Intra-articular Platelet-rich Plasma Research Articles

Autologous Conditioned Plasma and Hyaluronic Acid Injection for Isolated Grade 4 Osteochondral Lesions of the Knee in Young Active Adults.

Objectives: To compare the short-term benefits and results of autologous conditioned plasma (ACP) and hyaluronic acid (HA) injection in osteochondral defects in the knee of young adults. The effectiveness of intra-articular platelet-rich plasma (PRP) injections has been evaluated in osteoarthritis. However, few studies investigated its efficacy in knee osteochondral defects.Methods: This is a retrospective analysis of prospectively collected data. A matched cohort of 30 patients in each group was studied. Group 1 received three HA injections at weekly intervals, and group 2 received three ACP injections at two weekly intervals. We measured Kujala, Lysholm, Oxford, and visual analog scale (VAS) scores at baseline, six, 12, and 36 months to assess function and pain.Results: Most lesions were in the medial femoral condyles in both groups, followed by lateral femoral condyle and patellofemoral regions. In group 1 (HA), the mean pre-injection scores for Kujala, Lysholm, and Oxford improved significantly at six and 12 months. The scores decreased at 36 months, however, they remained significantly better than the baselines (P < 0.05). The pre-injection VAS scores continued to improve significantly from 6.06±0.785 to 3.40±0.912 at 36 weeks. In group 2 (ACP), VAS and the outcome scores showed a consistent and statistically significant improvement from pre-injection to 36 months. Conclusions: Our study confirms the short-term clinical benefits of using ACP for symptomatic osteochondral defects of the knee. Further high-quality comparative studies with longer follow-ups are needed to ascertain whether ACP is beneficial in the long term.

Comparing the Efficacy of Intra-Articular Single Platelet-Rich Plasma(PRP) versus Novel Crosslinked Hyaluronic Acid for Early-Stage Knee Osteoarthritis: A Prospective, Double-Blind, Randomized Controlled Trial.

Background and Objectives: For the treatment of knee osteoarthritis (OA), intra-articular platelet-rich plasma (PRP) and novel crosslinked single-dose hyaluronic acid (HA) have both been reported to improve outcomes, but no study has compared them for the treatment of knee OA. We hypothesized patients with early-stage knee OA who received PRP injections would have more WOMAC score changes than those who received HA injections. This is the first prospective, double-blind, parallel, randomized controlled trial comparing the efficacy of intra-articular single-dose PRP versus novel crosslinked HA (HyajointPlus) for treating early-stage knee OA. Materials and Methods: This study analyzed 110 patients randomized into the PRP (n = 54) or HA (n = 56) groups. The primary outcome is the change of WOMAC score at 1-, 3-, and 6-month follow-ups compared to baseline. Results: The data revealed significant improvements in all WOMAC scores in the PRP group at 1-, 3-, and 6-month follow-up visits compared with the baseline level except for the WOMAC stiffness score at the 1-month follow up. In the HA group, significant improvements were observed only in the WOMAC pain score for all the follow-up visits and in WOMAC stiffness, function, and total scores at 6-month follow-up. When comparing the change of WOMAC score at 1-, 3-, and 6-month follow-ups, no significant differences were found between PRP and HA group. Conclusions: This study revealed that both PRP and HA can yield significant improvements in WOMAC scores at 6-month follow-up without any between-group differences at 1-, 3-, and 6-month follow-ups. Thus, both the single-injection regimens of PRP and HA can improve the functional outcomes for treating early-stage knee OA.

Does Bone Marrow Edema Influence the Clinical Results of Intra-Articular Platelet-Rich Plasma Injections for Knee Osteoarthritis?

Platelet-rich plasma (PRP) is increasingly used for the intra-articular treatment of knee osteoarthritis (OA). However, clinical studies on PRP injections reported controversial results. Bone marrow edema (BME) can cause symptoms by affecting the subchondral bone and it is not targeted by intra-articular treatments. The aim of this study was to investigate if the presence of BME can influence the outcome of intra-articular PRP injections in knee OA patients. A total of 201 patients were included in the study, 80 with and 121 without BME at the baseline MRI. BME area and site were evaluated, and BME was graded using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Patients were assessed with International Knee Documentation Committee (IKDC) score Knee injury and Osteoarthritis Outcome Score (KOOS) subscales, the EuroQol-Visual Analogue Scale (EQ-VAS), and the Tegner score at baseline, 2, 6, and 12 months. Overall, the presence of BME did not influence the clinical results of intra-articular PRP injections in these patients treated for knee OA. Patients with BME presented a similar failure rate and clinical improvement after PRP treatment compared to patients without BME. The area and site of BME did not affect clinical outcomes. However, patients with a higher BME grade had a higher failure rate.

