Platelet-rich plasma treatment in symptomatic patients with knee osteoarthritis: preliminary results in a group of active patients

Abstract

Background: With increasing frequency, platelet-rich plasma (PRP) preparations have been used to treat cartilage lesions to regenerate tissue homeostasis and retard the progression of knee osteoarthritis (OA).

Purpose: To determine the effectiveness of intra-articular PRP injections in active patients with knee OA and to evaluate clinical outcomes in patients with and without previous surgical treatment for cartilage lesions.

Study design: Case series.

Materials and methods: Fifty patients with knee OA were followed for a minimum of 12 months. All were treated with 2 intra-articular injections of autologous PRP. Twenty-five patients had undergone a previous operative intervention for cartilage lesions, whereas 25 had not. Operated patients had undergone either cartilage shaving or microfracture. Multiple evaluative scores were collected at pretreatment and at 6 and 12 months posttreatment. The required sample of patients was determined beforehand by using statistical power analysis; International Knee Documentation Committee (subjective) score was defined as the primary parameter. A P value of less than 0.05 was considered statistically significant. General linear model-repeated measure test evaluated within-time improvement for each variable for all patients. Post hoc test with Bonferroni adjustment for multiple comparisons was performed to investigate the significance in improvement within time evaluations for each variable for the total sample. The differences in improvement between operated and nonoperated patients were also investigated, as were those between sexes.

Results: All patients showed significant improvement in all scores at 6 and 12 months (P < 0.01) and returned to previous activities. No significant difference in improvement was found between the evaluated subgroups (P < 0.01).

Conclusions: The PRP treatment showed positive effects in patients with knee OA. Operated and nonoperated patients showed significant improvement by means of diminishing pain and improved symptoms and quality of life.

Clinical relevance: There are only a few studies of PRP treatment for cartilage on osteoarthritic knees. Different PRP products might be more or less appropriate to treat different types of tissues and pathologies. The clinical efficacy of PRP remains under debate, and a standardized protocol has not yet been established.

Keywords: cartilage; cartilage shaving; knee; microfracture; osteoarthritis; platelet-rich plasma.

Figure 1.

Platelet-rich plasma preparation: (A) blood aspiration, (B) centrifugation of the blood sample for 9 minutes, (C) fraction of platelet-rich plasma after centrifugation (yellow upper part in tube), and (D) knee intra-articular infiltration.

Figure 2.

Diagram showing Knee injury and Osteoarthritis Outcome Score improvement from preinjection evaluation to 6- and 12-month follow-up in all patients (P < 0.01).

Figure 3.

Diagrams showing Knee injury and Osteoarthritis Outcome Score improvement from preinjection evaluation to 6- and 12-month follow-up in patients (P < 0.01) (A) with previous operation, (B) without previous operation and in patients who had undergone (C) cartilage shaving and (D) microfracture.

Figure 4.

Graphs showing International Knee Documentation Committee objective score significant improvement (P < .01) from (A) preinjection to (B) 12-month follow-up for patients who had undergone either previous cartilage shaving (Sla) or microfracture (Slb).