The use of PRP injections in the management of knee osteoarthritis

Abstract

Osteoarthritis (OA) is a degenerative disease involving joint damage, an inadequate healing response and progressive deterioration of the joint architecture that commonly affects the knee and/or hip joints. It is a major world public health problem and is predicted to increase rapidly with an ageing population and escalating rate of obesity. Autologous blood-derived products possess much promise in the repair and regeneration of tissue and have important roles in inflammation, angiogenesis, cell migration and metabolism in pathological conditions, including OA. Utilising platelet-rich plasma (PRP) to treat tendon, ligament and skeletal muscle has shown variable results across many studies with the current evidence base for the efficacy of PRP in treating sports injuries remaining inconclusive. More uniformly positive results have been observed by various studies for PRP in OA knee in comparison to hyaluronic acid, other intra-articular injections and placebo than in other musculoskeletal tissue. However, methodological concerns as well as satisfactory PRP product classification prevent the true characterisation of this treatment. Thus, further research is required to investigate how leukocyte inclusion, activation and platelet concentration affect therapeutic efficacy. Furthermore, the optimisation of timing, dosage, volume, frequency and rehabilitation strategies need to be ascertained. For knee OA management, these concerns must be addressed before this promising treatment can be widely implemented.

The efficacy of different sources of mesenchymal stem cells for the treatment of knee osteoarthritis

“…Adipose tissue provides a rich source of MSCs in comparison to bone marrow, and as such is frequently used in a variety of Fig. 1 A comparison of a healthy knee (left) and a demonstrating OA pathology (right); reproduced from (O'Connell et al 2019) clinical and regenerative medicine research studies. The cellular components can be extracted as a cell pellet through washing and centrifugation steps which may also be referred to in literature as a stromal vascular fraction (SVF).…”

“…Although results are improved compared with baseline measurements, the outcomes still eventually plateau or start to decline within 2 years following intervention. Thus, combined treatment strategies combining other injectable agents, such as platelet-rich plasma (PRP) (O'Connell et al 2019), should be investigated to determine their effect on enhancing engraftment efficiency (Atashi et al 2015). Furthermore, there is a requirement for improved management of OA following treatments; this could include postintervention rehabilitation to optimise the therapeutic effect and guarantee a long-lasting efficacy (Fahy et al 2017).…”

Intraarticular injection of bone marrow-derived mesenchymal stem cells enhances regeneration in knee osteoarthritis

“…Fibroblastic-like (spindle-shaped) morphology Plastic-adherent property under standard culture conditions Differentiation potential into osteoblasts, adipocytes, and chondroblasts in vitro Expression of surface markers including CD105; CD73 and; CD90 Lack of expression of: CD45; CD34; CD14; or CD11b; CD79α or CD19 and; HLA-DR Table 3 Overview of successful and fundamental pre-clinical studies that outline the safety and efficacy of BM-MSCs intra-articular injections (organised by animal model) [20] to evaluate success, which may introduce unintended bias [38,42], due to physicians influencing patient responses. This may be improved by digital administration of questionnaires therefore, it will be completed individually with no external input [48].…”

“…Surgical interventions may be beneficial when mechanical deformity is present; however, therapeutic benefit is limited to late-stage OA and is not considered as a long-term solution. Alternatively, cellular regenerative therapies, including mesenchymal stem cells (MSCs) [19] and cell-derived products (such as platelet-rich plasma [20]) have shown therapeutic promise. Since OA is degenerative, likely involving endogenous MSC depletion, investigation into this therapy is supported by BM-MSCs inherent characteristics ( Fig.…”

Arthroseprävention und mögliche zukünftige Ansätze der Arthrosetherapie – Sicht der Orthopädie und Unfallchirurgie

“…Mögliche Optionen für die biologische Augmentation der Gelenkknorpelrekonstruktion sind u. A. die additive Applikation (Injektion) von Wachstumsfaktoren, Plättchenkonzentraten sowie Zellkonzentraten oder ex vivo expandierten mesenchymalen Stammzellen (MSZ) [6,23].…”