Arthroscopy: The Journal of Arthroscopic & Related Surgery
Systematic ReviewEfficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review
Section snippets
Methods
A systematic review was registered on PROSPERO on August 12, 2014 (registration ID: CRD42014013032). Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.17 English-language original research therapeutic level I evidence (based on Oxford Centre for Evidence Based Medicine) randomized comparative trials were eligible for inclusion.18 The studies that were sought compared the use of autologous PRP with HA viscosupplementation, corticosteroid, placebo, or
Results
Six articles (739 patients, 817 knees) were analyzed (Table 2). There were 39% males and 61% females with a mean age of 59.9 years per patient and 59.2 years per knee and mean follow-up of 38 weeks per patient and 37 weeks per knee. Radiographically, the Kellgren-Lawrence and Ahlback grading systems were used determine severity of knee OA. Two studies used the Ahlback classification system and showed that 58.2% were grade I, 32.4% were grade II, and 9.4% were grade III. Four studies used the
Discussion
It was determined that intra-articular PRP injections significantly improve the clinical outcomes in symptomatic knee OA. PRP was also shown to be significantly better than HA or placebo for the treatment of symptomatic knee OA. Treating OA nonoperatively has been ongoing for several decades. Multiple studies have reported the use of HA, PRP, and corticosteroids, among other agents, in the nonoperative treatment of OA. While there are a good amount of studies documenting the use of HA in the
Conclusions
In patients with symptomatic knee OA, PRP injection results in significant clinical improvements up to 12 months postinjection. Clinical outcomes and WOMAC scores are significantly better after leukocyte-poor PRP versus HA at 3 to 12 months postinjection. There is limited evidence for comparing leukocyte-rich versus leukocyte-poor PRP in this study.
References (37)
- et al.
Cartilage injuries: a review of 31516 knee arthroscopies
Arthroscopy
(1997) - et al.
Applications of platelet-rich plasma in musculoskeletal and sports medicine: an evidence-based approach
PM&R
(2011) - et al.
Platelet intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degenerations to osteoarthritis
Arthroscopy
(2011) Best evidence synthesis: an intelligent alternative to metaanalysis
J Clin Epidemiol
(1995)- et al.
Platelet-rich plasma: the PAW classification system
J Arthroscopy Related Surg
(2012) - et al.
A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis
J Arthroscopy Related Surg
(2012) - et al.
Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a randomized controlled trial
J Arthroscopy Related Surg
(2013) - et al.
Wound healing in the PU.1 null mouse: tissue repair is not dependent on inflammatory cells
Curr Biol
(2003) - et al.
Use of a validated algorithm to judge the appropriateness of total knee arthroplasty in the United States: a multicenter longitudinal cohort study
Arthritis Rheumatol
(2014) AAOS clinical practice guidelines. Treatment of osteoarthritis of the knee: evidence-based guideline, 2d ed
J Am Acad Orthop Surg
(2013)
Platelet-rich plasma application in chondrogenesis
Adv Biomed Res
The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis
Am J Sports Med
The role of platelets in the treatment of Achilles tendon injuries
J Orthop Res
Platelet-rich plasma in rotator cuff repair: a prospective randomized study
Am J Sports Med
Platelet-rich plasma as a treatment for patellar tendinopathy. A double-blind, randomized controlled trial
Am J Sports Med
Platelet-rich plasma injections for the treatment of hamstring injuries: a randomized controlled trial
Am J Sports Med
Anti-inflammatory effect of platelet-rich plasma on nucleus pulposus cells with response of TNF-α and IL-1
J Orthop Res
Platelet-rich plasma releasate inhibits inflammatory processes in osteoarthritic chondrocytes
Am J Sports Med
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See commentary on page 506
The authors report the following potential conflicts of interest or sources of funding: P.C.M. is on the Speaker's Bureau/Paid Presentation of Genzyme; receives research support from DePuy, a Johnson & Johnson Company, Arthrex, and Zimmer; and is on the editorial/governing board of the Journal of Knee Surgery and Orthobullets.com. K.E.V. receives IP royalties from Solana and is a paid consultant for Solana, Stock, and Wright Medical. J.D.H. is on the editorial board of Arthroscopy, the Journal of Arthroscopic and Related Surgery, and Frontiers in Surgery and receives publication royalties from SLACK.