Platelet-rich Plasma In Osteoarthritis Research Articles

The use of platelet-rich plasma in osteoarthritis - the current state of knowledge

Introduction and objective: Osteoarthritis (OA) is a chronic condition characterized by progressive damage to the joint cartilage and bone. Platelet-rich plasma (PRP) has gained increasing interest as a potential therapeutic approach for relieving symptoms and improving joint function. The aim of this article is to present the current knowledge regarding the PRP preparation method, mechanisms of action, and treatment outcomes in OA based on scientific literature and recent research. Materials and methods: A review of scientific literature available on Google Scholar, PubMed, and Via Medica journal database was conducted using relevant keywords. State of knowledge: Platelet-rich plasma is obtained from the patient's own blood using differential centrifugation method, resulting in a concentration of platelets (PLT) that is 300-700% higher compared to the baseline. PLTs release various biologically active substances, including growth factors, which stimulate tissue repair and regeneration processes. Numerous studies have shown that PRP administration in patients with osteoarthritis of the knee and hip joints leads to pain reduction and improved joint function. The therapeutic effect yields long-lasting results, lasting up to 12 months after the completion of the treatment. Conclusions: The use of platelet-rich plasma (PRP) in the treatment of osteoarthritis presents a promising alternative to conventional therapies. However, further research is needed to confirm the effectiveness of PRP on a larger sample size and assess the long-term effects of this therapy. Knowledge regarding dosage, treatment protocols, and the duration of therapy remains limited.

Evaluation of efficacy and safety of intraarticular injections of leucocyte poor platelet rich plasma in osteoarthritis knee patients

Background: The present study evaluates the safety and efficacy of intraarticular injections of leucocyte poor platelet rich plasma (LP-PRP) in osteoarthritis (OA) knee patients. Patients with early osteoarthritis (K-L grading 1 and 2)-clinically and radiologically and those who gave consent to participate in the study were injected with 2.4 ml per knee of LP-PRP over unilateral or bilateral knees at 0, 1, 2 and 6 months of LP-PRP injections. Methods: 100 patients with osteoarthritis knee pain were injected with LP-PRP at 0.1.2 months on OPD basis. LP-PRP was prepared in a centrifugation machine at 2000 RPM for 4 minutes and 2000 RPM for 10 minutes for two consecutive times and then injected into knee with a medial suprapatellar approach using 20/21 G needle. This was repeated at 1 and 2 months of follow-up. Assessment of efficacy in terms of pain relief was done on the basis of visual analog score (VAS) and clinical outcomes on the basis of knee injury and osteoarthritis outcome scores (KOOS) at 0, 1, 2, 6 months following injection of LP-PRP. Results: The mean VAS at pre-injection was 7.22±0.965 which reduced to 3.06±1.223 at post-injection follow-up at 6 months. The mean KOOS at pre injection was 33.4±7.51 which increased to 78.86±8.80 at post-injection follow-up at 6 months. Conclusions: LP-PRP has emerged as an intriguing therapy option for knee OA, and our study has shown that it is effective after 6 months.

ПРИМЕНЕНИЕ PRP-ТЕРАПИИ ПРИ ОСТЕОАРТРИТЕ КОЛЕННОГО СУСТАВА В КЛИНИЧЕСКОЙ И СПОРТИВНОЙ МЕДИЦИНЕ: ОБЗОР ЛИТЕРАТУРЫ

The analysis of data from domestic and foreign literature devoted to certain aspects of the use of platelet-rich plasma in osteoarthritis of the knee joint was carried out. The world experience of using PRP in traumatology and sports medicine is summarized on this topic. The search was carried out using the electronic databases Pubmed, MEDLINE, Embase, Scopus, eLibrary for the period from 2003 to 2020. To search, we used keywords and their combinations: “platelet-rich plasma”, “cartilage pathology”, “osteoarthritis of the knee joint”, “athletes”. According to the results of the study, it was found that PRP therapy can be considered a useful method of treating patients with knee osteorarthritis (COA). According to the results of the search, 248 articles were found. Nineteen studies met the inclusion criteria. A limited number of reliable works have been published in the available literature. Further research is needed to understand the short- and long-term effects of PRP on patients with COA.