Efficacy of Autologous Intra-articular Platelet Rich Plasma Injection as a Biological Adjuvant in Early Primary Osteoarthrosis Knee—A Prospective Study

Introduction Classical characteristics of osteoarthrosis are reduction or loss of articular cartilage, new bone formation, accompanied by synovial proliferation resulting in pain, loss of joint function, and disability. Platelet rich plasma (PRP) has been used to provide stimulus for local regeneration and healing. The present study was conducted with the aim of evaluating the clinical outcome and efficacy of injecting PRP intra-articularly in early primary osterarthrosis knee. Objective Prospective study was conducted with the aim of evaluating the clinical outcome of efficacy of injection of PRP in early primary osteoarthrosis knee with respect to pain, stiffness, function and quality of life, in short-term follow-up. Attempt was made to standardize protocol and formulate PRP. Materials and Methods Patients were divided into two groups: one treated with two autologous PRP injections at 2 weeks interval and second received symptomatic treatment with physiotherapy. Patients were prospectively evaluated at baseline and then at 1 month, 3 months, and 6 months of follow-up using the visual analog scale (VAS) score, Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score, and range of movements. Results There was reduction in VAS score in group 1 patients compared with group 2 patients with the p-value &lt;0.0001 which was highly significant. There was a significant improvement in WOMAC score at 1 month, 3 months, and 6 months in group 1 compared with group 2 patients. Conclusion Autologous PRP in osteoarthrosis of knee has emerged as a simple technique, sensitive procedure, and cost-effective treatment option. Administration of intra-articular PRP injections reduced the VAS score significantly and also a significant improvement in the WOMAC score was observed in patients who were treated with PRP injection. The two doses of injection of PRP were found to give adequate relief in short term of 6 months and further long-term studies are required.

Time to Total Knee Arthroplasty after Intra-Articular Hyaluronic Acid or Platelet-Rich Plasma Injections: A Systematic Literature Review and Meta-Analysis.

Intra-articular (IA) hyaluronic acid (HA) and platelet-rich plasma (PRP) injections are increasingly being prescribed for knee osteoarthritis (KOA). However, failure of the medical treatment may result in total knee arthroplasty (TKA). We wondered if IA HA or PRP injections (intervention) may delay the time to TKA (outcome) among KOA patients (population), compared to KOA patients not receiving these injections (comparator). For this systematic literature review (SLR) and meta-analysis, we selected observational studies with at least one group of patients receiving IA HA or PRP and with TKA data available. The main outcome was time from the diagnosis of KOA to TKA. We included 25 articles in the SLR (2,824,401 patients) and four in the meta-analysis. The mean strengthening the reporting of observational studies in epidemiology (STROBE) score was 63%. For patients receiving versus not receiving HA injections, the delay between a declared diagnosis of KOA to TKA was increased by 9.8 months (95% CI (8.2–11.4)). As compared with standard of care, the effect size of HA injections for this outcome was 0.57 (95% CI (0.36–0.76)). Only one study described a median time from PRP injections to TKA of 4.1 years (range 0.3–14.7). IA HA injections were associated with increased time to TKA. Causality cannot be concluded because of missing confounder factors as comorbidities. Data were insufficient to conclude any effect of PRP injections on TKA delay.

Effect of Combined Intraosseous and Intraarticular Infiltrations of Autologous Platelet-Rich Plasma on Subchondral Bone Marrow Mesenchymal Stromal Cells from Patients with Hip Osteoarthritis.

