Intra-articular Platelet-rich Plasma Research Articles

Intra-articular corticosteroid injections versus platelet-rich plasma as a treatment for cervical facetogenic pain: a randomized clinical trial

ObjectiveThe study’s primary objective was to compare the effectiveness of intra-articular platelet-rich plasma injections versus corticosteroid injections for the treatment of cervical facetogenic pain. Secondary aims were to compare self-rated...

Platelet-Rich Plasma Injections Do Not Improve the Recovery After Arthroscopic Partial Meniscectomy: A Double-Blind Randomized Controlled Trial

Background: Arthroscopic meniscectomy is one of the most performed surgical procedures in orthopaedics. Different approaches have been proposed to improve patient recovery but with unsatisfactory results. Platelet-rich plasma (PRP) augmentation has been proposed as a strategy to improve the recovery after meniscectomy. Purpose: To investigate the clinical benefits of an intra-articular PRP injection after meniscectomy, in terms of faster and better patient recovery. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Ninety patients were randomized into a treatment group, with arthroscopic partial meniscectomy immediately followed by a 5-mL injection of autologous conditioned plasma, and a control group with partial meniscectomy alone. Patients were evaluated at baseline and at 15, 30, 60, and 180 days of follow-up with the visual analog scale (VAS) score for pain (primary outcome), as well as with International Knee Documentation Committee subjective score, Knee injury and Osteoarthritis Outcome Score subscales, Tegner score, and EuroQol-Visual Analog Scale score. Objective evaluation was performed analyzing knee range of motion and circumference and the International Knee Documentation Committee objective score. Complications, patient judgment, and satisfaction were documented as well. Results: No major complications and an overall significant improvement in the clinical scores were observed in both groups. Overall, the comparative analysis did not demonstrate significant between-group differences in absolute values or improvements of both subjective and objective scores, as well as activity level. The improvement in terms of VAS pain score for the treatment group was significant already at 15 days (from 4.3 ± 2.5 to 2.5 ± 2.5; P = .014), while in the control group it became significant at 30 days (from 3.7 ± 2.3 to 2.0 ± 2.4; P = .004). No significant differences were observed between the 2 groups in terms of judgment of treatment results and satisfaction. Conclusion: A single postoperative injection of PRP was not able to significantly improve patient recovery after arthroscopic partial meniscectomy. PRP augmentation did not provide overall benefits at a short-term follow-up (6 months) in terms of pain relief, function, objective parameters, and return-to-sport activities. Registration: NCT02872753 (ClinicalTrials.gov identifier).

Leukocytes Do Not Influence the Safety and Efficacy of Platelet-Rich Plasma Injections for the Treatment of Knee Osteoarthritis: A Double-Blind Randomized Controlled Trial

Background: Platelet-rich plasma (PRP) is increasingly used for the injection treatment of knee osteoarthritis (OA). However, the role of leukocytes contained in PRP is controversial, with some preclinical studies suggesting detrimental effects and others emphasizing their contribution in secreting bioactive molecules. Purpose: To compare the safety and effectiveness of leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP) for the treatment of knee OA. Hypothesis: That leukocytes could influence results both in terms of adverse events and clinical outcomes. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This double-blind randomized controlled trial included 132 patients with Kellgren-Lawrence grade 1-3 knee OA who were randomized to a 3-injection cycle of either LR-PRP or LP-PRP. Patients were prospectively assessed at baseline and at 2, 6, and 12 months with subjective evaluations comprising the International Knee Documentation Committee (IKDC) subjective score, the KOOS (Knee injury and Osteoarthritis Outcome Score), the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), the visual analog scale for pain, the EuroQol–visual analog scale, the EuroQol–5 dimensions, and the Tegner activity scale. Objective evaluations consisted of the IKDC objective score, active/passive range of motion, and circumference of the index and contralateral knees. Patient judgment of the treatment was recorded as well as adverse reactions and failures. Results: An overall improvement in subjective and objective outcomes was documented, with no differences between the 2 groups, except for the improvement in the IKDC subjective score at 2 months, which was greater for the LR-PRP group compared with the LP-PRP group (14.8 ± 14.8 vs 8.6 ± 13.3, respectively; P = .046), as well as for active (P = .021) and passive (P = .040) ROM of the index knee at 6 months, showing statistically significant higher values in the LP-PRP group; and for quadriceps circumference of the index (P = .042) and contralateral (P = .045) knees at 12 months, which were significantly greater in the LR-PRP group. The IKDC subjective score improved from 42.5 ± 17.6 at baseline to 55.6 ± 21.4 at 12 months for the LR-PRP group (P < .0005) and from 45.7 ± 16.4 to 55.3 ± 20.4 for the LP-PRP group (P = .001). No differences in terms of patient treatment judgment were observed at all follow-up time points. No severe adverse events related to the treatment were reported, but some mild adverse events related to the treatment were observed: 16 in the LR-PRP group and 17 in the LP-PRP group. Treatment failed in 5 patients in the LR-PRP group and 2 in the LP-PRP group. Conclusion: This double-blind randomized controlled trial demonstrated that leukocytes did not affect the safety and efficacy of intra-articular PRP injections for the treatment of patients with knee OA. Both LR-PRP and LP-PRP demonstrated comparable clinical outcomes at all follow-up time points, without showing differences in subjective and objective outcomes or in adverse events and treatment failures. Registration: NCT04187183 (ClinicalTrials.gov).

