Skip to main content
SpringerLink
Log in

PRP in the Treatment of Cartilage Defects and Early Osteoarthritis of the Knee

  • Living reference work entry
  • First Online:
Sports Injuries

  • 345 Accesses

Abstract

With increasing frequency, platelet-rich plasma (PRP) preparations have been used to treat cartilage lesions to regenerate tissue homeostasis and retard the progression of knee osteoarthritis (OA). Several authors reported promising preliminary clinical results after the treatment of knee OA with PRP injections. In a prospective case series, 50 patients with knee OA were treated with two intra-articular injections of autologous PRP and followed up for a minimum of 12 months. All patients showed significant improvement in all scores at 6–12 months (p < 0.01), by means of diminishing pain and improved symptoms and quality of life. No significant difference in improvement was found between the evaluated subgroups (p < 0.01). In another prospective, randomized study, 93 patients (119 knees) with early stages of knee OA were followed up for a minimum of 2 years; 50 knees were randomly selected prior to the first injection to receive a second cycle at the completion of 1 year. At 2 years, scores declined in both groups but remained above the pretreatment values; patients with two cycles showed higher mean values in all the scores. However, the clinical efficacy of PRP remains under debate, and a standardized protocol has not yet been established. Different PRP products might be more or less appropriate to treat different types of tissues and pathologies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Akeda K, An HS, Okuma M (2006) Platelet rich plasma stimulates porcine articular chondrocyte proliferation and matrix biosynthesis. Osteoarthritis Cartilage 14(12):1272–1280

    Article  PubMed  CAS  Google Scholar 

  • Alberts B, Bray D, Lewis J, Raff M, Roberts K, Watson JD (1994) Molecular biology of the cell, 3rd edn. Garland Science, New York

    Google Scholar 

  • Altman R, Asch E, Bloch D et al (1986) Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum 29:1039–1049

    Article  PubMed  CAS  Google Scholar 

  • Anitua E, Sanchez M, Nurden AT et al (2006) New insights into and novel applications for platelet rich and fibrin therapies. Trends Biotechnol 24(5):227–234

    Article  PubMed  CAS  Google Scholar 

  • Anitua E, Sanchez M, Nurden AT et al (2007a) Platelet-released growth factors enhance the secretion of hyaluronic acid and leads hepatocyte growth factor production by synovial fibroblasts from arthritic patients. Rheumatology 46(12):1769–1772

    Article  PubMed  CAS  Google Scholar 

  • Anitua E, Sanchez M, Orive G, Andia I (2007b) The potential impact of the preparation rich in growth factors (PRGF) in different medical fields. Biomaterials 28:4551–4556

    Article  PubMed  CAS  Google Scholar 

  • Aspenberg P, Virchenko O (2004) Platelet concentrate injections improves Achilles tendon repair in rats. Acta Orthop Scand 75(1):93–99

    Article  PubMed  Google Scholar 

  • Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G (2006) Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 19(2), CD005328

    Google Scholar 

  • Bendinelli P, Matteucci E, Dogliotti G et al (2010) Molecular basis of anti-inflammatory action of platelet-rich plasma on human chondrocytes: mechanisms of NF-κB inhibition via HGF. J Cell Physiol 225(3):757–766

    Article  PubMed  CAS  Google Scholar 

  • Bennett NT, Schultz GS (1993) Growth factors and wound healing: biochemical properties of growth factors and their receptors. Am J Surg 165(6):728–737

    Article  PubMed  CAS  Google Scholar 

  • Block JA, Shakoor N (2010) Lower limb osteoarthritis: biomechanical alterations and implications for therapy. Curr Opin Rheumatol 22(5):544–550

    Article  PubMed  Google Scholar 

  • Borzini P, Mazzucco L (2005) Tissue regeneration and in-loco administration of platelet derivatives: clinical outcome, heterogeneous products, heterogeneity of the effector mechanisms. Transfusion 35:1759–1767

    Article  Google Scholar 

  • Cugat R, Carrillo JM, Serra I, Soler C (2006) Articular cartilage defects reconstruction by plasma rich growth factors. In: Zanasi S, Brittberg M, Marcacci M (eds) Basic science, clinical repair and reconstruction of articular cartilage defects: current status and prospects. Timeo Editore, Bologna, pp 801–807

