the evidence pertaining to the safety and effectiveness of PRP compared with nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of osteoarthritis of the knee was conducted.Results. The evidence base supporting the use of PRP for the treatment of osteoarthritis was poor. No comparative studies were identified that compared the use of PRP to NSAIDs, the current treatment option for osteoarthritis of the knee in Australia. Despite the lack of effectiveness evidence, the use of PRP injections was rapidly increasing in the private sector using an inappropriate Medicare Benefits Schedule item number.Conclusions. This assessment highlights the potential of using established horizon scanning methodologies to identify targets for full or partial disinvestment of ineffective, inefficient or harmful clinical practices.What is known about the topic? PRP is rapidly diffusing in the private health system in Australia, however the use of a Medicare Benefits Schedule item number meant that this practice was being subsidised by the public reimbursement of treatment fees. What does this paper add? Traditional horizon scanning tends to identify technologies for health systems to invest in. The evidence on the effectiveness of PRP was examined with the purpose of exploring investment in an innovative treatment that may have reduced the number of invasive procedures being performed in the public hospital system. The current evidence base does not support the use of PRP injections for the treatment of osteoarthritis. It does, however, support the use of horizon scanning as an inexpensive methodology to identify possible disinvestment targets associated with potential patient harm and high health service expenditure. What are the implications for practitioners? Practitioners should be aware that public funding for the injection of PRP should not be used for the treatment of osteoarthritis.

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“…84,85 These preclinical trials have led to a few small clinical studies. A 2012 review by Filardo et al 70 found 2 pre-clinical papers and 5 clinical trials focusing on the use of BMC in cartilage regeneration. Although these studies have small numbers, they offer a good start at unraveling the clinical potential of BMC.…”

Section: Autologous Bone Marrow Concentrate (Bmc)mentioning

confidence: 99%

“…However, middle-aged patients with moderate to severe OA demonstrated no significant benefit with PRP over HA. 45,70 Knop et al 71 conducted a comprehensive and systematic search of the literature on the use of PRP in the treatment of OA of the knee. A total of 23 studies were selected with nine being controlled trials and of these seven randomized, which included total of 725 patients.…”

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confidence: 99%

Emerging Potential of Cell Based Therapies for Articular Cartilage Repair and Regeneration

Venkatesh¹

2017

ATROA

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Abbreviations: ACI, autologous chondrocyte implantation;MSCs, mesenchymal stem cells; PRP, platelet-rich plasma; BMC, autologous bone marrow concentrate; TKR, total knee replacement IntroductionOsteoarthritis is a form of arthritis described as a degenerative joint disease that results from the breakdown of articular cartilage and underlying subchondral bone.1,2 Cartilage is firm, rubbery, protein substance that serves as a "cushion" between the bones, providing a smooth, gliding surface for joint motion. As the cartilage breaks down, it causes pain, swelling, stiffness and problems moving the joint.3 Therefore, Osteoarthritis is a chronic disease and a major cause of disability, characterized by irreversible cartilage degeneration, bony changes of the joints, deterioration of tendons and ligaments, and inflammation of the synoviumas shown in Figure 1. 4 An initial degeneration, known as the 'pre-OA' state may be reversible spontaneously or through preventive measures, however, if not stopped, the disease progresses to later stages which results in loss of articular cartilage surface integrity, break down of bone and osteophyte formation.3,5 OA can affect any joint, but it most often occurs in the knee, hip, lower back and neck, small joints in the finger and base of the big toe ( Figure 2). 6,7Osteoarthritis of the knee is the most common chronic condition affecting all races, gender and ages, but known to be the most common in elderly and obese people. 8,9 The knee acts as a conduit for transferring body weight essential for normal human mobility and the menisci is known to maintain the normal function of the knee, distribute load, lubricate the joint and provide joint stability. Injury to the meniscus from ageing cartilage, repetitive activity or trauma results in pain, limits movement and can accelerate the occurrence and development of OA. In general, partial or complete meniscectomy causes OA of the knee. 8,10,11 While the prevalence of OA increases with age and causes significant decline in the quality of life of individuals above the age of 65, there is increasing evidence of OA in younger population as a result of prior injuries such as anterior cruciate ligament tear or meniscal tears. 8,12,13 Figure 1 Comparison schematic between healthy knee and arthritic knee.Osteoarthritis affects about 237 million of the population, of which an estimated 9 million people alone in United States suffer from symptomatic knee osteoarthritis and it is predicted that an additional 19 million people will be affected by arthritis by 2020. 14-17The incidence of chondral defects is frequent with sporting injuries, and in elderly patients specifically 10% of population over the age of 55 years have troublesome knee pain, and of those, 25% are severely disabled.18 Depending on disease severity, management ranges from conservative treatment to surgical intervention, including total knee replacement. 14,19 In recent years the number and cost of TKR has increased dramatically between 2001 and 2012 from 305,000 to 610,000 procedu...

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Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial

Cited by 350 publications

References 33 publications

PRP for Degenerative Cartilage Disease: A Systematic Review of Clinical Studies

PRP for Degenerative Cartilage Disease: A Systematic Review of Clinical Studies

Platelet-rich plasma: a case study for the identification of disinvestment opportunities using horizon scanning

Emerging Potential of Cell Based Therapies for Articular Cartilage Repair and Regeneration

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