Efficacy of Platelet-Rich Plasma Intra-articular Injections in Hip and Knee Osteoarthritis.

Osteoarthritis (OA) is a chronic degenerative disorder that causes significant pain and functional limitations. Platelet-rich plasma (PRP) therapy has gained considerable attention in recent years in the treatment of musculoskeletal injuries. In this narrative review, we aim to investigate the role of intra-articular PRP injections in the treatment of knee and hip OA. The review also discusses different classifications of PRP based on composition. Furthermore, this narrative review also identified various limitations of PRP therapy in OA. PRP is classified into different types based on cell content and fibrin architecture, including pure platelet-rich plasma (P-PRP), leukocyte- and platelet-rich plasma (L-PRP),pure platelet-rich fibrin (P-PRF), and leukocyte- andplatelet-rich fibrin (L-PRF).Various clinical trials have shown that PRP is an effective option for the treatment of knee and hip OA. However, the superiority of PRP over hyaluronic acid has been reported inconsistently. This variability can be attributed to PRP preparation techniques. The safety profiles of PRP are generally favorable and the adverse effects are generally mild in nature. Although there is sufficient evidence in support of PRP in the treatment of OA, the long-term effects of PRP have not been reported. Further studies should focus on longer follow-up periods to identify the efficacy and safety of PRP in treating knee OA. There is also a need for standardization of PRP preparations in OA management.

Efficacy of Intra-articular Platelet-rich Plasma versus Hydrocortisone with Local Anaesthetic Injection in Temporomandibular Joint Disorders - A Prospective Study

Abstract Introduction: Temporomandibular joint (TMJ) is subjected to many disorders commonly termed temporomandibular disorders (TMDs) which include TMJ hypermobility, ankylosis and internal derangement. In the past, many non-invasive conservative treatment modalities were tried out for their treatment which include joint unloading, the use of anti-inflammatory agents and physiotherapy. In recent times, injections of corticosteroids and platelet-rich plasma (PRP) into the TMJ have been proposed as alternative therapeutic methods. The main objective of the prospective study was to compare the efficacy of intra-articular injection of PRP and hydrocortisone with local anaesthetic agents in reducing the symptoms in patients with TMDs. Materials and Methods: This prospective study included 30 patients with TMDs, out of which 15 patients (Group I) received PRP injections and 15 patients (Group II) received hydrocortisone with local anaesthetics for arthrocentesis in their affected joints. The patients were assessed for pain, maximum interincisal mouth opening, TMJ sound and disc displacement. Results: The pain was markedly reduced in patients who received PRP injections (Group I) as compared to those who received hydrocortisone injection (Group II). An increase in mouth opening was similar in both the groups, and TMJ sounds were reduced in patients who received PRP. Magnetic resonance imaging also showed that PRP-treated patients showed better articular disc repair than patients treated with hydrocortisone. Discussion: PRP increases chondrocyte proliferation and production of matrix molecules and helps maintain the integrity of the chondral surface, thereby facilitating joint movement, whereas corticosteroids are more potent anti-inflammatory agents and they act by inhibiting prostaglandin synthesis which is the mediator of inflammation. Thus, the use of PRP has been proven to show better results in reducing the symptoms of TMDs and also helped in articular disc repair.