Osteoarthritis (OA) is a debilitating condition that significantly impacts its patients and is closely associated with advancing age and senescence. Treatment with autologous platelet rich plasma (PRP) is a novel approach that is increasingly being researched for its effects. Subchondral bone mesenchymal stromal cells (MSCs) are key progenitors that form bone and cartilage lineages that are affected in OA. This study investigated the changes in subchondral bone MSCs before and after combined intraosseous (IO) and intraarticular (IA) PRP infiltration. Patient bone marrow aspirates were collected from 12 patients (four male, eight female) aged 40–86 years old (median 59.5). MSCs were expanded in standard media containing human serum to passage 1 and analysed for their colony-forming potential, senescence status, and gene expression. Hip dysfunction and Osteoarthritis Outcome Score (HOOS) at baseline and 6 months post second infiltration were used to assess the clinical outcomes; seven patients were considered responders and five non-responders. The number of colony-forming MSCs did not increase in the post treatment group, however, they demonstrated significantly higher colony areas (14.5% higher compared to Pre) indicative of enhanced proliferative capacity, especially in older donors (28.2% higher). Senescence assays also suggest that older patients and responders had a higher resistance to senescent cell accumulation. Responder and non-responder MSCs tended to differ in the expression of genes associated with bone formation and cartilage turnover including osteoblast markers, matrix metalloproteinases, and their inhibitors. Taken together, our data show that in hip OA patients, combined IO and IA PRP infiltrations enhanced subchondral MSC proliferative and stress-resistance capacities, particularly in older patients. Future investigation of the potential anti-ageing effect of PRP infiltrations and the use of next-generation sequencing would contribute towards better understanding of the molecular mechanisms associated with OA in MSCs.

A comparative study to assess the clinical outcomes in osteoarthritis of the knee between intra-articular platelet rich plasma (PRP) injections vs intra-articular corticosteroid injections

Osteoarthritis (OA) is by far the most common form of joint disease throughout the world. It is strongly associated with age, and extremely common in older people, Some studies estimate that over 80% of people over 55 years of age have osteoarthritis of at least one joint. It mainly affects the hips, knees, spine, hands and feet. Hip and knee OA are the most important because of the high prevalence of pain and disability that they cause in older adults. Methodology: Patients visiting the Department Of Orthopaedics, Narayan Medical College and Hospital that meet the inclusion criteria. Patient were be divided into 2 groups randomly (30 in each group).one group was administered intra- articular corticosteroid injection (1 ml of triamcinolone acetonide with 1ml of 2% lignocaine without epinephrine). And the other group was administered intra-articular prp injection into the affected knee (5 ml of prp). Following treatment they were assessed using mcmaster universities arthritis index (womac) [56 visual analogue scale (vas), scoring systems which will be recorded through questionnaires prior to the injection to record baseline scores and post injection then at 6 weeks, 3, 6 and 12months follow-up. Result: Significant difference was seen in mean WOMAC scores in Group A and Group B at 1 week, 4weeks, 8 weeks, 12 weeks and 12 months but no significant differences were observed at 6 months. Significant differences were seen in the VAS score for Group A and Group B subjects at 1 week, 4 weeks, 8 weeks, 12 weeks, 6 months and 12 months when compared using independent t test as p

Ultrasound-Tailored Treatment of Subacromial Shoulder Pain

Background and Objectives: Subacromial shoulder pain is the most common cause of shoulder pain consultation in musculoskeletal practice. Partial supraspinatus tendon tears have frequently been treated using a subacromial corticosteroid injection or surgery. The clinical use of a platelet-rich plasma (PRP) injection is an alternative treatment method for the condition, despite the paucity of evidence of its efficacy. The objective of the study was to assess the clinical effectiveness of autologous PRP in comparison to steroid injection in terms of pain relief and functional restoration in subacromial shoulder pathology. Methodology: All the patients above 18 years of either sex presenting with complaints of shoulder pain and painful abduction and elevation of arm for more than 6 weeks and not received any steroid injection in the previous 6 months were included in the study. In intra-articular PRP (IA-PRP), i.e., test group, 20 patients received 3 ml of single IA PRP injection, and in the steroid group (control group), 20 patients received 1 ml of intra-articular corticosteroid (IA CS) into glenohumeral joint under ultrasound (US) guidance. All patients were prospectively followed for 6 months. Results: There were no differences in visual analog scale (VAS) and disability scores between the PRP and corticosteroid groups at 1-month follow-up. However, the PRP group had better scores than the corticosteroid group on both the VAS and disability scores at 3- and 6-month follow-up. The VAS and disability scores did not change significantly at 6-month follow-up in the corticosteroid group; however, the PRP group showed continued improvement in both VAS and disability scores between 1- and 6-month follow-up. The PRP group had better scores than the corticosteroid group on shoulder range of motion after postintervention follow-up after 1 month. There were no complications in either group. Conclusion: Both subacromial PRP and corticosteroid injections had a positive clinical response in the treatment of shoulder pain. In view of the reached results, it may be assumed that steroid injections may provide symptomatic relief but not promote healing which makes PRP injection a good alternative as it is simple, easy to use, easily available, prepared from patient's own blood, and cost-effective. US-guided injections may increase the efficacy of accurately targeted injections.