    Google Scholar 

  • de Vos RJ, Weir A, van Schie HT et al (2010) Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA 303(2):144–149

    Article  PubMed  Google Scholar 

  • Dohan-Ehrenfest DM, Rasmusson L, Albrektssson T (2008) Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol 27(3):158–167

    Article  Google Scholar 

  • Everts PA, Knape JT, Weibrich G et al (2006) Platelet-rich plasma and platelet gel: a review. J Extra Corpor Technol 38(2):174–187

    PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA (2009) Platelet rich plasma: from basic science to clinical applications. Am J Sports Med 37(11):2259–2272

    Article  PubMed  Google Scholar 

  • Frisbie D, Kawcak C, Werpy N et al (2007) Clinical biochemical and histological effects of intraarticular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis. Am J Vet Res 68(3):290–296

    Article  PubMed  Google Scholar 

  • Gaissmaier C, Fritz J, Krackhardt T, Flesch I, Aicher WK, Ashammakhi N (2005) Effect of human platelet supernatant on proliferation and matrix synthesis of human articular chondrocytes in monolayer and three-dimensional alginate cultures. Biomaterials 26(14):1953–1960

    Article  PubMed  CAS  Google Scholar 

  • Gobbi A, Bathan L (2009) Biological approaches for cartilage repair. J Knee Surg 22(1):36–44

    Article  PubMed  Google Scholar 

  • Gobbi A, Karnatzikos G, Mahajan V, Malchira S (2012) Platelet-rich plasma treatment in symptomatic patients with knee osteoarthritis: preliminary results in a group of active patients. Sports Health 4(2):162–172

    Article  PubMed  PubMed Central  Google Scholar 

  • Gobbi A, Karnatzikos G, Kumar A (2014a) Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes. Knee Surg Sports Traumatol Arthrosc. 22(9):1986-96. doi: 10.1007/s00167-013-2676-8

    Google Scholar 

  • Gobbi A, Lad D, Karnatzikos G (2014b) The effects of repeated intra-articular PRP injections on clinical outcomes of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-2987-4. [Epub ahead of print]

    Google Scholar 

  • Gomoll A, Farr J (2009) Future developments in cartilage repair. In: Cole B, Gomoll A (eds) Biologic joint reconstruction. Slack, Thorofare, pp 163–168

    Google Scholar 

  • Graziani F, Ivanovski S, Cei S, Ducci F, Tonetti M, Gabriele M (2006) The in vitro effect of different PRP concentrations on osteoblasts and fibroblasts. Clin Oral Implants Res 17(2):212–219

    Article  PubMed  Google Scholar 

  • Habib GS (2009) Systemic effects of intra-articular corticosteroids. Clin Rheumatol 28(7):749–756

    Article  PubMed  Google Scholar 

  • Habib GS, Saliba W, Nashashibi M (2010) Local effects of intra-articular corticosteroids. Clin Rheumatol 29(4):347–356

    Article  PubMed  Google Scholar 

  • Harrison S, Vavken P, Kevy S, Jacobson M, Zurakowski D, Murray MM (2011) Platelet activation by collagen provides sustained release of anabolic cytokines. Am J Sports Med 39(4):729–734

    Article  PubMed  PubMed Central  Google Scholar 

  • Hepper CT, Halvorson JJ, Duncan ST, Gregory AJ, Dunn WR, Spindler KP (2009) The efficacy and duration of intra-articular corticosteroid injection for knee osteoarthritis: a systematic review of level I studies. J Am Acad Orthop Surg 17(10):638–646

    PubMed  Google Scholar 

  • Hunter W (1743) On the structure and diseases of articulating cartilage. Philos Trans Rsoc Lond B Biol Sci. 9:277

    Google Scholar 

  • Irrgang JJ, Anderson AF, Boland AL et al (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29(5):600–613

    PubMed  CAS  Google Scholar 

  • Jacobs JJ, King TR, Klippel JH, Berven SH et al (2013) Beyond the decade: strategic priorities to reduce the burden of musculoskeletal disease. J Bone Joint Surg Am 95(17):e1251–e1256

    Article  PubMed  Google Scholar 

  • Kon E, Filardo G, Delcogliano M et al (2009) Platelet-rich plasma: new clinical application. A pilot study for treatment of jumper’s knee. Injury 40(6):598–603

