Efficiency of platelet-rich plasma therapy in knee osteoarthritis does not depend on level of cartilage damage

Abstract

Objectives Osteoarthritis of the knee is common and often leads to significant physical disability. While classic conservative therapeutic approaches aim for symptoms like pain and inflammation, procedures like the intraarticular application of hyaluronic acids (HA) or platelet-rich plasma (PRP) are thought to stimulate the endogenous HA production, stop catabolism of cartilage tissue, and promote tissue regeneration. To analyse whether the positive effects of PRP injections are associated with the level of cartilage damage, patient satisfaction with the treatment was correlated with the level of knee joint osteoarthritis quantified by MRI. Methods PRP was performed with a low-leukocyte autologous conditioned plasma (ACP) system in 59 patients. A pre-treatment MRI was performed and a Whole-Organ MRI Score (WORMS) was used to score the level of knee osteoarthritis by 14 features: integrity of the cartilage, affection of the bone marrow, subcortical cysts, bone attrition, osteophytes, integrity of the menisci and ligaments, presence of synovitis, loose bodies, and periarticular cysts. A multivariate analysis with ordinary least squares regressions was used. Results Although pain symptoms and severity of clinical osteoarthritis symptoms decreased, regression analysis could not detect a correlation between the degree of cartilage damage measured by the WORMS score and a positive response to PRP therapy. Conclusion This study suggests that intraarticular injection of PRP might improve osteoarthritis symptoms and reduces the pain in patients suffering from osteoarthritis of the knee joint independent from the level of cartilage damages quantified by the whole-organ MRI scoring method WORMS.

Assessments of Therapeutic Effects of Platelet-rich Plasma in Knee Osteoarthritis: Possible Role of Inflammatory Cytokines

“…Unfortunately, the included treated patients didn't show any signi cant improvements in the patellafemoral cartilage volume or meniscal disintegrity. In accordance, Burchard et al [32] suggested that intraarticular injection of PRP may improve symptoms of osteoarthritis and decrease pain in patients with knee joint osteoarthritis, independent of the level of cartilage damage quanti ed by the whole organ MRI scoring method. Furthermore, a study by Laudy et al [33] demonstrated that in patients with knee osteoarthritis, PRP injections resulted in decreased pain, improved function and global assessment, and changes in joint imaging.…”

Intra-articular injection with Autologous Conditioned Plasma does not lead to a clinically relevant improvement of knee osteoarthritis: a prospective case series of 140 patients with 1-year follow-up

“…This prospective case series aims to assess the effectiveness of ACP in clinical practice and to investigate the effect of sex, age, BMI, radiographic OA grade (Kellgren and Lawrence), history of knee trauma, and baseline Knee Injury and Osteoarthritis Outcome Score (KOOS) on clinical outcome. Since there is no consensus on whether PRP is more effective in mild or advanced OA (Lana et al 2016, Jubert et al 2017, Burchard et al 2019, we included patients with symptomatic OA of all grades. We hypothesize that treatment with ACP leads to clinically relevant improvement in KOOS 5 and that clinical outcome can be predicted with any of the investigated patient factors.…”

Intra-articular platelet-rich plasma vs corticosteroids in the treatment of moderate knee osteoarthritis: a single-center prospective randomized controlled study with a 1-year follow up

“…We hypothesized that the improvement of both parameters (pain and function) were mainly due to control of the inflammation of the knee rather than the trophic effect of PRP on cartilage. This rationale is due to the fact that it has not yet been demonstrated that the improvement of knee function after PRP treatment correlates with a volume increase of the articular cartilage [ 38 – 40 ], even when has been demonstrated that in vitro, TGF-β1/3 can induce chondrogenesis of mesenchymal stem cells [ 41 ]. However, there is evidence that suggests that PRP has other effects on the joints other than the anti-inflammatory and this may probably explain why the group that received PRP had better results than the CS group.…”