Paper 15: Micro-Fragmented Adipose Tissue versus Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis: A Prospective Randomized Controlled Trial at 2-year follow-up

Objectives:Pre-clinical and clinical studies supported the use of intra-articular micro-fragmented adipose tissue (MF-AT) injections to address knee osteoarthritis (OA), suggesting their safety and clinical benefits. Nevertheless, no high-level studies investigated the potential of MF-AT over other biological products like platelet-rich plasma (PRP). The aim of this randomized controlled trial (RCT) was to compare a single injection of MF-AT to PRP in terms of clinical outcome and disease-modifying properties in patients with symptomatic knee OA.Methods:A total of 118 patients with symptomatic knee OA were randomly assigned to: single intra-articular MF-AT vs single intra-articular PRP injection. All patients were evaluated before the injection and at 1, 3, 6, 12, and 24 months with the International Knee Documentation Committee (IKDC) subjective score, the Knee injury and Osteoarthritis Outcome Score (KOOS) pain subscales, the EuroQol-Visual Analogue Scale (EQ-VAS) and EuroQol-5D (EQ-5D), and the Visual Analogue Scale (VAS). The treated knees were evaluated at baseline and at 6, 12, and 24 months of follow-up with radiographs and high-resolution (1.5 T) magnetic resonance imaging (MRI) with the Whole-Organ Magnetic Resonance Imaging Score (WORMS).Results:Both MF-AT and PRP provided a statistically and clinically significant improvement up to the last follow-up of 24 months. No differences were found between MF-AT and PRP groups in terms of adverse events (18.9% vs 10.9%), failures (15.1% vs 25.5%), and all clinical outcomes at all follow-ups. Radiographs and MRI findings did not show significant changes after the injection, neither as improvement, nor as disease progression, with no intergroup difference. Patients with moderate/severe OA treated with MF-AT showed a significantly higher IKDC improvement at 6 months compared to PRP (15.7±19.0 vs 8.6±14.2, p=0.041). Similarly, more patients with moderate/severe OA treated with MF-AT reached the minimal clinically important difference (MCID) for the IKDC subjective score at 6 months compared to the PRP group (75.0% vs 34.6%, p=0.005).Conclusions:A single intra-articular injection of both MF-AT and PRP provided a significant clinical improvement up to 24 months in patients with symptomatic knee OA. Both treatments showed a comparable low number of failures and adverse events, without signs of disease progression. Overall, no differences could be documented in both clinical and imaging results between the two biological approaches. Compared with PRP, MF-AT provided a higher clinical improvement at 6 months in moderate-severe OA.

CORRELATION BETWEEN RISK FACTORS AND CLINICAL OUTCOMES FOLLOWING INTRAARTICULAR INJECTION OF AUTOLOGOUS PLATELET RICH PLASMA IN EARLY OSTEOARTHRITIS KNEE

Introduction: Osteoarthritis (OA) knee is one of the major cause of disability particularly in the elderly .Management of OA knee with intraarticular Platelet Rich Plasma (PRP) is an emerging new technique. Aim : Aim of our study was to assess the efficacy of intra-articular injection of platelet rich plasma (PRP) in knee osteoarthritis and to investigate the correlation between risk factors likeBody mass index ,ageandseverity of osteoarthritis with clinical outcome after intraarticular injection of platelet rich plasma Study setting : Department of Physical Medicine and Rehabilitation,Government Kilpauk medical college, Chennai, India, from March 2021 to January 2022. Materials and methods : 64 patients with mean age of 56.52 ±7.53 who were diagnosed with grade 1 and 2 knee OA and who had undergone 2 doses of intraarticular injection of PRP were selected for the study and we retrospectively analysed the role of age, BMI, and Kellgren Lawrence grade of OA knee and their correlation with clinical outcome after intervention .Outcome measures used wereVAS and WOMAC scores Results: VAS and WOMAC scores before the procedure and final outcome after procedure using wilcoxn signed rank test showed that there was significant improvement in the outcome scores measured at followup done at 4th month . Subgroup analysis of patients stratified for age, Body mass index (BMI) and, KLgradewas performed for determining the individual effect of each risk factor on the outcome scores . It is found that the effect of PRP on people with BMI less than 25 ,KL grade 1 and age group &lt;60 ,is significantly better than subjects with BMI more than 25 ,KL grade 2 and age group &gt; 60 years. Conclusion: The use of intraarticular platelet-rich plasma definitely improves functional outcome in patients with OA and results in improved quality of life. Higher KL and risk factors like increased age, and BMI, has shown poorer outcome when compared to younger subjects , with lower BMI and KL grade , and hence modification in treatment protocol can be considered for such patients.

The Use of Intra-articular Platelet-Rich Plasma as a Therapeutic Intervention for Hip Osteoarthritis: A Systematic Review and Meta-analysis

Background: There is a cohort of patients in whom hip preservation surgery is not indicated, because they have developed signs of early osteoarthritis (OA), and nor can they have a hip replacement, as they are too early in the disease process. Management of this cohort of patients is not standardised and both pharmacological and nonpharmacological measures are utilised to reduce pain. Interventions available for early OA include intra-articular injections of steroids, viscosupplementation and more recently platelet-rich plasma (PRP). However, the use of PRP in hip OA has not yet been studied systematically. Purpose: To assess intra-articular PRP as a therapeutic intervention for hip OA, including the duration of efficacy, influence of dose and composition of PRP, and the incidence of adverse effects. Study Design: A systematic review and meta-analysis; Level of evidence, 4. Methods: We performed literature searches on the MEDLINE, EMBASE, CINAHL, WEB OF SCIENCE, COCHRANE, and SCOPUS databases, and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Data were pooled using random-effects meta-analysis. We assessed the quality of the included studies using the methodological index for non-randomized studies instrument, with an additional assessment for randomized controlled trials with the revised Cochrane risk of bias tool for randomized trials. This is the first study to concisely collate the available data on the use of PRP in hip OA. Results: Eight studies were included in the analysis, with data from a total of 331 patients. PRP significantly reduced pain compared with the baseline at multiple time points, with the greatest effect at the 1- to 2-month follow-up, but PRP significantly improved function only at the 1- to 2-month follow-up. A significantly larger reduction in pain was achieved with a single injection of PRP compared with multiple injections, a total injected dose of PRP <15 mL compared with ≥15 mL, and use of a leukocyte-poor PRP preparation compared with leukocyte-rich PRP. There were no lasting adverse effects. Conclusion: Low- and moderate-quality evidence suggests that PRP reduces pain and improves function at the end-point follow-up of studies compared with the baseline. Moderate-quality evidence suggests that a larger reduction in pain is achieved with a single injection of PRP compared with multiple injections, and low-quality evidence attributes a larger reduction of pain with a total injected dose of PRP <15 mL compared with ≥15 mL and using leukocyte-poor PRP compared with leukocyte-rich PRP.

Intra-articular Injection of Hyaluronic Acid (HA) and Plateletrich Plasma (PRP) in the Treatment of Mild and Moderate Osteoarthritis of Knee

Background: Osteoarthritis (OA) is the most prevalent chronic joint disorder worldwide and is associated with significant pain and disability. Introduction of platelet-rich plasma (PRP) injection has been viewed as an advance in the management of OA knee. Objective: To compare the effectiveness of PRP and Hyaluronic Acid (HA) in the treatment of mild and moderate OA knee Methods: The present randomized clinical trial had been conducted in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from 2018 to 2019. A total of 154 patients with mild and moderate OA knee were randomly allocated into two groups: group A (received PRP injection) and group B (received HA injection) where 133 patients completed the follow-up schedule. Outcomes were measured by OA specific translated and validated Bengali instrument- Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire and visual analogue scale (VAS 0-10). They were followed-up for 6 months. Results: There was no significant statistical difference at the baseline between the groups regarding age, sex, grading of OA knee, side involvement, mean duration of the disease, VAS scores and WOMAC scores. After one month, VAS score significantly decreased in PRP group compared to HA group (p&lt;0.001). However, there was no statistical difference regarding total WOMAC scores between two groups (p=0.063). In third and sixth month, VAS score significantly decreased in PRP group compared to HA group (p&lt;0.001). Though the stiffness and physical activity scores of WOMAC did not reduce significantly, the pain score reduced significantly in PRP group compared to HA group. In both groups, significant reduction of VAS and WOMAC total scores was observed after six months follow-up compared to baseline values (p&lt;0.001). Conclusion: Intra-articular platelet-rich plasma improves pain and function of the knee in patients with osteoarthritis. Though intra-articular hyaluronic acid also improves pain and function in the foot, PRP is more effective than hyaluronic acid. Multi-centered clinical trial with long term follow-up should be conducted to see the effects of PRP and HA. Bangladesh Med Res Counc Bull 2021; 47(1): 62-69

Regenerative Effect of Low-Intensity Pulsed Ultrasound and Platelet-Rich Plasma on the Joint Friction and Biomechanical Properties of Cartilage: A Non-traumatic Osteoarthritis Model in the Guinea Pig.

This study was aimed at investigating the effects of platelet-rich plasma (PRP) and low-intensity pulsed ultrasound (LIPUS) on the joint friction parameters and biomechanical properties of articular cartilage in a non-traumatic knee osteoarthritis (OA) model. Fifty adult male Dunkin Hartley guinea pigs were randomly divided into five groups: control, OA60, OA+US, OA+PRP and OA+US+PRP). Non-traumatic knee OA was induced with a single dose of 3 mg of mono-iodoacetate (MIA) by intra-articular injection. Intra-articular PRP was injected twice in the OA+PRP and OA+US+PRP groups. LIPUS was delivered in 10 sessions in the OA+US and OA+US+PRP groups. By use of the pendulum free oscillation test, joint friction (coefficient of friction) was measured. In addition, the instantaneous elastic modulus and aggregate modulus were measured using the stress-relaxation test. MIA injection decreased cartilage thickness, instantaneous elastic modulus and aggregate modulus, and increased joint friction. The friction coefficients in the OA+US and OA+US+PRP groups reached near-normal values, and there was no significant difference compared with the control group (p=0.232 and p=0.459, respectively). The instantaneous elastic modulus and aggregate modulus in the OA+US group increased significantly compared with the OA+PRP group (p < 0.05). It seems that both LIPUS and PRP injection effectively improved joint lubrication, but LIPUS was superior to PRP in improving the mechanical properties of the articular cartilage.

Assessment of clinical outcome of platelet rich plasma (PRP) injection in progression of mild to moderate osteoarthritis patients, a retrospective study

Background and Objectives: Global reports (2020) state that an annual 86.7 million people (age >20 years) are diagnosed with incident knee Osteoarthritis. Various therapies and medications have been given to treat this condition and one such upcoming therapy is the use of Platelet-rich plasma. In spite of the promising outcomes, some experts in the field are yet skeptical about the use of Platelet-rich plasma therapy to treat osteoarthritis. In this study, the investigators attempt to measure the clinical outcome of platelet-rich plasma therapy in patients with progression of mild to moderate osteoarthritis. Methods: Analysis of 102 patient records was carried out from the years 2016-2020 to assess the clinical outcome of the intra-articular Platelet Rich Plasma (PRP) injection in the progression of mild to moderate osteoarthritis patients from the period of pre-injection to 12 months post-injection. Assessment tools such as the VAS and the WOMAC score were used. IBM SPSS software version 1.0 was used for the statistical data analysis. Results: Medical records analyzed of the patients showed a gradual decrease in pain, observed over a period of 12 months post-injection (as assessed by the VAS and WOMAC score). Significant reduction in swelling (Friedman test: Chi-square = 199.68, P< 0.0001) and tenderness (Friedman test: Chi-square = 199.14, P< 0.0001) was also observed. Conclusion: A significant reduction in pain, swelling, tenderness and improvement in function was observed post 12 months of the injection given. The results are encouraging when compared to pre-injection pain and symptoms, suggesting a positive clinical use of PRP injections for mild to moderate osteoarthritic patients.

