July 03, 2018
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Platelet-rich plasma injection effective alternative for knee OA

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An intra-articular injection of platelet-rich plasma may be an effective alternative to hyaluronic acid in the treatment of knee osteoarthritis, particularly in patients with mild forms of the condition, according to findings published in Arthritis Research & Therapy.

“Although the relevant literature has moderate applicability and strength of evidence, the current guidelines of the American Association of Orthopedic Surgeons do not recommend or oppose the use of [platelet-rich plasma] in the treatment of knee OA,” Ren Yizhong, MD, of the Second Affiliated Hospital of Inner Mongolia Medical University, China, and colleagues wrote. “However, comparison studies conducted on the use of intra-articular injection of [platelet-rich plasma] compared with [hyaluronic acid] for mild or moderate knee OA showed a higher clinical outcome score with [platelet-rich plasma] than with the latter.”

To determine whether platelet-rich plasma is superior to hyaluronic acid in the treatment of knee OA, the researchers in 2016 conducted a systematic review of randomized clinical trials using the Cochrane Central Register of Controlled Trials, PubMed and Embase databases. Focusing on English-language, human in vivo studies that compared platelet-rich plasma treatments to hyaluronic acid, they used the following key words in their search: “Platelet-rich plasma,” “PRP,” “platelet-rich fibrin,” “PRF,” “platelet,” “plasma,” “arthritis,” “osteoarthritis,” “gonarthrosis” and “degeneration.” They also searched presentations and abstracts from the annual meeting of the American Academy of Orthopaedic Surgeons, EULAR, the American Academy of Physical Medicine and Rehabilitation, the American College of Rheumatology and the Osteoarthritis Research Society International.

An intra-articular injection of platelet-rich plasma may be an effective alternative to hyaluronic acid in the treatment of knee osteoarthritis, particularly in patients with mild forms of the condition, according to researchers.
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The researchers identified seven articles, representing 908 patients and 908 knees, that met their inclusion criteria. Outcome measures included efficacy and response to treatment for recovery as defined by the Western Ontario and McMaster Universities Osteoarthritis Index, the International Knee Documentation Committee, the Knee Injury and Osteoarthritis Outcome Score, the EuroQol visual analogue scale and the Tegner score.

According to the researchers, all studies demonstrated statistically significant improvements in clinical outcomes — including pain, physical function and stiffness — with platelet-rich plasma injection. In addition, with the exception of two studies, nearly all showed significant differences between the two treatments regarding clinical outcomes of pain and function.

“[Platelet-rich plasma] intra-articular injection of the knee may be an effective alternative treatment for knee OA, especially in patients with mild knee OA,” Yizhong and colleagues wrote. “However, some studies suggested that [platelet-rich plasma] is not more effective than [hyaluronic acid]. A large, multicenter, randomized trial study is needed to further assess the efficacy of [platelet-rich plasma] treatment for patients with knee OA.” – by Jason Laday

Disclosure: Yizhong reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.