Intra-Articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Review of Their Current Molecular Mechanisms of Action and Their Degree of Efficacy

Abstract

Knee osteoarthritis (OA) is estimated to affect more than 10% of the population, with a lifetime risk of 45%. Contemporary guidelines advise control of body weight, therapeutic physical exercise, drug treatment (oral non-steroidal anti-inflammatory drugs, paracetamol, opioids), and mechanical aids (walking aids, braces, orthoses). Nevertheless, these treatments typically have only short-term benefits. Intra-articular corticosteroids are typically advised, but only for short-term pain alleviation, given that their benefits last only a few weeks. The efficacy of hyaluronic acid is controversial. When the aforesaid options fail, total knee arthroplasty is generally recommended as an efficacious treatment. However, it is costly and can involve medical and postoperative complications. Therefore, determining alternate safe and effective treatments for knee OA is paramount. Platelet-rich plasma (PRP) has lately been investigated for the treatment of knee OA. This article reviews recent knowledge concerning PRP’s molecular mechanisms of action. The effectiveness of intra-articular PRP injections in the knee joint remains controversial, although most recent publications show pain alleviation in the short term. Orthopedic surgeons treating people with knee OA are becoming increasingly interested in PRP, despite indecisive clinical data and basic science information. Further studies comparing PRP with placebo are required.

Investigation of the Ameliorating Effect of Copper Albumin Complex on Lysyl oxidase in monosodium iodoacetate -Induced Knee Osteoarthritis in Rats

“…However, the benefits of these treatments are frequently just temporary. Intra-articular corticosteroids are often advised, but only for temporary pain relief due to their short-lived advantages (Rodríguez-Merchán, 2022). Pain, stiff joints, functional impairment, and even incapacity are all symptoms of KOA, which places a significant strain on healthcare services (Abbasi, 2017).…”

Intra-articular Injections for Treating Knee Osteoarthritis: A Classification According to Their Mechanism of Action

“…21,58 Platelet-rich plasma includes a series of preparations such as pure PRP, leukocyte-and PRP, pure platelet-rich fibrin, and leukocyte-and platelet-rich fibrin. 59 The mechanisms of action of PRP are related to the release of growth factors and other molecules from the α granules of platelets, including platelet-derived growth factor, TGF-β, growth factor-like to insulin type I, vascular endothelial growth factor, and others, 21,58 favoring the inhibition of proinflammatory cytokines, the decrease of MMP-13, elevation in hyaluronan synthase 2 expression in synoviocytes, increase in cartilage activity, and the stimulation of cell proliferation and protein secretion from the superficial zone of articular cartilage. 21,58,59 It has been reported that PRP is more effective in reducing pain and improving function than placebo, HA, and CS, in the medium and long terms.…”

Platelet-rich plasma preserves cartilage thickness and delays total knee arthroplasty in osteoarthritis with an inflammatory phenotype: a 5-year follow-up retrospective study

“…This 'in ammation-damage cycle' represents the most typical OA pathomechanism and clinical features, providing opportunities to develop disease modifying approaches. In principle, PRP mainly acts by releasing growth factors and immuno regulatory cytokinesto activate tissue repair responses and alleviate in ammatory microenvironment [20]. Thus, PRP could suppress the above vicious cycle from both controlling damage and anti-in ammation respectively, and we can hypothesise that PRP might exhibit maximum therapeutic effect on the in ammatory phenotype.…”