Tibiofemoral chondromalacia treated with platelet-rich plasma and hyaluronic acid

Abstract

Background: The objective of the present study was to determine if platelet rich plasma (PRP) can increase tibiofemoral cartilage regeneration and improve knee function. Methods: Fourty consecutive and strictly selected patients affected by grade II or III chondromalacia underwent 1 yr of treatment (nine injections) with autologous PRP in a liquid form with 2.0 to 2.5-fold platelet concentration (20 cases) or with hyaluronic acid (HA) (20 patients). Outcome measures included the Lysholm, Tegner, International Knee Documentation Committee (IKDC), Western Ontario and McMaster (WOMAC) Osteoarthritis Index, and Short Form (SF)-36 scores. MRI arthroscopic and histologic assessment were used to evaluate cartilage thickness and degree of degeneration before and after treatment (1 yr after the primary arthroscopy). Results: The study demonstrated significant improvement in Lysholm, Tegner, IKDC, WOMAC, and SF-36 scores in both groups. Cartilage assessment revealed no significant macroscopic or microscopic structural regeneration as well as no cartilage height increase in either group. Higher content of chondrocytes and proteoglycans in cartilage was proven in both groups after treatment without a statistically significant difference between the groups. There were no adverse events observed. Conclusions: PRP and HA significantly reduced pain and improved quality of life in patients with a low degree of cartilage degeneration. MRI and arthroscopic assessment did not confirm any significant cartilage structural improvement. The content of chondrocytes and proteoglycans in cartilage was higher in the PRP group than in the HA group after the treatment but did not reach statistical significance.