Effectiveness of intraosseous infiltration of autologous platelet-rich plasma in the area of the bone marrow edema in osteoarthritis of the knee joint

A.V Lychagin,D.S Bobrov,O.I Islaieh,A.V Garkavi,P.I Katunyan,R.H Yavlieva,E.Yu Tselisheva

doi:10.24075/brsmu.2019.053

A.V Lychagin, D.S Bobrov + Show 5 more

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https://doi.org/10.24075/brsmu.2019.053

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Abstract

Osteoarthritis (OA) affects both elderly people, for whom it is one of the main causes of disability, and people of active working age and is an urgent clinical and social problem of resistance of pain syndrome to therapy. The disease is characterized by both destruction of intra-articular and paraarticular structures, such as subchondral bone. While OA is an important sign of pathological changes believe the bone marrow edema (BME). This work examines the effect of BME on development osteoarthritis, and therapeutic approaches to the management of patients with OA. The aim of the study was to develop a method of treatment of BME in OA of the knee joint by locally intraosseous injection of autologous thrombotic-rich plasma (PRP) into the edema zone. In this study 17 patients with the diagnosis: Osteoarthritis II-IV Grade. according to the classification of Kellgren–Lawrence, in which areas of local inflammation in the form of BME were detected on MRI in the subchondral zone in accordance with the international classification of WORMS (Whole Organ Magnetic Resonance Imaging Score). The mean age of patients was 41,7 ± 14,3 years, 10 of them were women and 7 men. Patients were treated with autological platelet-rich plasma under x-ray control injected from extra-articular intraosseous access in the area of BME. Evaluation of effectiveness of treatment performed by VAS, WOMAC and KOOS scales, before the introduction of autoplasma, after 1 and 3 months after the start of treatment. Three months after the manipulation, there was a statistically significant decrease in the intensity of inflammatory syndrome: for WOMAC by 17.5%, for KOOS by 19.4% and for VAS by 33,1% (p < 0,01). Thus, the efficiency of intraosseous Infiltration of autologous platelet-rich plasma in the treatment of patients with OA, accompanied by edema of the bone marrow in the subchondral zone, was proved.

Highlights

Author contribution: Lychagin AV and Islaieh OI — research planning, literature collection and analysis, data interpretation, draft preparation; Garkavi AV — research planning, data interpretation; Katunyan PI — research planning, draft preparation; Bobrov DS, Yavlieva RH and Tselisheva EYu — research planning
This study aimed to develop a platelet-rich plasma (PRP) therapy against OAassociated bone marrow edema (BME) that implies local intraosseous injections into the edema zone
According to MRI, 2 patients had minimal BME, in 7 patients the edema was moderate and in 8 it was qualified as severe (Fig. 4)

Summary

Introduction

Author contribution: Lychagin AV and Islaieh OI — research planning, literature collection and analysis, data interpretation, draft preparation; Garkavi AV — research planning, data interpretation; Katunyan PI — research planning, draft preparation; Bobrov DS, Yavlieva RH and Tselisheva EYu — research planning. ЭФФЕКТИВНОСТЬ ВНУТРИКОСТНОГО ВВЕДЕНИЯ АУТОЛОГИЧНОЙ ОБОГАЩЕННОЙ ТРОМБОЦИТАМИ ПЛАЗМЫ В ЗОНУ ОТЕКА КОСТНОГО МОЗГА ПРИ ОСТЕОАРТРОЗЕ КОЛЕННОГО СУСТАВА. Целью исследования была разработка методики лечения ОКМ при ОА коленного сустава путем локального внутрикостного введения в зону отека аутологичной обогащенной тромбоцитами плазмы (PRP). Оценку эффективности лечения проводили по шкалам ВАШ, WOMAC и KOOS до введения аутоплазмы, через 1 и 3 месяца после начала лечения. Через 3 месяца после манипуляции отмечалось статистически значимое снижение показателей интенсивности воспалительного синдрома: по WOMAC на 17,5%, KOOS на 19,4% и по ВАШ на 33,1% (p < 0,01). Доказана эффективность внутрикостного введения аутологичной обогащенной тромбоцитами плазмы в лечении пациентов с ОА, сопровождающимся ОКМ в субхондральной зоне. И. Ислейих — планирование исследования, подбор литературы, интерпретация данных, подготовка черновика рукописи; А. И. Катунян — планирование исследования, подготовка черновика рукописи; Д. Peculiar to the disease are chronic pain, destruction and loss of articular cartilage, remodeling of subchondral bone, formation of osteophytes, inflammation of the synovial membrane of varying degree, involvement of both intraarticular and paraarticular structures in the pathological process [5]

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