Effects of intra-articular Platelet-Rich Plasma (PRP) injections on osteoarthritis in the thumb basal joint and scaphoidtrapeziotrapezoidal joint.

Intra-articular injection of platelet rich plasma (PRP) has been reported to decrease pain and improve function in knee osteoarthritis. There are few reports on the effect of PRP in the treatment of osteoarthritis in the hand. Our aim was to evaluate the effect of PRP-injections on pain and functional outcome in the short-term for osteoarthritis in the thumb basal joint and scaphoidtrapeziotrapezoidal (STT) joint. A retrospective analysis was performed of 29 patients treated with intra-articular PRP injection for painful osteoarthritis in the thumb basal joint (21 patients) or STT joint (eight patients). The patients received two consecutive, radiologically guided PRP injections at an interval of 3-4 weeks. Pain at rest and on load (numerical rating scale (NRS) 0-10), Patient-rated Wrist and Hand Evaluation (PRWHE) score (0-100), grip strength (Jamar) and key pinch were recorded pre-injection and 3 months after the second injection. Mean age was 63 (range 34-86) years and 17 patients were women. We used generalized estimating equations (GEE) to analyze the effect on the outcome variables. Possible predictors were included in the model (high pain level pre-injection, gender, age, manually demanding work, affected joint (thumb base or STT) and use of analgesic). The GEE analysis showed that PRP injections had no effect on reported pain, PRWHE score, grip strength or key pinch. 16/28 patients experience a positive effect according to a yes/no question. The short-term effect of PRP for osteoarthritis in the thumb base and STT-joint is doubtful and needs to be properly investigated in placebo-controlled studies.

The use of intra‐articular platelet rich plasma for the symptomatic management of osteoarthritis of the knee: a pilot study

Osteoarthritis of the knee is a chronic inflammatory condition resulting in significant patient disability, with intra-articular platelet rich plasma (PRP) injections having shown potential to improve symptomatic outcomes. This retrospective cohort pilot study aimed to observe whether PRP injections were beneficial in the symptomatic management of knee osteoarthritis in an Australian population, based on patient reported outcomes. An additional aim was to observe for an association between the number of injections and patient characteristics, such as body mass index, age, sex and radiologically determined severity of the disease. The cohort was drawn from those who attended Ballarat Orthopaedic and Sports Medicine for PRP injections and who had completed the appropriate pre- and post-injection Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. WOMAC scores were analysed to observe for any difference following a course of PRP injections. The data suggest that the use of PRP improved patient reported WOMAC scores. Additionally, it was shown that two injections had a greater effect than one injection, with a third injection providing no further benefit. Finally, there was an association with lower WOMAC scores post PRP therapy amongst male participants compared to female participants. These results suggest two PRP injections are optimal for the symptomatic management of knee osteoarthritis, identifying a need for further prospective research in this Australian population.

Clinical Response After Treatment of Knee Osteoarthritis With a Standardized, Closed-System, Low-Cost Platelet-Rich Plasma Product: 1-Year Outcomes.