La lesión del hueso subcondral no influye en los resultados clínicos a 12 semanas en los pacientes tratados con plasma rico en plaquetas intraarticular por artrosis de rodilla: estudio retrospectivo

ObjectiveTo determine if subchondral bone damage can influence the clinical results of intraarticular platelet-rich-plasma (PRP) treatment in knee osteoarthritic patients. Material and methodsA retrospective review of patients treated with intraarticular PRP injections for knee osteoarthritis who previously underwent a Magnetic Resonance (MR) of the knee was performed. Visual Analogic Score (VAS) was assesed for pain, whereas WORMS MR score was adapted to assess the damage to the subchondral bone (WORMSsc score). ResultsSixty-one patients were treated with 3 weekly injections of PRP. Mean VAS reduction was 27.67±13.13 points (P<.005). WORMS sc mean score was 32±18.5 points. NO correlation between WORMSsc and VAS was found. A moderate correlation between WORMSsc score and Preoperative VAS was found (r=.43; P<.005). ConclusionThere is no correlation between the damage to the subchondral bone assesed by MR and pain relief at 12 weeks in patients treated with intraarticular platelet-rich plasma in patients with knee osteoarthritis. A greater damage to the subchondral bone could be associated with more pain.

Effectiveness of Intra-articular Botulinum Toxin Type A with Hyaluronic Acid Compared to Intra-articular Platelet-rich Plasma with Hyaluronic Acid in Improving Pain and Functional Limitation in Knee Osteoarthritis

Abstract Background: Knee osteoarthritis (KOA) is the most common cause of chronic knee pain causing functional disability and dependency. Multiple interventions have been used in reducing pain and improving functionality. We intend to compare the efficacy of intra-articular platelet-rich plasma (PRP) and hyaluronic acid (HA) with botulinum toxin type A and HA in bilateral Grade 3 and 4 KOA. Methods: Prospective single-blinded randomized controlled trial conducted for 6 months. Among 54 participants, 27 received intra-articular botulinum toxin type A with HA (Group A), and the other 27 received intra-articular PRP with HA (Group B), single session. Pain (Numerical Rating Scale [NRS]) and functional limitation (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) were assessed at 2, 4, 12, and 24 weeks postintervention. Effect of weight and physiotherapy on NRS and WOMAC score were assessed. P &lt;0.05 was considered statistically significant. Data were analyzed by statistical software R version 4.2.3. Results: Fifty-four participants were enrolled. There was no loss to follow-ups. Except for age (P &lt; 0.001) and mean height (P = 0.013), other demographic data were insignificant. Preprocedural NRS was significantly high in Group A (P = 0.04). Overall NRS postprocedure was significantly lesser in Group B, P &lt; 0.001. The mean WOMAC score postprocedure was significantly low in Group B, P &lt; 0.001. Group B had increased heart rate which was statistically significant (P = 0.051). The mean reduction in WOMAC score was observed with regular physiotherapy in Group B (P = 0.023). Reduction in weight was directly proportional to reduction in NRS (P = 0.015). Conclusion: Intra-articular PRP with HA, single session, is effective in improving pain, functionality, and safe in Grade 3 and 4 KOA.

Treatment of Chronic Haemophilic Synovitis with PRP: Clinical and In Vitro Studies.