    Article  PubMed  Google Scholar 

  • Kon E, Buda R, Filardo G et al (2010) Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc 18(4):472–479

    Article  PubMed  Google Scholar 

  • Lieberman JR, Daluiski A, Einhorn TA (2002) The role of growth factors in the repair of bone: biology and clinical applications. J Bone Joint Surg Am 84(6):1032–1044

    PubMed  Google Scholar 

  • Lopez-Vidriero E, Goulding KA, Simon DA, Sanchez M, Johnson DH (2010) The use of platelet-rich plasma in arthroscopy and sports medicine: optimizing the healing environment. Arthroscopy 26(2):269–278

    Article  PubMed  Google Scholar 

  • Luyten FP, Denti M, Filardo G, Kon E, Engebretsen L (2011) Definition and classification of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-011-1743–2

    Google Scholar 

  • Mankin HJ (1982) The response of articular cartilage to mechanical injury. J Bone Joint Surg Am 64(3):460–466

    PubMed  CAS  Google Scholar 

  • Marx RG, Stump TJ, Jones EC, Wickiewicz TL, Warren RF (2001) Development and evaluation of an activity rating scale for disorders of the knee. Am J Sports Med 29(2):213–218

    PubMed  CAS  Google Scholar 

  • Mazzucco L, Balbo V, Cattana E, Borzini P (2008) Platelet-rich plasma and platelet gel preparation using Plateltex. Vox Sang 94(3):202–208

    Article  PubMed  CAS  Google Scholar 

  • Mazzucco L, Balbo V, Cattana E, Guaschino R, Borzini P (2009) Not every PRP gel is born equal: evaluation of growth factor availability for tissues through four PRP-gel preparations. FibrinetR, Regen PRP-KitR, PlateltexR and one manual procedure. Vox Sang 97(2):110–118

    Article  PubMed  CAS  Google Scholar 

  • McCarrel T, Fortier L (2009) Temporal growth factor release from platelet-rich plasma, trehalose lyophilized platelets, and bone marrow aspirate and their effect on tendon and ligament gene expression. J Orthop Res 27(8):1033–1042

    Article  PubMed  CAS  Google Scholar 

  • McKinley BJ, Cushner FD, Scott WN (1999) Debridement arthroscopy: 10-year follow-up. Clin Orthop Relat Res 367:190–194

    Google Scholar 

  • Menetrey J, Kasemkijwattana C, Day CS et al (2000) Growth factors improves muscle healing in vivo. J Bone Joint Surg Br 82(1):131–137

    Article  PubMed  CAS  Google Scholar 

  • Milano G, Sanna Passino E, Deriu L et al (2010) The effect of platelet rich plasma combined with microfractures on the treatment of chondral defects: an experimental study in a sheep model. Osteoarthritis Cartilage 18(7):971–980

    Article  PubMed  CAS  Google Scholar 

  • Minas T, Gomoll AH, Rosenberger R et al (2009) Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques. Am J Sports Med 37(5):902–908

    Article  PubMed  Google Scholar 

  • Mishra A, Pavelko T (2006) Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med 34(11):1774–1778

    Article  PubMed  Google Scholar 

  • Molloy T, Wang Y, Murrell G (2003) The roles of growth factors in tendon and ligament healing. Sports Med 33(5):381–394

    Article  PubMed  Google Scholar 

  • Nakagawa K, Sasho T, Arai M et al (2007) Effects of autologous platelet-rich plasma on the metabolism of human articular chondrocytes. Osteoarthritis Cartilage 15(suppl 2):B134

    Article  Google Scholar 

  • Nuki G (2008) Osteoarthritis. In: Luqmani R, Robb J, Porter D et al (eds) Textbook of orthopaedics, trauma and rheumatology. Mosby, Chicago, p 193

    Google Scholar 

  • Pratsinis H, Kletsas D (2007) PDGF, bFGF and IGF-I stimulate the proliferation of intervertebral disc cells in vitro via the activation of the ERK and Akt signaling pathways. Eur Spine J 16(11):1858–1866

    Article  PubMed  PubMed Central  Google Scholar 

  • Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS): development of a self-administered outcome measure. J Orthop Sports Phys Ther 28(2):88–96

