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. 2024 Nov;52(13):3223-3231.
doi: 10.1177/03635465241283463. Epub 2024 Oct 14.

Influence of Platelet Concentration on the Clinical Outcome of Platelet-Rich Plasma Injections in Knee Osteoarthritis

Angelo Boffa  1 , Luca De Marziani  1 , Luca Andriolo  1 , Alessandro Di Martino  1 , Iacopo Romandini  1 , Stefano Zaffagnini  1 , Giuseppe Filardo  2   3
Affiliations

Influence of Platelet Concentration on the Clinical Outcome of Platelet-Rich Plasma Injections in Knee Osteoarthritis

Angelo Boffa et al. Am J Sports Med. 2024 Nov.

Abstract

Background: Platelet-rich plasma (PRP) is one of the most frequently used orthobiologic products for the injection treatment of patients affected by knee osteoarthritis (OA). Some preliminary evidence supports the influence of platelet concentration on patients' clinical outcomes.

Purpose: To analyze if platelet concentration can influence the safety and clinical efficacy of PRP injections for the treatment of patients with knee OA.

Study design: Cohort study; Level of evidence, 3.

Methods: This study consisted of 253 patients with knee OA (142 men, 111 women; mean ± SD age, 54.8 ± 11.4 years; Kellgren-Lawrence grades 1-3) who were treated with 3 intra-articular injections of 5 mL of autologous leukocyte-rich or leukocyte-poor PRP. All patients were prospectively evaluated at baseline and at 2, 6, and 12 months. Patients were clinically assessed thorough the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and the International Knee Documentation Committee (IKDC) Subjective score. Platelet concentration was correlated with clinical outcome. Further analysis was performed by stratifying patients into 3 groups (homogeneous for OA severity) based on platelet concentration (high, medium, and low). All complications and adverse events were reported, as well as failures.

Results: An overall statistically significant improvement in all clinical scores was documented from baseline to each follow-up evaluation. Platelet concentration positively correlated with clinical outcome. KOOS Pain improved more with higher platelet concentration at 2 months (P = .036; rho = 0.132), 6 months (P = .009; rho = 0.165), and 12 months (P = .014; rho = 0.155). The same trend was shown by the other KOOS subscales and by the IKDC Subjective score, as well as by the comparison of the groups of high-, medium-, and low-platelet PRP. The highest failure rate (15.0%) was found in the low-platelet group as compared with the medium-platelet group (3.3%) and the high-platelet group (3.3%). No differences were observed among the 3 groups in terms of adverse events.

Conclusion: This study demonstrated that platelet concentration influences the clinical outcome of PRP injections in knee OA treatment. PRP with a higher platelet concentration provides a lower failure rate and higher clinical improvement as compared with PRP with a lower platelet concentration, with overall better results up to 12 months of follow-up in patients with knee OA.

Keywords: PRP; concentration; knee; osteoarthritis; platelets.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: S.Z. reports nonfinancial support from personal fees from I+ SRL and grants from Fidia Farmaceutici SPA, Cartiheal Ltd, IGEA Clinical Biophysics, Biomet, and Kensey Nash, outside the submitted work. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Score improvement from baseline to 6 months of follow-up and correlation with PRP number of leukocytes (109/L; not significant) and platelets (109/L): (A) IKDC Subjective (P = .019; rho = 0.148) and (B) KOOS Pain (P = .009; rho = 0.165). IKDC, International Knee Documentation Committee; KOOS, Knee injury and Osteoarthritis Outcome Score; PRP, platelet-rich plasma.
See this image and copyright information in PMC

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