Efficacy of Autologous Conditioned Serum (ACS), Platelet-Rich Plasma (PRP), Hyaluronic Acid (HA) and Steroid for Early Osteoarthritis Knee: A Comparative Analysis

Abstract

Background Intra-articular injection therapy constituting corticosteroids, viscosupplements and blood-derived products are considered to have a key role in non-operative management of osteoarthritis knee. While corticosteroids and viscosupplements have proven short-term efficacy in early osteoarthritis; orthobiologics are gaining increased attention in osteoarthritis management. The aim of present study was thus to compare two commonly used biologics (platelet-rich plasma/PRP and autologous conditioned serum/ACS) to each other and to established therapies. Methods After required institutional clearances, all patients presenting with early primary osteoarthritis knee who had failed initial conservative management and received only unilateral knee injection were included. Patients in the PRP group were compared to the other groups (comprising the HA/hyaluronic acid group, steroid group, and a matched cohort who had been administered ACS for the same indication earlier). Clinical outcome was evaluated using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire and Visual Analogue scale (VAS) pre-injection and at 6 months. Results ACS and PRP did not have any significant difference in terms of either WOMAC score (p = 0.154) or VAS score at 6 months (p = 0.850). The scores for both these orthobiologics were better than the control groups (HA group and Steroid group). Between the two control groups, HA group had better VAS scores as compared to the Steroid group (p = 0.008). ConclusionThe clinical outcomes following intra-articular injection of ACS and PRP are better than controls (HA and steroid), but a difference between the two orthobiologics could not be demonstrated. Level of Evidence 3b.

Autologous Conditioned Plasma and Hyaluronic Acid Injection for Isolated Grade 4 Osteochondral Lesions of the Knee in Young Active Adults

“…Notably, the double syringe system used in our study generated LP-PRP, which Noh et al [23] reported has higher transforming growth factor beta 1 (TGF-b1) and fibroblast growth factor 2 (FGF-2) concentrations than leukocyte-rich PRP produced with the GPS III Platelet Concentration System (Zimmer Biomet, Warsaw, IN, USA). Khurana et al compared the efficacy of PRP with ACP for early knee osteoarthritis at six months follow-ups and concluded that there was no difference between the two injections [24].…”

Single versus Three Doses of Intraarticular Platelet-Rich Plasma Injection in Treatment of Early Osteoarthritis Knee Joint—A Prospective Comparative Study

“…• Place of collection-operation theater • Amount of blood collected-40 mL of venous blood was collected (gave around 5-7 mL of PRP after double spin) • Site-from the antecubital vein or femoral vein under strict aseptic precautions with an effort to avoid irritation and trauma to the platelets with the syringe • Vials used-multiple vacutainers or test tubes containing ethylenediaminetetraacetic acid as an anticoagulant. • Processing-The tubes were centrifuged at 3,000 rpm for 10 minutes to separate erythrocytes (soft spin), and at 5,000 rpm for 10 minutes to concentrate platelets (hard spin)-double-spin techniquE 11,12 • Extraction of PRP was done with the help of another syringe and the final PRP was loaded for injection in a 10 mL syringe.…”

“…7 8 9 10 Compared with hyaluronic acid, corticosteroids, autologous conditioned serum, and placebo, PRP has been found to have improved outcomes in recent studies. 8 10 11 12 13…”

The use of intra‐articular platelet rich plasma for the symptomatic management of osteoarthritis of the knee: a pilot study

“…7 As PRP is, on balance, an antiinflammatory cytokine mixture, there is evidence to suggest that intra-articular PRP is superior to both corticosteroids and hyaluronic acid and is most notably more effective in the longterm. 3,5,[8][9][10][11][12][13][14][15][16][17] However, further investigation into optimizing intraarticular PRP for the symptomatic management of non-operative knee osteoarthritis is warranted.…”

“…Intra‐articular injections of platelet rich plasma (PRP), an autologous blood product obtained via venesection, has been shown to be effective in the symptomatic management of knee osteoarthritis and may slow disease progression 7 . As PRP is, on balance, an anti‐inflammatory cytokine mixture, there is evidence to suggest that intra‐articular PRP is superior to both corticosteroids and hyaluronic acid and is most notably more effective in the long‐term 3,5,8–17 . However, further investigation into optimizing intra‐articular PRP for the symptomatic management of non‐operative knee osteoarthritis is warranted.…”