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. 2024 Nov;32(11):2938-2949.
doi: 10.1002/ksa.12320. Epub 2024 Jul 4.

Platelet-rich plasma injections for the management of knee osteoarthritis: The ESSKA-ICRS consensus. Recommendations using the RAND/UCLA appropriateness method for different clinical scenarios

Elizaveta Kon  1   2 , Laura de Girolamo  3 , Lior Laver  4   5   6 , Luca Andriolo  7 , Isabel Andia  8 , Ricardo Bastos  9   10 , Philippe Beaufils  11 , Leela Biant  12   13 , Berte Bøe  14 , Angelo Boffa  7 , Ramon Cugat  15   16   17 , Alessandro Di Martino  7 , Christoph Erggelet  18 , Michael Iosifidis  19   20 , Baris Kocaoglu  21 , Jérémy Magalon  22   23   24 , Rodica Marinescu  25 , Stefan Nehrer  26   27 , Philipp Niemeyer  28 , Marko Ostojić  29 , Tomasz Piontek  30 , Mikel Sánchez  31   32 , Kristof Sas  33   34 , Georges Skarpas  35   36   37 , Thomas Tischer  38 , Lucienne Vonk  39   40 , Giuseppe Filardo  41   42   43
Affiliations

Platelet-rich plasma injections for the management of knee osteoarthritis: The ESSKA-ICRS consensus. Recommendations using the RAND/UCLA appropriateness method for different clinical scenarios

Elizaveta Kon et al. Knee Surg Sports Traumatol Arthrosc. 2024 Nov.

Abstract

Purpose: The aim of this consensus was to develop evidence- and expert-based patient-focused recommendations on the appropriateness of intra-articular platelet-rich plasma (PRP) injections in different clinical scenarios of patients with knee osteoarthritis (OA).

Methods: The RAND/UCLA Appropriateness Method was used by the European Society of Sports Traumatology, Knee Surgery, and Arthroscopy (ESSKA), as well as the International Cartilage Regeneration and Joint Preservation Society (ICRS) to reach a consensus and produce recommendations for specific patient categories combining best available scientific evidence with the collective judgement of a panel of experts.

Results: Scenarios were defined based on first treatment vs first injective treatment vs second injective treatment, age (<50/50-65/66-80/>80), tibiofemoral vs patellofemoral involvement, OA level (Kellgren-Lawrence/KL 0-I/II-III/IV), and joint effusion (dry knee, minor-mild or major effusion). Out of 216 scenarios, in 84 (38.9%) the indication was considered appropriate, in 9 (4.2%) inappropriate and in 123 (56.9%) uncertain. The parameters associated with the highest consensus were PRP use after failed injective treatments (62.5%), followed by PRP after failed conservative treatments and KL 0-III scenarios (58.3%), while the highest uncertainty was found for PRP use as first treatment and KL IV OA (91.7% and 87.5% of uncertain scenarios, respectively).

Conclusion: This ESSKA-ICRS consensus established recommendations on the appropriateness or inappropriateness of PRP injections for the treatment of knee OA, providing a useful reference for clinical practice. PRP injections are considered appropriate in patients aged ≤80 years with knee KL 0-III OA grade after failed conservative non-injective or injective treatments, while they are not considered appropriate as first treatment nor in KL IV OA grade.

Level of evidence: Level I.

Keywords: OA; consensus; knee; osteoarthritis; platelet‐rich plasma.

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References

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