Intra-articular blood, iron and hemosiderin, hydroxyl radical cytokines, and neo-angiogenesis cause synovial inflammation, which leads to cartilage and joint damage. Platelet-rich plasma (PRP) inhibits most of the mediators that produce and maintain synovitis. We compile here our work showing the clinical effectiveness of intra-articular PRP injections and their potential role in stopping articular cartilage damage due to bleeding and its possible repair. A total of 116 joints, including knees (63%), elbows (19.8%), and ankles (17.2%), were treated with intra-articular injections of PRP. Moreover, we also show here the number of extracellular DNA traps (ETs) and the PRP effect in the synovial fluid of patients at the time of treatment and six months after. Clinically, it is demonstrated that PRP is effective in reducing bleeding episodes (p < 0.001) and pain (p < 0.0001) and improving the hemophilia joint health score (HJHS) (p < 0.001) at one year of follow-up. Furthermore, our results demonstrate that PRP inhibits ET formation in vitro and reconstitutes the immune system's cellular components in the synovial fluid of patients after treatment. We conclude that PRP can be considered an effective, safe, and easy treatment for hemophilic synovitis.

The Effectiveness of Leukocyte-Poor Platelet-Rich Plasma Injections for Symptomatic Mild to Moderate Osteoarthritis of the Knee With Joint Effusion or Bone Marrow Lesions in a Japanese Population: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Background: Intra-articular platelet-rich plasma (PRP) injections have been proposed for the treatment of knee osteoarthritis (OA); however, their effectiveness in Japanese patients remains unclear. Purpose: To investigate whether 3 intra-articular injections of leukocyte-poor PRP (LP-PRP) improve symptoms and joint function in symptomatic Japanese patients with mild to moderate knee OA. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Of 72 patients screened, 30 were included and randomized to receive LP-PRP (n = 15) or saline (placebo; n = 15) injections between March 2019 and February 2023. Patients attended a screening visit and 3 treatment visits at 1 week apart, followed by 3 follow-up visits (at 4, 12, and 24 weeks) after the initial treatment visit. The primary efficacy outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, whereas the secondary efficacy outcome measures were the proportion of patients showing a visual analog scale (VAS) improvement of ≥50%. Magnetic resonance imaging was performed to evaluate joint effusion and bone marrow lesions using the Whole-Organ Magnetic Resonance Imaging Score. Patients were followed for 24 weeks. Results: Patients in the PRP group (mean age, 65.9 years) had a mean hip-knee-ankle angle of 5.1°, with 7 and 8 patients demonstrating Kellgren-Lawrence grade 2 and 3 knee OA, respectively. Patients in the placebo group (mean age, 67.9 years) had a mean hip-knee-ankle angle of 3.8°, with 6 and 9 patients showing Kellgren-Lawrence grade 2 and 3 knee OA, respectively. No significant differences were identified in any baseline factors. The percentage change in Western Ontario and McMaster Universities Osteoarthritis Index scores from baseline to 24 weeks was significantly different (P= .032) between the PRP (median, 75.9%; quantile 1 [Q1], 49.6; quantile 3 [Q3], 94.1]) and placebo (median, 27.7%; Q1, –9.4; Q3, 80.9]) groups. Overall, 73.3% and 28.6% of the PRP group and placebo group, respectively, exhibited an improvement in visual analog scale scores of ≥50%, with a significant improvement observed in the PRP group (P = .027). Changes in bone marrow lesions from baseline to 24 weeks, as assessed on magnetic resonance imaging, significantly differed between groups (P = .017), with no significant differences in other secondary endpoints. Conclusion: In Japanese patients with knee OA, 3 intra-articular LP-PRP injections led to clinical improvements at 24-week follow-up and significant functional improvements and pain relief after 24 weeks.

Efficacy of Ultrasound-Guided Injection of Platelet-Rich Plasma in Treatment of Sports-Related Meniscal Injuries

Abstract Purpose Meniscal injuries are a common occurrence in sports-related activities, often leading to pain, reduced joint function, and impaired athletic performance. This study aimed to evaluate the role of ultrasound-guided intra-articular platelet-rich plasma (PRP)-rich fluid injection which was obtained through serial centrifugation in the treatment of meniscal injuries resulting from sports activities. Materials and Methods A prospective study was conducted involving 54 cases with grade I, II, and III meniscal injuries, aged 18 and 43 years. PRP-rich fluid was prepared by subjecting autologous blood samples to a two-step centrifugation process. Patients were assessed pretreatment and at regular intervals posttreatment. Results Patients reported reduced pain and improved joint functionality following treatment. Average age of the patients was 34.4 years, and average follow-up period was 275.1 days. It is noteworthy that no cases of bilateral meniscal injuries were identified; indicating that the focus was primarily on single knee injuries. Predominance of grade II injuries suggests that the PRP intervention might be particularly effective in addressing more severe meniscal tears. Conclusion The results of our study provide compelling evidence for the positive impact of PRP augmentation in meniscus repair. Our findings indicate that PRP therapy has the potential to bring about substantial benefits for individuals with meniscus tears of the knee, particularly in terms of pain relief and enhanced functional capabilities.

Platelet-rich plasma injections for the management of knee osteoarthritis: The ESSKA-ICRS consensus. Recommendations using the RAND/UCLA appropriateness method for different clinical scenarios.

The aim of this consensus was to develop evidence- and expert-based patient-focused recommendations on the appropriateness of intra-articular platelet-rich plasma (PRP) injections in different clinical scenarios of patients with knee osteoarthritis (OA). The RAND/UCLA Appropriateness Method was used by the European Society of Sports Traumatology, Knee Surgery, and Arthroscopy (ESSKA), as well as the International Cartilage Regeneration and Joint Preservation Society (ICRS) to reach a consensus and produce recommendations for specific patient categories combining best available scientific evidence with the collective judgement of a panel of experts. Scenarios were defined based on first treatment vs first injective treatment vs second injective treatment, age (<50/50-65/66-80/>80), tibiofemoral vs patellofemoral involvement, OA level (Kellgren-Lawrence/KL 0-I/II-III/IV), and joint effusion (dry knee, minor-mild or major effusion). Out of 216 scenarios, in 84 (38.9%) the indication was considered appropriate, in 9 (4.2%) inappropriate and in 123 (56.9%) uncertain. The parameters associated with the highest consensus were PRP use after failed injective treatments (62.5%), followed by PRP after failed conservative treatments and KL 0-III scenarios (58.3%), while the highest uncertainty was found for PRP use as first treatment and KL IV OA (91.7% and 87.5% of uncertain scenarios, respectively). This ESSKA-ICRS consensus established recommendations on the appropriateness or inappropriateness of PRP injections for the treatment of knee OA, providing a useful reference for clinical practice. PRP injections are considered appropriate in patients aged ≤80 years with knee KL 0-III OA grade after failed conservative non-injective or injective treatments, while they are not considered appropriate as first treatment nor in KL IV OA grade. Level I.

162 Outcomes Following Surgical Management of Temporomandibular Disorder in a Specialist Setting

Abstract Introduction Temporomandibular joint (TMJ) dysfunction is an increasingly prevalent condition affecting 31% of adults and 11% of children/adolescents. Initial management is usually conservative with physiotherapy, diet modification, analgesics, and education. 5-10% of patients require surgical treatment. TMJ arthroscopies allows minimally invasive surgery for joints with early degenerative changes. The purpose is to provide symptomatic relief and improve function. Aim To evaluate clinical outcomes 3 months post TMJ surgery. Method Retrospective data was collected from the notes of all patients who underwent procedures between February 2019 and August 2023. Data collected included pain/diet scores, mouth opening, Wilkes staging, clinical diagnosis and the use of intra-articular Platelet Rich Plasma or steroid injections. Results 147 procedures were undertaken. The average age was 43 with an 83.0% female predominance. Overall, 1 arthroplasty, 1 eminectomy, 11 total joint replacements and 134 arthroscopies with/without arthrocentesis were performed with positive results. Mouth opening scores increasing from an average of 27.4mm to 29.5mm, diet scores from 5.8 to 7.5 and pain scores reducing from 7.1 to 4.4. At the 3 month follow up, 53 patients were planned for further monitoring, 32 discharged, 9 listed for a further arthroscopy and 15 for a TMJ replacement. Conclusions Surgical management provides good outcomes and Level 2 arthroscopy is an essential tool in the armamentarium. Development of an integrated physiotherapy pathway as well as educational leaflets has been vital. Educational Leaflets improved patient experience with re-audit results showing positive outcomes. Involvement of clinical psychologists is required for a multidisciplinary approach.

Efficacy of platelet rich plasma (PRP) injection in the treatment of knee pain in patients with osteoarthritis knee.

Objective: To assess the efficacy of intra-articular PRP injections in patients with knee osteoarthritis. Study Design: Cross Sectional. Setting: Orthopedic Department of Mardan Medical Complex. Period: 13th August to 14th December 2023. Methods: Involving 50 diagnosed osteoarthritis patients at demographic data, grades of osteoarthritis, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were recorded pre-treatment. Patients received PRP injections at three intervals, and post-treatment WOMAC scores were assessed. Statistical analysis included mean, standard deviations, and a paired t-test. Results: The study comprised 66% female patients, with a mean age of 50.08±5.82 and mean BMI of 27.16±3.53. Regarding grades of osteoarthritis, grade 1, grade 2 and grade 3 comprised of n=14(28%), 19(38%), 17(34%) respectively PRP treatment significantly reduced WOMAC scores from a pre-treatment mean of 56.62±5.70 to 27.54±4.79 (p &lt; 0.001). Conclusion: The significant reduction in WOMAC scores post-treatment suggests that intra-articular PRP injections may serve as a valuable intervention in the short term management of knee osteoarthritis.

Platelet-rich plasma intra-articular knee injections from open preparation techniques do not pose a higher risk of joint infection: A systematic review of 91 randomized controlled trials and 5914 injections.

To compare the infection rate of intraarticular platelet-rich plasma (PRP) knee injections between open and closed techniques in randomized controlled trials (RCTs) published in the last decade. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Scopus and Virtual Health Library were accessed in October 2022 using the terms 'platelet-rich plasma', 'PRP', 'knee' and 'tibiofemoral' alone and in combination with Boolean operators AND/OR. RCTs published during the last 10 years evaluating PRP intra-articular knee injections were considered eligible. Studies were excluded if the kit/preparation technique was not described. Data were presented using individual studies' absolute values, totals, and pooled percentages. Publication bias was assessed using the ROBIS tool. Ninety-one studies met the predetermined eligibility criteria. Forty-one implemented a closed technique, while 50 were open. All studies implementing a closed technique disclosed their commercial kits. Only 16 studies (17.58%) failed to report joint infections. Among the studies reporting joint infections as outcomes, 30 implemented a closed technique with 1195 patients, 1921 intra-articular knee injections and 95.44% of patient follow-up. On the other hand, 45 of them implemented an open technique with 2290 patients, 3993 intra-articular knee injections and 97.07% of patient follow-up. No patient had a joint infection among the included studies. Thirty-three studies prepared their PRP in controlled environments (36.26%). Most studies did not report where the preparation occurred (48.35%). Only twelve studies disclosed using laminar flow during preparation (13.19%). The infection rate for both techniques was 0 per 1000 knee injections. Open PRP preparation techniques do not pose a higher risk of joint infection and can lower manufacturing costs when appropriate facilities are available. However, PRP preparation setting and laminar flow implementation data are deficient, and minimal requirements for good manufacturing practices demand further studies while adhering to local and regional regulations. Level I, systematic review of RCTs.

Comparison of clinical and functional outcomes of physical therapy alone versus additional intraarticular injection of platelet rich plasma in treatment of frozen shoulder in Indian population

Background: Frozen shoulder (adhesive capsulitis) involves significant restriction of shoulder motion due to an inflammatory process and typically follows stages of pain, stiffness, and recovery over 2-3 years. This study explores the efficacy of platelet-rich plasma (PRP) injections, alongside conventional physiotherapy, as a non-operative treatment to enhance recovery in patients with adhesive capsulitis. Methods: This prospective, randomized, open, blinded, single-center clinical study involving 50 patients with adhesive capsulitis, comparing intra-articular PRP injections and physical therapy with physical therapy alone over 24 weeks. Primary outcomes were assessed using the shoulder pain and disability index (SPADI) and visual analog scale (VAS), with follow-ups at 6, 12, and 24 weeks to evaluate pain, function, and patient satisfaction. Results: In adhesive capsulitis (AC), intra-articular platelet-rich plasma (IA-PRP) injections with physical therapy (PT) provided superior pain relief, functional improvement, and higher treatment satisfaction after 24 weeks compared to PT alone. The IA-PRP group also showed better VAS scores and reduced acetaminophen use, indicating more effective pain management. Conclusions: In AC, IA-PRP injections showed greater pain relief and improved shoulder mobility compared to PT alone after 12 weeks. PRP's effectiveness highlights its potential, especially when corticosteroids are unsuitable, though longer-term studies are needed to confirm these results.

Exploring the Efficacy of Biologics in Knee Osteoarthritis: Ultrasound Evaluation of Cartilage Regeneration Effects.

Biologics like growth factors, stem cells, and platelet-rich plasma show potential in stimulating cartilage regrowth and reducing inflammation. By synthesizing preclinical and clinical studies, this study offers insights into how these biologics work and their effectiveness in treating knee osteoarthritis. Twenty-four participants with knee osteoarthritis (Kellgren - Lawrence grade II or III) were enrolled after obtaining consent. They received three doses of 2ml intraarticular platelet-rich plasma at 1month intervals. The clinical assessment involved the oxford knee score (OKS) and visual analogue scale (VAS) for pain on Days 0, 90, and 180. Ultrasound measured femoral and trochlear cartilage thickness pre- (Day 0) and post-PRP (Day 90-180). Before treatment, the average pain score was 7.2 (p = 1.03). On Day 90 post-PRP, it decreased to 5 (p = 0.81), and by Day 180, it further reduced to 4.5 (p = 0.97). The initial total OKS was 33.5 (p = 1.76), which increased to 36 (p = 1.71) on Day 90 and 38.5 (p = 1.89) on Day 180. The femoral and trochlear cartilage thickness also showed improvement from baseline (0.92) to Day 90 (0.96) and Day 180 (1.01), indicating significant cartilage healing post-PRP administration. Our study highlights the probability of PRP in treating knee OA, highlighting their ability to alleviate symptoms, enhance joint function, and promote articular cartilage regeneration.

Effect of platelet-rich plasma injections versus placebo on pain and quality of life in patients with hip osteoarthritis: A double-blind, randomized clinical trial.

This study aims to compare the efficacy of intra-articular platelet-rich plasma (PRP) injections over a saline placebo in terms of reduction of pain and impact on quality of life among patients with hip osteoarthritis. A total of 60 patients (29 males, 31 females, mean age: 57.9±7.3 years; range, 47 to 69 years) with known hip osteoarthritis of Kellgren-Lawrance (KL) Grades 2/3 were randomized into placebo (n=30) and PRP groups (n=30) between June 2014 and June 2015. Both groups received intra-articular injections into the hip joint under ultrasound guidance for three consecutive weeks. The patients were followed for six months, and pain reduction was assessed using the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire, and Short Form Health Survey-36 (SF-36). Intra-articular PRP treatment showed no advantage over a saline placebo in terms of VAS scores during activity. Both groups showed a significant improvement in VAS activity scores at one and six months. The placebo group showed improvements in VAS resting scores, whereas the PRP group did not. Both groups showed no improvement in WOMAC-total scores. Both groups showed no significant improvement across most SF-36 domains with the exception of improved physical role functioning at one month and general health at one and six months in the placebo group. Intra-articular injections of PRP show no significant difference compared to a saline placebo over a period of six months on pain, function, and quality of life scores in patients with hip osteoarthritis.

Intra-Articular Platelet-Rich Plasma Injection After Anterior Cruciate Ligament Reconstruction