Background:Intra-articular infiltration of platelet-rich plasma (PRP) is an alternative therapeutic option to classic hyaluronic acid for the treatment of symptomatic knee osteoarthritis (KOA). However, variation in preparation methods and quality assessment of PRP makes the study of its real clinical efficacy difficult.Purpose:To (1) evaluate the clinical efficacy of a characterized PRP product prepared in a standardized manner and in a closed-system for the treatment of KOA and to (2) evaluate the association of the clinical response to PRP-related variables.Study Design:Case series; Level of evidence, 4.Methods:We recruited 130 patients with nonoperative KOA and evaluated them for 1 year. PRP was prepared from a donation of autologous blood, obtaining 3 aliquots of approximately 10mL of product, which were frozen, allowing platelet disruption, platelet factor release, and long-term storage, until administration. Patients were treated 3 consecutive times every 4 weeks with an intra-articular PRP knee injection under sterile conditions. Complete blood count was performed on the whole-blood sample and the processed PRP before freezing it, for product quality assessment. Patients were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and basic satisfaction scale at 3 months, 6 months, and 1 year after intervention.Results:Quality assessment confirmed a leukocyte-poor PRP product (white blood cell count, 0.09 ± 0.09 × 109/L) with a high platelet purity (platelet count, 630.86 ± 191.75 × 109/L). WOMAC scores improved, and basic satisfaction was achieved in 70% of patients. No adverse events were reported. No correlations were observed between PRP quality parameters and clinical results. PRP complete treatment production costs were €108/US$125 (€36/US$41.6 per injection).Conclusion:This standardized PRP production method resulted in improved WOMAC scores at 1 year postoperatively in 70% of patients with KOA. This technique was safe and affordable and ensured consecutive infiltrations with the same product to each patient.

Efficiency of Intra-Articular Platelet-Rich Plasma Injection in Grade I and Grade II Osteoarthritis in the Knee Joints: A Longitudinal Study

Aim: To assess the efficiency of intra-articular platelet-rich plasma (PRP) injection in grade I and grade II osteoarthritis in the knee joints Study design: A longitudinal study Place and Duration: This study was conducted at Murshid Hospital and Health Care Center Karachi Pakistan from January 2021 to June 2021. Methodology: The ages of the patients were between 35 years and 65 years. All the patients were diagnosed with osteoarthritis of grade I and grade II. A total of 3 injections of PRP were injected intraarticular in the knees at an interval of 4 weeks. Patients were asked to come for a follow-up in the outpatient department. They were assessed for physical mobility and pain related to arthritis using the WOMAC score. The assessment was done when the treatment was given and after 6 months. Results: A total of 250 patients were considered in the present study. The mean age of the patients was 55.63±5.65 years. The ratio of disease in females to males was 3:1. A total of 178 patients had grade I osteoarthritis and 72 patients had grade II osteoarthritis according to Kellgren–Lawrence classification. A total of 210 patients had reported experiencing symptoms for less than 2 years and the remaining 40 had been experiencing the symptoms for more than 2 years. The mean WOMAC score was 82.9 before the treatment was started and it was 39.15 after 6 months of the treatment. The improvement of WOMAC score was more in the patients having symptoms for less than 2 years. Minor hyperemia was seen in 4 patients and those patients were managed conservatively by ice application and activity limitation. None of the patients showed signs of infection. Conclusion: The intraarticular injection of PRP proved to be beneficial and effective in the treatment of grade I and grade II early osteoarthritis. Keywords: Osteoarthritis, Platelet-rich plasma, PRP, knee joint

Clinical results of PRP application for Gonartrosis; Comparison of one or two week interval application achievements

Objective: Intra-articular platelet-rich plasma PRP (platelet-rich plasma) treatment can be applied at an early stage of Gonarthrosis in addition to medical treatment. There is no consensus in the literature regarding the dose interval of PRP. Our aim in this study is to compare the short-term clinical results of three doses of PRP administered at one and two-week intervals in the treatment of early-stage Gonarthrosis. Material and Methods: Three doses of PRP were applied to one knee of the patients at intervals of one week and to the other knee at intervals of two weeks. All patients were clinically evaluated with McMaster Universities Arthritis Index (WOMAC) and Visual Analogue Scale (VAS) before the PRP application and at the 1st, 3rd and 6th months after the application. Results: The mean age of 61 (40 female, 21 male) patients included in this study was 56.75 years and the mean BMI (Body Mass Index) was determined as 25.45±3.15 kg/m2. In the clinical evaluation at the end of the 1st, 3rd, and 6th months after PRP, there was no significant difference between the one-week interval and two-week application. However, it was observed that PRP application provided statistically significant improvement in WOMAC and VAS scores in both applications (p&lt;0.05). Conclusion: According to the findings we obtained in our study, it has been determined that there was no difference between applying three doses of PRP at one- or two-weeks intervals.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist