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

Abstract

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.

Review of concentration yields in commercially available platelet-rich plasma (PRP) systems: a call for PRP standardization

“…More is not necessarily better as too high of a platelet concentration can be detrimental to the healing process 33. Yamaguchi et al 34 showed PRP concentration had a dose-dependent effect on intestinal anastomotic healing in rats, where a lower PRP platelet concentration (2 000 000/µL) exerted positive effects, while the higher PRP platelet count (5 000 000/µL) was harmful to healing.…”

Glycosaminoglycan and Proteoglycan Biotherapeutics in Articular Cartilage Protection and Repair Strategies: Novel Approaches to Visco‐supplementation in Orthobiologics

“…[402] Inclusion of a cellular matrix along with PRP-HA intra-articular injections is reported to further improve long term beneficial effects in over 50% of patients avoiding surgery in 80% of cases at 4 year follow up. [394] A Meta-analysis of randomized controlled trial data confirmed the efficacy and safety of PRP injections for the treatment of knee OA. [394] A Meta-analysis of randomized controlled trial data confirmed the efficacy and safety of PRP injections for the treatment of knee OA.…”

“…[391] A systematic review, which included data from six randomized controlled trials comparing the effectiveness of PRP with other intra-articular injections, exercise, or analgesia for a minimum of 6 months PRP produced statistically significant improvements in WOMAC scores for up to 12 months. [393][394][395] www.advancedsciencenews.com www.advtherap.com HA hydrogel n/a Dexamethasone Cortocosteroid [310] Adant (Suprahyal) 500-1000 Tenoxicam NSAID [311] Variofill (Adoderm, Langenfeld, Gmbh) HMWCR Diclofenac Sodium clodronate Triamcinolone acetonide Ropivacaine HCl NSAID DMOAD Cortocosteroid Anaesthetic [312] [ 313] Hydros, Hydros-TA HMW Triamcinolone acetonide Cortocosteroid [314] Cingal 1900 Triamcinolone acetonide Cortocosteroid [315] Hylan GF-20 HMWCR Triamcinolone acetonide Cortocosteroid [316] HA solution 800 Mannitol Anti-oxidant [317] Go-on matrix Ostenil Plus 1500 Mannitol Anti-oxidant [320] Happyvix 1500 Mannitol Anti-oxidant [320] Happycross 1500 Mannitol Anti-oxidant [320] Synolis V-A 2000 Sorbitol Anti-oxidant [320] HA 4AR conjugate 2200 4 aminoresorcinol Anti-oxidant [321] Ostenil 1000-2000 l-glutathione Anti-oxidant [322] Arthrum HCS 2800 CS GAG [320] Surgical Syonium 2800 CS GAG [320] HA-sCT conjugate 200 Salmon calcitonin DMOAD [323] HA ADAMTS inhibitor n/a ADAMTS inhibitor DMOAD [324] HA hydrogel 60-120 Doxycycline DMOAD [296] Hanox Hanox M-XL 1500 n/a Cortivazol Triamcinolone hexacetonide Mannitol + lidocaine clorhydrate Cortocosteroid Cortocosteroid Anti-oxidant + local anaesthetic [325] n/a, not available; HMW, high molecular weight; HMWCR, high molecular weight cross-linked. [393][394][395] www.advancedsciencenews.com www.advtherap.com HA hydrogel n/a Dexamethasone Cortocosteroid [310] Adant (Suprahyal) 500-1000 Tenoxicam NSAID [311] Variofill (Adoderm, Langenfeld, Gmbh) HMWCR Diclofenac Sodium clodronate Triamcinolone acetonide Ropivacaine HCl NSAID DMOAD Cortocosteroid Anaesthetic …”

“…[392,393] Adverse events with PRP treatment were not significantly increased in comparison with other knee OA treatments consistent with earlier studies using PRP as an intervention in knee OA. [393][394][395] HA hydrogel n/a Dexamethasone Cortocosteroid [310] Adant (Suprahyal) 500-1000 Tenoxicam NSAID [311] Variofill (Adoderm, Langenfeld, Gmbh) HMWCR Diclofenac Sodium clodronate Triamcinolone acetonide Ropivacaine HCl NSAID DMOAD Cortocosteroid Anaesthetic [312] [ 313] Hydros, Hydros-TA HMW Triamcinolone acetonide Cortocosteroid [314] Cingal 1900 Triamcinolone acetonide Cortocosteroid [315] Hylan GF-20 HMWCR Triamcinolone acetonide Cortocosteroid [316] HA solution 800 Mannitol Anti-oxidant [317] Go-on matrix Go- Ostenil Plus 1500 Mannitol Anti-oxidant [320] Happyvix 1500 Mannitol Anti-oxidant [320] Happycross 1500 Mannitol Anti-oxidant [320] Synolis V-A 2000 Sorbitol Anti-oxidant [320] HA 4AR conjugate 2200 4 aminoresorcinol Anti-oxidant [321] Ostenil 1000-2000 l-glutathione Anti-oxidant [322] Arthrum HCS 2800 CS GAG [320] Surgical Syonium 2800 CS GAG [320] HA-sCT conjugate 200 Salmon calcitonin DMOAD [323] HA ADAMTS inhibitor n/a ADAMTS inhibitor DMOAD [324] HA hydrogel 60-120 Doxycycline DMOAD [296] Hanox [325] n/a, not available; HMW, high molecular weight; HMWCR, high molecular weight cross-linked.…”

Ultrasound Diagnostic and Therapeutic Injections of the Hip and Groin

“…A recent meta-analysis, however, concluded that there was still a lack of standardisation of HA for hip conditions and proposed that this is the best conservative therapy before surgery [23]. Similarly, another systematic review supported the safety and benefit in PRP treatment for hip osteoarthritis but given the considerable heterogeneity between studies and cost, further research is needed to establish the optimal PRP protocol [24]. …”