The Use of Platelet-Rich Plasma in Symptomatic Knee Osteoarthritis

Abstract

With average life expectancy and the rising prevalence of obesity, osteoarthritis (OA) is creating an increasingly large financial and physical burden on the U.S. population today. As the body ages and experiences trauma, articular cartilage surfaces in joints are gradually worn away, leading to OA. Traditionally, treatment options have included lifestyle modifications, pain management, and corticosteroid injections, with joint replacement reserved for those who have exhausted nonsurgical measures. More recently, hyaluronic acid, micronized dehydrated human amniotic/chorionic membrane tissue, and platelet-rich plasma (PRP) injections have started to gain traction. PRP has been shown to have both anti-inflammatory effects through growth factors such as transforming growth factor-β and insulin-like growth factor 1, and stimulatory effects on mesenchymal stem cells and fibroblasts. Multiple studies have indicated that PRP is superior to hyaluronic acid and corticosteroids in terms of improving patient-reported pain and functionality scores. Unfortunately, there are many variations in PRP preparation, and lack of standardization in factors, such as speed and duration of centrifugation, leads to wide ranges of platelet and leukocyte concentrations. This review examines the current literature addressing the use of PRP in symptomatic knee OA and addresses suggestions for future studies in this area.

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

“…In the present study, 47 sport-active patients were treated with 3 injections of PRP and evaluated for up to 24 months of follow-up, not only looking at clinical scores but also addressing specific sport-related questions. In this population, a significant improvement in all scores was reported without significant adverse events related to treatment, confirming the evidence present in the literature that suggests that PRP is safe and effective to treat knee OA [16,22,23]. Moreover, results further improved after 12 months: IKDC and EQ-VAS continued to improve over time, with a significant difference between 12 months follow-up and 24 months follow-up.…”

“…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].…”

“…Preclinical evidence showed that PRP might promote a favorable environment for joint tissue healing [22]. Nevertheless, although recent reviews and meta-analysis showed good results using PRP for the treatment of OA [16,[22][23][24], the literature is still very sparse on the use of PRP for the treatment of active patients, and more evidence is needed to document potentials and limitations in this population, both in terms of clinical improvement and return to sport.…”

Procedural Treatments for Knee Osteoarthritis: A Review of Current Injectable Therapies

“…is will generate either leukocyte-poor (LP) or leukocyte-rich (LR) PRP, respectively [29,35]. No clear benefit has been established between using either LP-PRP or LR-PRP, but adverse events seem to be more common with LR-PRP [35,57].…”

Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration

“…In the last decade, there has been increasing interest in the utilization of biologically active adjuncts in the treatment of sports injuries. The most popular of these therapies is platelet‐rich plasma (PRP), an autologous blood product that is obtained by drawing peripheral venous blood followed by centrifugation to remove red blood cells, leaving concentrated platelets and plasma . PRP is rich in various growth factors that include but are not limited to: PDGF, VEGF, TGF‐β, EGF, FGF, and IGF.…”