The efficacy of the leg swing and quadriceps strengthening exercises versus platelet-rich plasma and hyaluronic acid combination therapy for knee osteoarthritis: A retrospective comparative study

Abstract

The aim of this was to investigate the efficacy of physical exercise (leg swing and quadriceps strengthening exercises) versus platelet-rich plasma (PRP) and hyaluronic acid (HA) combination therapy. From January 2020 to August 2021, 106 patients with Kellgren–Lawrence Grade I–III knee osteoarthritis were divided into leg swing and quadriceps strengthening exercises (Group A) and intra-articular combination injections of PRP and HA (Group B) according to the treatment strategies. Patients in Group A received regular leg swing and quadriceps strengthening exercises for 3 months. Patients in Group B received 2 intra-articular combination injections of PRP (2 mL) and HA (2 mL) every 2 weeks. The primary outcome measures were the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities (WOMAC) score. Secondary outcomes included single leg stance test and functional activity by 2-minute walk test and time up and go test. All outcomes were evaluated at baseline and again 1, 3, 6, and 12 months. The VAS and WOMAC scores were similar in both groups at 1 and 3 months after treatment (P > .05); however, Group A patients had significantly superior VAS and WOMAC scores than Group B patients at 6 and 12 months after treatment. For the single leg stance test, 2-minute walk test, and time up and go test, Group A patients were significantly superior to Group B throughout follow-up (P < .001). The leg swing and quadriceps strengthening exercises resulted in a significantly better clinical outcomes than the combined PRP and HA therapy, with a sustained lower pain score and improved quality of life, balance ability, and functional activity within 12 months.

Clinical and Biochemical Implications of Hyaluronic Acid in Musculoskeletal Rehabilitation: A Comprehensive Review

“…It was demonstrated that both groups showed improvements in pain, quality of life, balance ability, and functional activity [79]. However, the leg swing and quadriceps strengthening exercise group exhibited more significant improvements compared with the intra-articular PRP combined with HA injection group, and these benefits were sustained even after 6 months [79].…”

“…A very recent study conducted by Ma et al ( 2023) compared the effectiveness of two treatment approaches for KOA, one involving leg swinging and quadriceps strengthening exercises and the other involving a combination therapy of platelet-rich plasma (PRP) and HA. This trial included 106 patients with KOA graded as I-III according to the KL scale, who were divided into two groups [79].…”

“…Patients were instructed to initially lift their leg to approximately 45 • from the vertical line and then gradually increase the range to around 60 • . Patients were encouraged to perform approximately 500 leg swings daily [79].…”

“…Patients were advised to repeat this exercise approximately 200 times per day. These two physical exercises were to be alternated during the patient's spare time, with enrolled patients instructed to perform them daily at home for a period of 3 months [79].…”

“…The second group of patients received intra-articular injections of 2 mL each of PRP and HA (Eufflexa, Ferring Pharmaceuticals, Saint-Prex, Suisse), with the HA having a high MW ranging from 2.4 to 3.6 million Da. These injections were administered every 2 weeks [79].…”