Prognostic Factors Related to Clinical Response in 210 Knees Treated by Platelet-Rich Plasma for Osteoarthritis.

Many studies have shown the effectiveness of platelet-rich plasma (PRP) in the treatment of knee osteoarthritis. We aimed to determine the factors associated with good or poor response to PRP injections in knee osteoarthritis. This was a prospective observational study. Patients with knee osteoarthritis were recruited from a university hospital. PRP was injected twice at a one-month interval. Pain was assessed on a visual analog scale (VAS) and function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic stage was collected and defined according to the Kellgren-Lawrence classification. Patients were classified as responders if they met the OMERACT-OARSI criteria at 7 months. We included 210 knees. At 7 months, 43.8% were classified as responders. Total WOMAC and VAS were significantly improved between M0 and M7. Physical therapy and a heel-buttock distance >35 cm were the two criteria associated with poor response at M7 by multivariate analysis. Pain VAS at M7 appeared to be lower in patients with osteoarthritis for less than 24 months. No adverse effects were reported. PRP treatment in knee osteoarthritis appears to be well-tolerated and effective, even in patients who reacted poorly to hyaluronic acid. Response was not associated with radiographic stage.

Platelet-rich plasma contributes to chondroprotection by repairing mitochondrial function via AMPK/NF-κB signaling in osteoarthritic chondrocytes

Osteoarthritis (OA), also known as degenerative osteoarthritis, has a complex etiology, and its pathogenesis remains unclear. Platelet-rich plasma (PRP) therapy has been widely used in medicine and other related professions since its clinical application was first reported in the 1980 s and the 1990 s. This study aimed to investigate the effects and potential mechanisms of PRP in OA. An in vitro model of osteoarthritis was constructed by lipopolysaccharide (LPS) stimulation, and the effect of PRP on LPS-induced chondrocytes was evaluated. The results indicated that although LPS inhibited chondrocyte proliferation and promoted inflammation and apoptosis, these effects were reversed by PRP. In addition, the LPS-suppressed expression of aggrecan, TGF-β, PDGF, and COL2A1 was restored by PRP, whereas the LPS-enhanced expression of MMP3 was suppressed by PRP. Furthermore, PRP inhibited LPS-induced mitochondrial damage by suppressing reactive oxygen species production, mitochondrial permeability transition pore opening, Drp1 expression, and upregulating Mfn1 expression. In addition, PRP inhibited the phosphorylation of AMPK and NF-κB. Collectively, this study indicates that PRP might be a potential therapeutic candidate for the treatment of OA by repairing mitochondrial function through the activation of AMPK/NF-κB signaling.

Bibliometric analysis of the top 50 highly cited articles on platelet-rich plasma in osteoarthritis and tendinopathy.

The primary goal of this study was to compile the top 50 most cited articles on the use of platelet-rich plasma (PRP). A search of relevant studies was performed in accordance with the PRISMA guidelines in Web of Science. The top 25 most cited articles in osteoarthritisand tendinopathy were then compiled and evaluated. Level 1 evidence articles constituted the majority of the studies (64%) and were more likely to have a higher citation density. Altmetric data was highest for level 1 systematic reviews. Of the articles that report a positive outcome for PRP, 13% (2/16) had low risk of bias. This study defines the most cited and influential publications regarding PRP to further research in this area.

Role of Platelets in Osteoarthritis-Updated Systematic Review and Meta-Analysis on the Role of Platelet-Rich Plasma in Osteoarthritis.

Platelets are an essential component of hemostasis, with an increasing role in host inflammatory processes in injured tissues. The reaction between receptors and vascular endothelial cells results in the recruitment of platelets in the immune response pathway. The aim of the present review is to describe the role of platelets in osteoarthritis. Platelets induce secretion of biological substances, many of which are key players in the inflammatory response in osteoarthritis. Molecules involved in cartilage degeneration, or being markers of inflammation in osteoarthritis, are cytokines, such as tumor necrosis factor α (TNFα), interleukins (IL), type II collagen, aggrecan, and metalloproteinases. Surprisingly, platelets may also be used as a treatment modality for osteoarthritis. Multiple randomized controlled trials included in our systematic review and meta-analyses prove the effectiveness of platelet-rich plasma (PRP) as a minimally invasive method of pain alleviation in osteoarthritis treatment.

Role of platelet rich plasma in osteoarthritis of the knee joint

Background: Osteoarthritis (OA) is a leading cause of disability and doubles the number of visits to primary care practitioners for those with the condition in comparison to those without. OA affects the knee more often than any other joint, Platelet-rich plasma (PRP) is a concentrate of autologous blood growth factors which has been shown to provide some symptomatic relief in early osteoarthritis (OA) of the knee. Objective: the aim of this prospective study is to demonstrate the effectiveness of prp injection in patients with OA of the knee. Materials and Methods: 60 patients with 74 knees affected by variable grades of OA were enrolled in our study in Alwasity teaching hospital from January 2018 to December 2019 with follow up till December 2021. 49 patients with 62 knees were females and 11 patients with 12 knees were males, all patients received three injections of prp at weekly intervals and were followed up every three months for two years. Results: After one year of follow up 11 knees with KL-G I had decrease in VAS score to 0–2 (73.3%),19 knees with KL-G II had decrease of VAS score to 1–3 (70.3%),10 knees with KL-G III had decrease of VAS score to 4–5 (40%), All 7 knees with KL-G IV didn’t have any response during treatment or at the end of 1st year. All patients had scores similar to that before starting treatment at the end of 2nd year. Conclusion: The present state of knowledge holds promise for PRP of certain specifications for pain management in early OA knee. PRP has consistently been shown by various clinical studies to be useful in OA of the knee. Nevertheless, a lot of grey areas remain in our understanding of PRP and OA, and many more focused clinical and in vitro studies are required. PRP seems to be an evolving future trend.

Google Trends Analysis Shows Increasing Public Interest in Platelet-Rich Plasma Injections for Hip and Knee Osteoarthritis

BackgroundOsteoarthritis is a chronic musculoskeletal condition that frequently affects the hip and knee joints. Given the burden associated with surgical intervention for hip and knee osteoarthritis, patients continue to search for potential nonoperative treatments. One biologic therapy with mixed clinical and basic science evidence for treating osteoarthritis is platelet-rich plasma injections into the affected joint. We used the Google Trends tool to provide a quantitative analysis of national interest in platelet-rich plasma injections for hip and knee osteoarthritis. MethodsGoogle Trends parameters were selected to obtain search data from January 2009 to December 2019. Various combinations of “arthritis,” “osteoarthritis,” “PRP,” “platelet-rich plasma,” “knee,” and “hip” were entered into the Google Trends tool and trend analyses were performed. ResultsThree linear models were generated to display search volume trends in the United States for platelet-rich plasma and osteoarthritis, hip osteoarthritis, and knee osteoarthritis, respectively. All models showed increased Google queries as time progressed (P < .001), with R2 ranging from 0.837 to 0.940. Seasonal, income-related, and geographic variations in public interest in platelet-rich plasma for osteoarthritis were noted. ConclusionOur results demonstrate a significant rise in Google queries related to platelet-rich plasma injections for osteoarthritis of the hip and knee since 2009. Surgeons treating hip and knee osteoarthritis patients can expect continued interest in platelet-rich plasma, despite inconclusive clinical and basic science data. Trends in public interest may inform patient counseling, shared decision-making, and directions for future clinical research.

The Role of Platelet-rich Plasma in Osteoarthritis of Knee-joint

Background: Osteoarthritis is one of the leading causes of disability. Platelet-rich plasma (PRP) is known as autologous conditioned plasma is a concentrate of platelet-rich plasma protein derived from whole blood, centrifuged to remove red blood cells. Now it is used in treating OA. We have very few data regarding this issue. The aim of this study was to assess the role of platelet-rich plasma in osteoarthritis of knee-joint. Materials and methods: This was a prospective observational study which was conducted at the Department of Orthopaedics & Traumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh during the period from January 2018 to December 2018. In total 89 patients, diagnosed with grade I and II arthritis were included in this study as the study population. To all the participants three PRP injections were injected in the knees at 4-week interval. Patients were followed up and were assessed for pain and physical activity associated with arthritis using the Western Ontario and McMaster University Arthritis Index (WOMAC) score at the time of induction in the study and at 6 months interval. Results: The mean (±SD) WOMAC score of the participants was 82.94 (±5.12) at the baseline whereas it was found 37.87 (±4.73) at the follow up period after 6 months. After 6 months the mean (±SD) WOMAC score of male participants was found 36.93 (±5.71) and it was found 38.87 (±5.39) among female participants. This difference was statistically significant (P=0.021). Besides this, after 6 months the mean (±SD) WOMAC score of Kellgren–Lawrence grade-1 participants was 37.68 (±5.44) and it was found 40.13 (±5.01) among Kellgren–Lawrence grade-2 participants. This difference was statistically significant (P=0.002). Moreover, after 6 months the mean (±SD) WOMAC score of participants with ≤2 years duration of symptoms was 37.95 (±5.37) and it was found 41.66 (±4.28) among participants with >2 years duration of symptoms. This difference was extremely statistically significant. Conclusions: The proper sequential use of PRP injection for the treatment of osteoarthritis of knee-joint proved to be effective in our study. We recommend its wide use in the treatment of osteoarthritis of knee-joint.

Retraction Note to: Intra-articular injection in the knee of adipose derived stromal cells (stromal vascular fraction) and platelet rich plasma for osteoarthritis

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s12967-021-02852-z

Comparison of platelet counts in platelet-rich plasma (PRP) obtained by two methods from dogs

Platelet-rich plasma (PRP) is widely used in human medicine, but seldom used in veterinary practice. Even so, the efficacy of PRP in osteoarthritis, dental implants, bone defects and wound healing in dogs and horses is well documented. There are many commercially available PRP tubes and kits for horses and humans, but studies on the effectiveness of these products in dogs are limited. Researches have demonstrated that systems developed for humans and horses do not always produce the same results in dogs. In the present study, two prevailing systems, a sodium citrate-based system and a gel-based system, were compared in terms of their platelet output. The data obtained revealed that, although there was no statistically significant difference between the two systems, the sodium citrate-based kit is probably more efficient in practice due to its superiority in volume output. PRP is an important component of regenerative therapy. It is autologous and practical, but has not been sufficiently implemented in veterinary practice, but promising clinical satisfaction and must be considered in various conditions.

Autologous blood product injections including platelet-rich plasma for osteoarthritis of the knee

Autologous blood product injections including platelet-rich plasma for osteoarthritis of the knee

An Assessment of the effect of Platelet Rich Plasma in the Osteoarthritis of the Knee

Introduction: Osteoarthritis (OA) is estimated to be the fourth leading cause of disability. With prevalence as high as 17 to 60.6%. With a 100% increase in prevalence of knee osteoarthritis since the mid-20th century. No specific cure for OA appears to exist. Most of the patients have no option but to undergo joint replacement surgery which again is an option not without risk and limitations. Therefore, there is need for a treatment option which could avoid or delay a joint replacement and make patient comfortable till surgery becomes an absolute indication. The available interventional therapies are visco-supplementation and PRP therapy which help in delaying the disease progression. This study was undertaken with the aim to assess the functional outcome of the therapeutic values of Platelet Rich Plasma (PRP) in knee osteoarthritis. Materials and Method: The present study was conducted in the Department of Orthopaedics, Rohilkhand Medical College, Bareilly. All the patients affected by a Unilateral or Bilateral knee osteoarthritis of all radiological grades (grade 1-4), attending the department from November 2016 to October 2017 were invited to participate in the study. It is a prospectivestudy of 50 cases. The patients were administered with 3 doses of intra-articular PRP and were followed up till 6 months post PRP therapy. The cases of knee OA were radiologically classified by the Kellegren Lawrence Grade. The functional outcome in the patients was assessed by the WOMAC, IKDC and VAS scores. Results: A significant change in WOMAC score was observed. The range of change in WOMAC score at 1 week to 6 months follow-up was 9.85% to 24.84%. Changes in WOMAC score at all the follow up visits were statistically significant (p&lt;0.001).A subsequent decline in pre-treatment VAS score (Pain) was also observed at follow up visits at 1 week (1.15±0.69; 18.18%), 3 months (2.07±1.03; 32.63%) and 6 months (2.29±1.29; 36.14%). Conclusion: PRP is a very good alternative treatment modality in patients with knee OA from KL grade 1 to grade 3 to delay the progression of the disease and also it provided significant symptomatic improvement along with improvement in the functional outcome of the patients without any severe side-effects.

Role of Intra Articular Injections of Autologous Platelet Rich Plasma in Osteoarthritis of Knee Joint

Osteoarthritis is the most common form of arthritis and a leading cause of chronic disability, to a great extent in knee and/or hip joints. Osteoarthritis, commonly known as wear and tear in which a protective cartilage on the end of the bones wears down over time. osteoarthritis of the knees is one of five leading causes for disability among non-institutionalized adults. Osteoarthritis is the fourth leading cause of 'years lived with disability' (YLD), accounting for 3.0% of totals global YLD's. As per WHO by 2030. The most common symptoms of knee osteoarthritis are pain and physical limitations that have a significant effect on the individual's quality of life and her or his social and economic activities. Osteoarthritis diseases are a result of both mechanical and biological events that destabilize the normal biological coupling of degradation and synthesis of articular cartilage, chondrocytes, extracellular matrix, subchondral bone and subsequently synovial fluid. Current research efforts are focused on the identification of key biochemical pathways that can be targeted therapeutically through biological intervention for cartilage repair. Autologous platelet-rich plasma (PRP), which contains a pool of growth factors, appears to offer an easy solution for delivering multiple growth factors needed for tissue repair. PRP therapy provides delivery of a highly concentrated of growth factors to accelerate healing. The present study has been undertaken in Gandhi Medical College, Hospital, Hyderabad, Telangana, India to study the role of PRP in the osteoarthritis of knee joint. In this study PRP from the patient’s own blood i.e. autologous PRP has been immediately infiltrated into their knee joints with osteoarthritis and the results of injection of PRP have been observed and assess the functional outcome. It is a prospective longitudinal study on 100 patients with 161 primary osteoarthritic knee joints of Kellgren Lawrence radiological grade I-61 and II - 100. Patients were assessed with WOMAC (Western Ontario McMaster Universities Arthritis Index) scoring pre injection of PRP and post injection period of 1 month and 6 months. A reduction in WOMAC score is suggestive of improvement in the patient’s condition. In this study, the pain scores of the patients have decreased on the day of infiltration to one month and six months. Their mean scores have decreased from the day of infiltration to one month and six months. All the patients have started showing improvement at around two weeks and over all, the pain intensity has decreased in severity. It can be concluded that the efficacy of the PRP treatment from zero day to sixth month is statistically significant.

Platelet-rich plasma in osteoarthritis treatment: review of current evidence.

Platelet-rich plasma (PRP) is defined as a volume of plasma with a platelet concentration higher than the average in peripheral blood. Many basic, preclinical and even clinical case studies and trials report PRP’s ability to improve musculoskeletal conditions including osteoarthritis, but paradoxically, just as many conclude it has no effect. The purpose of this narrative review is to discuss the available relevant evidence that supports the clinical use of PRP in osteoarthritis, highlighting those variables we perceive as critical. Here, recent systematic reviews and meta-analyses were used to identify the latest randomized controlled trials (RCTs) testing a PRP product as an intra-articular treatment for knee osteoarthritis, compared with an intra-articular control (mostly hyaluronic acid). Conclusions in the identified RCTs are examined and compared. In total, five recent meta-analyses and systematic reviews were found meeting the above criteria. A total of 19 individual trials were identified in the five reviews but only 9 were level of evidence I RCTs, and many had moderate or high risks of bias. At present, results from these RCTs seem to favor PRP use over other intra-articular treatments to improve pain scales in the short and medium term (6–12 months), but the overall level of evidence is low. As a result, clinical effectiveness of PRP for knee osteoarthritis treatment is still under debate. This is, prominently, the result of a lack of standardization of PRP products, scarceness of high quality RCTs not showing high risks of bias, and poor patient stratification for inclusion in the RCTs.

Platelet rich plasma in osteoarthritis: More than a growth factor therapy

Osteoarthritis (OA) is the most commonly encountered degenerative joint disorder in clinical medicine and the pain and stiffness caused by osteoarthritis represents a leading cause of physical disability in individuals of retirement age. Treatment options for OA patients are limited and largely targeted to pain management. Such is the mechanism behind the most commonly prescribed OA therapies including acetaminophen, NSAIDs, opioids, and steroids. However, these palliative pain management tools do not address the underlying pathophysiology of OA disease. This leaves a significant clinical unmet need for disease modifying OA therapies. Growth factor therapies and regenerative medicine strategies are emerging as promising alternatives to palliative care because these treatments bring significant potential to control chronic inflammation, enhance cartilage repair, and restore other joint tissues to a healthy state. Interestingly, a Clinicaltrials.gov search using the terms “osteoarthritis” and “growth factor” identified 43 relevant studies. Of these, only 26% used growth factor therapies directly, including FGF-18, BMP-2, and transgenic human chondrocytes producing TGF-b1. 23% of the studies were dedicated to inhibitors of NGF. The overwhelming majority of studies (47%) used autologous blood products, especially platelet rich plasma (PRP), which constituted 33% of the total studies. This was interesting because although platelets in PRP do indeed harbor large quantities of different growth factors that can affect the status of the treated tissue, growth factors represent only a single aspect of the bioactivity of platelets. Furthermore, platelets represent only one aspect of the potential bioactivity of PRP. Depending upon the methods used for PRP generation, it may also contain other physiologically important components of the whole blood from which it is derived. Recent studies indicate non-platelet components of whole blood such as red blood cells and leukocytes are essential for normal platelet function, including growth factor release. Therefore, this narrative review discusses PRP from a physiological context that explores beyond platelet growth factors to encompass and illuminate roles of non-platelet cells in the bioactivity of PRP, and how these additional mechanisms lead to the conclusion that PRP can be much more than a growth factor therapy.

RETRACTED ARTICLE: Intra-articular injection in the knee of adipose derived stromal cells (stromal vascular fraction) and platelet rich plasma for osteoarthritis

BackgroundStromal vascular fraction (SVF) can easily be obtained from a mini-lipoaspirate procedure of fat tissue and platelet rich plasma (PRP) can be obtained from peripheral blood. We evaluated the safety and preliminary efficacy of administering SVF and PRP intra-articularly into patients with osteoarthritis grade 1 and 2.MethodsA total of ten patients underwent a local tumescent liposuction procedure to remove approximately 100 ml of fat tissue from the abdomen. SVF was isolated using an enzyme digestion and resuspended in PRP for intra-articular injection in the knee. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and six-minute walk distance (6MWD) were used to evaluate clinical effects and included measure of patient’s subjective assessment of pain, joint mobility, and physical disability. WOMAC score, 6MWD and laboratory tests were repeated at 3 and 6 months and 1, 1.5 and 2 years. XRAY and MRI were completed at 1 year.ResultsThe average total WOMAC score was 64 at baseline and significantly reduced to 52 at 3 months, 46 at 6 months, 42 at 1 year, 38 at 1.5 years, and 41 at 2 years. Patients walked an average of 1310 feet at baseline and demonstrated a statistically significant improvement at 3 and 6 months and 1, 1.5, and 2 years post treatment. Cartilage thickness as determined by MRI improved by at least 0.2 mm in six patients, was unchanged in two patients and decreased by at least 0.2 mm in two patients.ConclusionsOverall, all of the patients were pleased with the treatment results. They reported a reduction in pain levels, especially after 3 months. More importantly, the procedure demonstrated a strong safety profile with no severe adverse events or complications reported.Trial registration NCT03089762; Name of registry: http://www.clinicaltrials.gov

Platelet-Rich Plasma for the Management of Hip and Knee Osteoarthritis.

Knee and hip osteoarthritis (OA) are major public health problems worldwide causing pain, disability and impaired quality of life. This narrative paper discusses platelet-rich plasma (PRP) as a treatment for hip and knee OA, with a focus on evidence from randomised controlled trials (RCTs). Since the first RCT of PRP in 2012, there has been 15 RCTs in knee OA and three in hip OA, mostly comparing PRP to another intra-articular injection therapy, hyaluronic acid. All studies are of low to moderate methodological quality and use variable PRP protocols. In general, results showed that PRP is a safe treatment with potential to provide symptomatic benefit for OA at least in the short term (up to 12months). Younger patients with less severe disease may be more responsive. There are no RCTs investigating the effects of PRP on OA structural changes. No definitive conclusions can be made about the effects of PRP in OA given methodological concerns and considerable heterogeneity between studies. Further high-quality research is needed to establish the clinical and cost-effectiveness of PRP, the patients most likely to benefit and the optimal PRP protocol.

Management of knee osteoarthritis by combined stromal vascular fraction cell therapy, platelet-rich plasma, and musculoskeletal exercises: a case series.

IntroductionKnee osteoarthritis is associated with persistent joint pain, stiffness, joint deformities, ligament damage, and surrounding muscle atrophy. The complexity of the disease makes treatment difficult. There are no therapeutic drugs available to halt the disease progression, leaving patients dependent on pain medication, anti-inflammatory drugs, or invasive joint replacement surgery.Case presentationsFour patients with a history of unresolved symptomatic knee osteoarthritis were investigated for the therapeutic outcome of combining an exercise rehabilitation program with intra-articular injections of autologous StroMed (ie, stromal vascular fraction cells concentrated by ultrasonic cavitation from lipoaspirate) and platelet-rich plasma (PRP). The Knee Injury and Osteoarthritis Outcome Score questionnaire (KOOS) was administered along with physical function tests over a 12-month period. The first patient achieved a maximum therapeutic outcome of 100 in all five KOOS subscales (left knee), and 100 for four subscales (right knee). The second patient scored 100 in all five KOOS subscales (left knee), and greater than 84 in all subscales (right knee). Treatment of the third patient resulted in improved outcomes in both knees of >93 for four KOOS subscales, and 60 for the Function in Sport and Recreation subscale. The fourth patient improved to 100 in all five KOOS subscales. In all patients, the physical function “Get-up and Go” test and “Stair Climbing Test” returned to normal (a value of zero).ConclusionThis case series indicates that improved outcomes may be obtained when autologous stromal vascular fraction (StroMed) cell therapy is combined with traditional exercise practices and PRP for osteoarthritis. Of the seven joints treated: all patients’ scores of pain improved to >96; and quality of life scores to >93. Functional performance measures of mobility returned to normal. This simple treatment appears to be extremely effective for osteoarthritis disorders that have no drug treatment to halt disease progression.