Abstract
The use of platelet-rich plasma (PRP) has been supported by encouraging data from in vitro and preclinical in vivo studies, both in terms of safety and efficacy. This led to the wide use of PRP injections in the clinical practice, with promising results especially as a minimally invasive treatment for cartilage degeneration and osteoarthritis (OA). While many controversies remain on the best PRP formulation, the overall available clinical studies support the benefits of PRP, with functional improvement and reduction of pain-related symptoms up to 12 months, especially in young patients and early OA stages.
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References
Ayhan E, Kesmezacar H, Akgun I (2014) Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop 5(3):351–361. https://doi.org/10.5312/wjo.v5.i3.351
Crawford DC, Miller LE, Block JE (2013) Conservative management of symptomatic knee osteoarthritis: a flawed strategy? Orthop Rev 5(1):e2. https://doi.org/10.4081/or.2013.e2
Jevsevar DS (2013) Treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg 21(9):571–576. https://doi.org/10.5435/JAAOS-21-09-571
Bannuru RR, Osani MC, Vaysbrot EE et al (2019) OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil 27(11):1578–1589. https://doi.org/10.1016/j.joca.2019.06.011
Bruyere O, Honvo G, Veronese N et al (2019) An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum 49(3):337–350. https://doi.org/10.1016/j.semarthrit.2019.04.008
Filardo G, Kon E, Longo UG et al (2016) Non-surgical treatments for the management of early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24(6):1775–1785. https://doi.org/10.1007/s00167-016-4089-y
Kon E, Filardo G, Drobnic M et al (2012) Non-surgical management of early knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 20(3):436–449. https://doi.org/10.1007/s00167-011-1713-8
Marx RE (2001) Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent 10(4):225–228. https://doi.org/10.1097/00008505-200110000-00002
Sundman EA, Cole BJ, Fortier LA (2011) Growth factor and catabolic cytokine concentrations are influenced by the cellular composition of platelet-rich plasma. Am J Sports Med 39(10):2135–2140. https://doi.org/10.1177/0363546511417792
Di Matteo B, Kon E, Filardo G (2016) Intra-articular platelet-rich plasma for the treatment of osteoarthritis. Ann Transl Med 4(3):63. https://doi.org/10.3978/j.issn.2305-5839.2016.01.18
Foster TE, Puskas BL, Mandelbaum BR et al (2009) Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med 37(11):2259–2272. https://doi.org/10.1177/0363546509349921
Dhurat R, Sukesh M (2014) Principles and methods of preparation of platelet-rich plasma: a review and author’s perspective. J Cutan Aesthet Surg 7(4):189–197. https://doi.org/10.4103/0974-2077.150734
Filardo G, Kon E, Roffi A et al (2015) Platelet-rich plasma: why intra-articular? A systematic review of preclinical studies and clinical evidence on PRP for joint degeneration. Knee Surg Sports Traumatol Arthrosc 23(9):2459–2474. https://doi.org/10.1007/s00167-013-2743-1
Park SI, Lee HR, Kim S et al (2012) Time-sequential modulation in expression of growth factors from platelet-rich plasma (PRP) on the chondrocyte cultures. Mol Cell Biochem 361(1–2):9–17. https://doi.org/10.1007/s11010-011-1081-1
Rikkers M, Dijkstra K, Terhaard BF et al (2021) Platelet-rich plasma does not inhibit inflammation or promote regeneration in human osteoarthritic chondrocytes in vitro despite increased proliferation. Cartilage 13(2_suppl):991S–1003S. https://doi.org/10.1177/1947603520961162
Assirelli E, Filardo G, Mariani E et al (2015) Effect of two different preparations of platelet-rich plasma on synoviocytes. Knee Surg Sports Traumatol Arthrosc 23(9):2690–2703. https://doi.org/10.1007/s00167-014-3113-3
Ishida K, Kuroda R, Miwa M et al (2007) The regenerative effects of platelet-rich plasma on meniscal cells in vitro and its in vivo application with biodegradable gelatin hydrogel. Tissue Eng 13(5):1103–1112. https://doi.org/10.1089/ten.2006.0193
Pereira RC, Scaranari M, Benelli R et al (2013) Dual effect of platelet lysate on human articular cartilage: a maintenance of chondrogenic potential and a transient proinflammatory activity followed by an inflammation resolution. Tissue Eng A 19(11–12):1476–1488. https://doi.org/10.1089/ten.TEA.2012.0225
Mariani E, Canella V, Berlingeri A et al (2015) Leukocyte presence does not increase microbicidal activity of Platelet-rich Plasma in vitro. BMC Microbiol 15:149. https://doi.org/10.1186/s12866-015-0482-9
Kuyinu EL, Narayanan G, Nair LS et al (2016) Animal models of osteoarthritis: classification, update, and measurement of outcomes. J Orthop Surg Res 11:19. https://doi.org/10.1186/s13018-016-0346-5
Boffa A, Salerno M, Merli G et al (2021) Platelet-rich plasma injections induce disease-modifying effects in the treatment of osteoarthritis in animal models. Knee Surg Sports Traumatol Arthrosc 29(12):4100–4121. https://doi.org/10.1007/s00167-021-06659-9
Kanwat H, Singh DM, Kumar CD et al (2017) The effect of intra-articular allogenic platelet rich plasma in Dunkin-Hartley guinea pig model of knee osteoarthritis. Muscles Ligaments Tendons J 7(3):426–434. https://doi.org/10.11138/mltj/2017.7.3.426
Olifirenko O, Savosko S, Movchan O (2020) Knee joint structural changes in osteoarthritis and injections of platelet rich plasma and bone marrow aspirate concentrate. Georgian Med News (303):184–188
Jayaram P, Liu C, Dawson B et al (2020) Leukocyte-dependent effects of platelet-rich plasma on cartilage loss and thermal hyperalgesia in a mouse model of post-traumatic osteoarthritis. Osteoarthr Cartil 28(10):1385–1393. https://doi.org/10.1016/j.joca.2020.06.004
Asjid R, Faisal T, Qamar K et al (2019) Platelet-rich plasma-induced inhibition of chondrocyte apoptosis directly affects cartilage thickness in osteoarthritis. Cureus 11(11):e6050. https://doi.org/10.7759/cureus.6050
Yan L, Zhou L, Xie D et al (2019) Chondroprotective effects of platelet lysate towards monoiodoacetate-induced arthritis by suppression of TNF-alpha-induced activation of NF-kB pathway in chondrocytes. Aging 11(9):2797–2811. https://doi.org/10.18632/aging.101952
Yun S, Ku SK, Kwon YS (2016) Adipose-derived mesenchymal stem cells and platelet-rich plasma synergistically ameliorate the surgical-induced osteoarthritis in Beagle dogs. J Orthop Surg Res 11:9. https://doi.org/10.1186/s13018-016-0342-9
Wu JZZ, Qin X, Cai X (2016) Platelet-rich-plasma alleviates pathological symptoms in a rabbit model of osteoarthritis. Int J Clin Exp Med 9(11):21038–21047
Chouhan DK, Dhillon MS, Patel S et al (2019) Multiple platelet-rich plasma injections versus single platelet-rich plasma injection in early osteoarthritis of the knee: an experimental study in a guinea pig model of early knee osteoarthritis. Am J Sports Med 47(10):2300–2307. https://doi.org/10.1177/0363546519856605
Yokoyama M, Sato M, Tani Y et al (2017) Platelet-activated serum might have a therapeutic effect on damaged articular cartilage. J Tissue Eng Regen Med 11(12):3305–3312. https://doi.org/10.1002/term.2238
Almasry SM, Soliman HM, El-Tarhouny SA et al (2015) Platelet rich plasma enhances the immunohistochemical expression of platelet derived growth factor and vascular endothelial growth factor in the synovium of the meniscectomized rat models of osteoarthritis. Ann Anat 197:38–49. https://doi.org/10.1016/j.aanat.2014.10.006
Araya N, Miyatake K, Tsuji K et al (2020) Intra-articular injection of pure platelet-rich plasma is the most effective treatment for joint pain by modulating synovial inflammation and calcitonin gene-related peptide expression in a rat arthritis model. Am J Sports Med 48(8):2004–2012. https://doi.org/10.1177/0363546520924011
Khatab S, van Buul GM, Kops N et al (2018) Intra-articular injections of platelet-rich plasma releasate reduce pain and synovial inflammation in a mouse model of osteoarthritis. Am J Sports Med 46(4):977–986. https://doi.org/10.1177/0363546517750635
Ahmad MR, Badar W, Ullah Khan MA et al (2020) Combination of preconditioned adipose-derived mesenchymal stem cells and platelet-rich plasma improves the repair of osteoarthritis in rat. Regen Med 15(11):2285–2295. https://doi.org/10.2217/rme-2020-0040
Yin WJ, Xu HT, Sheng JG et al (2016) Advantages of pure platelet-rich plasma compared with leukocyte- and platelet-rich plasma in treating rabbit knee osteoarthritis. Med Sci Monit 22:1280–1290. https://doi.org/10.12659/msm.898218
Filardo G, Kon E, Buda R et al (2011) Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc 19(4):528–535. https://doi.org/10.1007/s00167-010-1238-6
Southworth TM, Naveen NB, Tauro TM et al (2019) The use of platelet-rich plasma in symptomatic knee osteoarthritis. J Knee Surg 32(1):37–45. https://doi.org/10.1055/s-0038-1675170
Altamura SA, Di Martino A, Andriolo L et al (2020) Platelet-rich plasma for sport-active patients with knee osteoarthritis: limited return to sport. Biomed Res Int 2020:8243865. https://doi.org/10.1155/2020/8243865
Campbell KA, Saltzman BM, Mascarenhas R et al (2015) Does intra-articular platelet-rich plasma injection provide clinically superior outcomes compared with other therapies in the treatment of knee osteoarthritis? A systematic review of overlapping meta-analyses. Arthroscopy 31(11):2213–2221. https://doi.org/10.1016/j.arthro.2015.03.041
Previtali D, Merli G, Di Laura Frattura G et al (2021) The long-lasting effects of “placebo injections” in knee osteoarthritis: a meta-analysis. Cartilage 13(1_suppl):185S–196S. https://doi.org/10.1177/1947603520906597
Filardo G, Previtali D, Napoli F et al (2021) PRP injections for the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials. Cartilage 13(1_suppl):364S–375S. https://doi.org/10.1177/1947603520931170
Di Martino A, Di Matteo B, Papio T et al (2019) Platelet-rich plasma versus hyaluronic acid injections for the treatment of knee osteoarthritis: results at 5 years of a double-blind, randomized controlled trial. Am J Sports Med 47(2):347–354. https://doi.org/10.1177/0363546518814532
Sanchez M, Jorquera C, Sanchez P et al (2021) Platelet-rich plasma injections delay the need for knee arthroplasty: a retrospective study and survival analysis. Int Orthop 45(2):401–410. https://doi.org/10.1007/s00264-020-04669-9
Buendia-Lopez D, Medina-Quiros M, Fernandez-Villacanas Marin MA (2018) Clinical and radiographic comparison of a single LP-PRP injection, a single hyaluronic acid injection and daily NSAID administration with a 52-week follow-up: a randomized controlled trial. J Orthop Traumatol 19(1):3. https://doi.org/10.1186/s10195-018-0501-3
Ahmad HS, Farrag SE, Okasha AE et al (2018) Clinical outcomes are associated with changes in ultrasonographic structural appearance after platelet-rich plasma treatment for knee osteoarthritis. Int J Rheum Dis 21(5):960–966. https://doi.org/10.1111/1756-185X.13315
Raeissadat SA, Ghorbani E, Sanei Taheri M et al (2020) MRI changes after platelet rich plasma injection in knee osteoarthritis (randomized clinical trial). J Pain Res 13:65–73. https://doi.org/10.2147/JPR.S204788
Mautner K, Malanga GA, Smith J et al (2015) A call for a standard classification system for future biologic research: the rationale for new PRP nomenclature. PM R 7(4 Suppl):S53–S59. https://doi.org/10.1016/j.pmrj.2015.02.005
Braun HJ, Kim HJ, Chu CR et al (2014) The effect of platelet-rich plasma formulations and blood products on human synoviocytes: implications for intra-articular injury and therapy. Am J Sports Med 42(5):1204–1210. https://doi.org/10.1177/0363546514525593
Cavallo C, Filardo G, Mariani E et al (2014) Comparison of platelet-rich plasma formulations for cartilage healing: an in vitro study. J Bone Joint Surg Am 96(5):423–429. https://doi.org/10.2106/JBJS.M.00726
Filardo G, Kon E, Pereira Ruiz MT et al (2012) Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach. Knee Surg Sports Traumatol Arthrosc 20(10):2082–2091. https://doi.org/10.1007/s00167-011-1837-x
Mariani E, Canella V, Cattini L et al (2016) Leukocyte-rich platelet-rich plasma injections do not up-modulate intra-articular pro-inflammatory cytokines in the osteoarthritic knee. PLoS One 11(6):e0156137. https://doi.org/10.1371/journal.pone.0156137
Kon E, Di Matteo B, Delgado D et al (2020) Platelet-rich plasma for the treatment of knee osteoarthritis: an expert opinion and proposal for a novel classification and coding system. Expert Opin Biol Ther 20(12):1447–1460. https://doi.org/10.1080/14712598.2020.1798925
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Boffa, A., Filardo, G. (2023). Platelet-Rich Plasma for Intra-articular Injections: Preclinical and Clinical Evidence. In: Stoddart, M.J., Della Bella, E., Armiento, A.R. (eds) Cartilage Tissue Engineering. Methods in Molecular Biology, vol 2598. Humana, New York, NY. https://doi.org/10.1007/978-1-0716-2839-3_28
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