Platelet-rich plasma (PRP) has been considered a promising treatment for musculoskeletal disorders. The effects of PRP on clinical outcomes of anterior cruciate ligament reconstruction (ACLR) are controversial. To compare subjective outcomes and graft maturity in patients undergoing ACLR with and without postoperative intra-articular PRP injection. This surgeon- and investigator-masked randomized clinical trial included patients treated at a national medical center in China who were aged 16 to 45 years and scheduled to undergo ACLR. Participants were enrolled between March 21, 2021, and August 18, 2022, and followed up for 12 months, with the last participant completing follow-up on August 28, 2023. Participants were randomized 1:1 to the PRP group (n = 60), which received 3 doses of postoperative intra-articular PRP injection at monthly intervals, or to the control group (n = 60), which did not receive postoperative PRP injection. Both groups had the same follow-up schedule. The primary outcome was the mean score for 4 subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS4) (range, 0-100, with higher scores indicating better knee function and fewer symptoms) at 12 months postoperatively. Secondary outcomes were patient-reported outcomes, graft maturity (on magnetic resonance imaging), and physical examinations at 3, 6, and 12 months. Among the 120 randomized participants (mean [SD] age, 29.0 [8.0] years; 84 males [70%]), 114 (95%) were available for the primary outcome analysis. The mean KOOS4 scores at 12 months were 78.3 (SD, 12.0; 95% CI, 75.2-81.4) in the PRP group and 76.8 (SD, 11.9; 95% CI, 73.7-79.9) in the control group (adjusted mean between-group difference, 2.0; 95% CI, -2.3 to 6.3; P = .36). Secondary outcomes were not statistically significantly different between the 2 groups except for sports and recreation level and graft maturity at 6 months. Intervention-related adverse events included pain at the injection site and knee swelling after injection. In this randomized clinical trial among patients undergoing ACLR, the addition of postoperative intra-articular PRP injection did not result in superior improvement of knee symptoms and function at 12 months compared with no postoperative injection. Further studies are required to determine appropriate indications for PRP in musculoskeletal disorders. Chinese Clinical Trial Registry Identifier: ChiCTR2000040262.

Platelet-Rich Plasma Treatments of Horizontal Meniscal Tears: A Comparative Analysis

Background: Meniscus injuries remain the most common indication for orthopedic surgery. Due to advances in magnetic resonance imaging (MRI), the number of patients diagnosed with meniscus injuries that do not extend into the articular surface has increased. Although treatments of complete meniscal tears are defined, treatment of meniscus injuries that do not extend into the articular surface is not clear yet.Objective: To determine the most optimal way of delivering platelet-rich plasma (PRP) into the knee joint for treatment of meniscus injuries (not extending into the articular surface) so that patients would improve clinically, and it would have also an effect on the meniscus shown on MRI.Materials and methods: We studied treatment results in 87 patients (50 men and 37 women). The patients were divided into 2 groups: group 1 received an ultrasound-guided PRP injection into the posterior horn, and group 2 received a standard intra-articular PRP injection via the superolateral approach. The treatment efficacy was assessed using visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, Lysholm score, and Knee Society Score (KSS). We also assessed changes on MRI 6 and 12 months after treatment.Results: The comparative analysis demonstrated that based on the findings of scores and MRI the ultrasound-guided intrameniscal PRP injection is more effective.Conclusions: Our results show that the intrameniscal PRP injection is a more effective and safe way to treat such meniscus injuries.

The Efficacy of Platelet-Rich Plasma Injection Therapy in Obese versus Non-Obese Patients with Knee Osteoarthritis: A Comparative Study.

Background/Objectives: Obesity is a common comorbidity in knee osteoarthritis (KOA) patients. Platelet-Rich Plasma (PRP) injection therapy may mitigate KOA. To further clarify potential patient selection for PRP injection therapy, we compared the outcomes in patients with different body mass index (BMI). Methods: A total of 91 patients with mild to moderate KOA were treated with three intra-articular PRP injections at 10 to 14-day intervals. Range of motion (ROM), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Visual Analogue Scale (VAS) were documented before and after the injections at 15 days, 6 months, 12 months, and at the last follow-up. Outcomes were compared between patients with a BMI over 30 kg/m2 (obese, n = 34) and under 30 kg/m2 (non-obese, n = 57). Results: Significant difference during the follow-up was detected in WOMAC score at the last follow-up favouring BMI under 30 group [17.8 ± 18.8 versus 10.5 ± 11.7, p = 0.023]. The odds ratio (OR) in BMI over 30 kg/m2 group for total knee arthroplasty was 3.5 (95% CI 0.3-40.1, p = 0.553), and OR for any arthroplasty was 7.5 (95% CI 0.8-69.8, p = 0.085) compared to non-obese patients. Conclusions: Obese patients benefitted from PRP injections in KOA but there is a minimal difference favouring non-obese patients in symptom alleviation in follow-up stages after 12 months. The risk of arthroplasty is higher for obese KOA patients.