Treatment Of Knee Osteoarthritic Pain with Platelet-Rich Plasma: A Systematic Review of Clinical Studies

Abstract

Introduction: Knee osteoarthritis is a degenerative joint disease that is secondary to degradation of articular cartilage, reformation of subchondral bone through degradation and proliferation as well as presence of synovitis. Materials & methods: This systematic review was conducted and reported as per Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Results: A total of 30 of the 48 comparators showed statistically significant superiority with platelet-rich plasma (PRP) compared with a control, while the other 16 comparators showed no significant difference between PRP and the comparator. Conclusion: We can only recommend PRP for patients with early-stage osteoarthritis (I or II) and who are aged below 65, based on our findings. Based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) recommendations, while studies reviewed were randomized controlled studies, and therefore, high grade, due to variance in imprecision, risk of bias and inconsistency among the 37 studies, it would be reasonable to rate this paper as subjectively moderate.

Two or four injections of platelet-rich plasma for osteoarthritic knee did not change synovial biomarkers but similarly improved clinical outcomes

“…In the present study, similarly improved VAS, WOMAC index, and SF-12 after PRP treatment agreed with several previous studies which reported significant pain relief and improved WOMAC index at one year of FU 9 – 11 , 18 , 35 , 36 . A recent meta-analysis including 34 randomized controlled trials in 1403 knees concluded that PRP provided better WOMAC than placebo and HA injection and better VAS than corticosteroid injection 37 .…”

“…Studies regarding PRP applied in knee OA showed that it improved patient's clinical outcomes by releasing several growth factors and cytokines, promoting reparation and minimization of the inflammation occurring in the process of degenerative arthritis 7 , 8 , 12 – 17 . Some studies reported that PRP injection for knee OA provided better pain relief and improved functional outcomes than placebo control, hyaluronic acid (HA), or steroid injection 18 – 20 . However, major guidelines do not include or recommend against the use of PRP for the treatment of knee OA 3 , 5 .…”

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

“…There were no significant differences between triple PRP injection and single PRP injection in the short-term curative effect [44]. In a systematic review reported by Aiyer, they only recommended PRP for patients with early-stage OA (1 or 2) and who were aged younger than 65 years [45].…”

“…In patients with knee OA, LR-PRP demonstrated effectiveness in meaningful end points for functional and patient-reported outcomes at early time points [51]. Table 2 summarizes the efficacy of intra-articular PRP injections in knee OA [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51].…”

Two or four injections of leukocyte-poor platelet-rich plasma for osteoarthritic knee did not affect changes of synovial cytokines and growth factors but similarly improved clinical outcomes

“…Studies regarding PRP applied in knee OA showed that it improved patient's clinical outcomes by releasing several growth factors and cytokines, promoting reparation and minimization of the in ammation occurring in the process of degenerative arthritis [10][11][12][13][14][15][16][17] . In addition, some studies reported that PRP injection for knee OA provided better pain relief and improved functional outcomes than placebo control, hyaluronic acid, or steroid injection [18][19][20] .…”