    Article  PubMed  CAS  Google Scholar 

  • Saito M, Takahashi KA, Arai Y et al (2009) Intra-articular administration of platelet-rich plasma with biodegradable gelatin hydrogel microspheres prevents osteoarthritis progression in the rabbit knee. Clin Exp Rheumatol 27(2):201–207

    PubMed  CAS  Google Scholar 

  • Sampson S, Reed M, Silvers H, Meng M, Mandelbaum B (2010) Injection of platelet rich plasma in patients with primary and secondary knee osteoarthritis: a pilot study. Am J Phys Med Rehabil 89(12):961–969

    Article  PubMed  Google Scholar 

  • Sánchez M, Anitua E, Cugat R et al (2009a) Nonunions treated with autologous preparation rich in growth factors. J Orthop Trauma 23(1):52–59

    Article  PubMed  Google Scholar 

  • Sánchez M, Anitua E, Orive G, Mujika I, Andia I (2009b) Platelet-rich therapies in the treatment of orthopaedic sport injuries. Sports Med 39(5):345–354

    Article  PubMed  Google Scholar 

  • Staudenmaier R, Froelich K, Birner M et al (2009) Optimization of platelet isolation and extraction of autogenous TGF-beta in cartilage tissue engineering. Artif Cells Blood Substit Immobil Biotechnol 37(6):265–272

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Tabata Y (2003) Tissue regeneration based on growth factor release. Tissue Eng 9(suppl 1):S5–S15

    Article  PubMed  CAS  Google Scholar 

  • Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    PubMed  Google Scholar 

  • Wang-Saegusa A, Cugat R, Ares O, Seijas R, Cuscó X, Garcia-Balletbó M (2011) Infiltration of plasma rich in growth factors for osteoarthritis of the knee short-term effects on function and quality of life. Arch Orthop Trauma Surg 131(3):311–317

    Article  PubMed  Google Scholar 

  • Weibrich G, Hansen T, Kleis W, Buch R, Hitzler WE (2004) Effect of platelet concentration in platelet rich plasma on peri-implant bone regeneration. Bone 34:665–671

    Article  PubMed  CAS  Google Scholar 

  • Weibrich G, Kleis WKG, Hitzler WE, Hafner G (2005) Comparison of the platelet concentrate collection system with the plasma-rich-in-growth-factors kit to produce platelet-rich plasma: a technical report. Int J Oral Maxillofacial Implants 20:118–123

    Google Scholar 

  • World Anti-Doping Agency http://www.wada-ama.org

  • Wu W, Chen F, Liu Y, Ma Q, Mao T (2007) Autologous injectable tissue-engineered cartilage by using platelet-rich plasma: experimental study in a rabbit model. J Oral Maxillofac Surg 65(10):1951–1957

    Article  PubMed  Google Scholar 

  • Yamaguchi R, Terashima H, Yoneyama S, Tadano S, Ohkohchi N (2012) Effects of platelet-rich plasma on intestinal anastomotic healing in rats: PRP concentration is a key factor. J Surg Res 173(2):258–266

    Article  PubMed  Google Scholar 

  • Zhang W, Moskowitz RW, Nuki G et al (2008) OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 16(2):137–162

    Article  PubMed  CAS  Google Scholar 

  • Zhang W, Nuki G, Moskowitz RW et al (2010) OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 18(4):476–499

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopaedic Arthroscopic Surgery International (O.A.S.I.) Bioresearch Foundation Gobbi NPO, Milan, Italy

    Alberto Gobbi, Georgios Karnatzikos & Dnyanesh G. Lad

Authors
  1. Alberto Gobbi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Georgios Karnatzikos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dnyanesh G. Lad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alberto Gobbi .

Editor information

Editors and Affiliations

  1. Dept. Orthopedics & Traumatology, Hacettepe University Fac. Medicine, Ankara, Turkey

    Mahmut Nedim Doral

  2. Gothenburg, Sweden

    Jon Karlsson

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Berlin Heidelberg

About this entry

Cite this entry

Gobbi, A., Karnatzikos, G., Lad, D.G. (2014). PRP in the Treatment of Cartilage Defects and Early Osteoarthritis of the Knee. In: Doral, M., Karlsson, J. (eds) Sports Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36801-1_157-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-36801-1_157-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Online ISBN: 978-3-642-36801-1

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation