Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Clinical Update: Why PRP Should Be Your First Choice for Injection Therapy in Treating Osteoarthritis of the Knee


Purpose of Review

The purpose of this review is to update the reader on the current applications of platelet-rich plasma (PRP) in the treatment of knee osteoarthritis (KOA). This review will focus on PRP’s effect on the osteoarthritic joint, how PRP compares to traditional treatments of KOA, and provide clinical feedback on the use of PRP in an orthopedic and sports medicine practice.

Recent Findings

Recent research into the applications of PRP for KOA has further indicated both the efficacy and safety of PRP treatment. Although research has shown a tendency toward better efficacy at earlier stages of osteoarthritis (OA), evidence exists to indicate positive effects at all stages of OA.


In summary, since KOA is an extremely prevalent condition that can be a challenge to treat, it is imperative that safe and effective nonoperative treatment methods be available to individuals that are suffering from this condition.

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

Fig. 1
Fig. 2


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.

    Cisternas M, Murphy L, Sacks J, Solomon D, Pasta D, Helmick C. Alternative methods for defining osteoarthritis and the impact on estimating prevalence in a US population-based survey. Arthritis Care Res. 2016;68:574–80. https://doi.org/10.1002/acr.22721.

  2. 2.

    Sibille K, Chen H, Bartley E, Riley J, Glover T, King C, et al. Accelerated aging in adults with knee osteoarthritis pain. Pain Rep. 2017;2:e591. https://doi.org/10.1097/PR9.0000000000000591.

  3. 3.

    Torio CM, Moore BJ. National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2013: Statistical Brief #204. 2016 May. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb-. Available from: https://www.ncbi.nlm.nih.gov/books /NBK368492/. Accessed 15 July 2018.

  4. 4.

    Zhao L, Kaye AD, Abd-Elsayed A. Stem cells for the treatment of knee osteoarthritis: a comprehensive review. Pain Physician. 2018;21:229–41.

  5. 5.

    Torstensen TA, Grooten WJA, Østerås H, Heijne A, Harms-Ringdahl K, Äng BO. How does exercise dose affect patients with long-term osteoarthritis of the knee? A study protocol of a randomised controlled trial in Sweden and Norway: the SWENOR Study. BMJ Open. 2018;8:e018471. https://doi.org/10.1136/bmjopen-2017-018471.

  6. 6.

    Lai L, Stitik T, Foye P, Georgy J, Patibanda V, Chen B. Use of platelet-rich plasma in intra-articular knee injections for osteoarthritis: a systematic review. PM R. 2015;7:637–48. https://doi.org/10.1016/j.pmrj.2015.02.003.

  7. 7.

    Ayhan E. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop. 2014;5:351–61. https://doi.org/10.5312/wjo.v5.i3.351.

  8. 8.

    Laver L, Marom N, Dnyanesh L, Mei-Dan O, Espregueira-Mendes J, Gobbi A. PRP for degenerative cartilage disease: a systematic review of clinical studies. Cartilage. 2016;8:341–64. https://doi.org/10.1177/1947603516670709.

  9. 9.

    Jang S, Kim J, Cha S. Platelet-rich plasma (PRP) injections as an effective treatment for early osteoarthritis. Eur J Orthop Surg Traumatol. 2012;23:573–80. https://doi.org/10.1007/s00590-012-1037-5.

  10. 10.

    Pearle AD, Warren RF, Rodeo SA. Basic science of articular cartilage and osteoarthritis. Clin Sports Med. 2005;24:1–12. https://doi.org/10.1016/j.csm.2004.08.007.

  11. 11.

    Martel-Pelletier J, Boileau C, Pelletier J, Roughley P. Cartilage in normal and osteoarthritis conditions. Best Pract Res Clin Rheumatol. 2008;22:351–84. https://doi.org/10.1016/j.berh.2008.02.001.

  12. 12.

    Moussa M, Lajeunesse D, Hilal G, El Atat O, Haykal G, Serhal R, et al. Platelet rich plasma (PRP) induces chondroprotection via increasing autophagy, anti-inflammatory markers, and decreasing apoptosis in human osteoarthritic cartilage. Exp Cell Res. 2017;352:146–56. https://doi.org/10.1016/j.yexcr.2017.02.012.

  13. 13.

    Murray I, Benke M, Mandelbaum B. Management of knee articular cartilage injuries in athletes: chondroprotection, chondrofacilitation, and resurfacing. Knee Surg Sports Traumatol Arthrosc. 2015;24:1617–26. https://doi.org/10.1007/s00167-015-3509-8.

  14. 14.

    LaPrade R, Dragoo J, Koh J, Murray I, Geeslin A, Chu C. AAOS research symposium updates and consensus. J Am Acad Orthop Surg. 2016;24:e62–78. https://doi.org/10.5435/JAAOS-D-16-00086.

  15. 15.

    Zlotnicki J, Geeslin A, Murray I, Petrigliano F, LaPrade R, Mann B, et al. Biologic treatments for sports injuries II think tank—current concepts, future research, and barriers to advancement, part 3. Orthop J Sports Med. 2016;4:232596711664243. https://doi.org/10.1177/2325967116642433.

  16. 16.

    Kanchanatawan W, Arirachakaran A, Chaijenkij K, Prasathaporn N, Boonard M, Piyapittayanun P, et al. Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 2015;24:1665–77. https://doi.org/10.1007/s00167-015-3784-4.

  17. 17.

    Campbell K, Erickson B, Saltzman B, Mascarenhas R, Bach B, Cole B, et al. Is local viscosupplementation injection clinically superior to other therapies in the treatment of osteoarthritis of the knee: a systematic review of overlapping meta-analyses. Arthroscopy. 2015;31:2036–2045.e14. https://doi.org/10.1016/j.arthro.2015.03.030.

  18. 18.

    Patil S, McCauley J, Pulido P, Colwell C. How do knee implants perform past the second decade? Nineteen- to 25-year followup of the press-fit condylar design TKA. Clin Orthop Relat Res. 2014;473:135–40. https://doi.org/10.1007/s11999-014-3792-6.

  19. 19.

    Beswick A, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012;2:e000435. https://doi.org/10.1136/bmjopen-2011-000435.

  20. 20.

    Walker L, Clement N, Deehan D. Predicting the outcome of total knee arthroplasty using the womac score: a review of the literature. J Knee Surg. 2018. https://doi.org/10.1055/s-0038-1666866.

  21. 21.

    Zhang W, Robertson J, Jones A, Dieppe P, Doherty M. The placebo effect and its determinants in osteoarthritis: meta-analysis of randomised controlled trials. Ann Rheum Dis. 2008;67:1716–23. https://doi.org/10.1136/ard.2008.092015.

  22. 22.

    Wang P, Yang L, Li H, Lei Z, Yang X, Liu C, et al. Effects of whole-body vibration training with quadriceps strengthening exercise on functioning and gait parameters in patients with medial compartment knee osteoarthritis: a randomised controlled preliminary study. Physiotherapy. 2016;102:86–92. https://doi.org/10.1016/j.physio.2015.03.3720.

  23. 23.

    Levy D, Petersen K, Scalley Vaught M, Christian D, Cole B. Injections for knee osteoarthritis: corticosteroids, Viscosupplementation, platelet-rich plasma, and autologous stem cells. Arthroscopy. 2018;34:1730–43. https://doi.org/10.1016/j.arthro.2018.02.022.

  24. 24.

    Bennell K, Hunter D, Paterson K. Platelet-rich plasma for the management of hip and knee osteoarthritis. Curr Rheumatol Rep. 2017;19:24. https://doi.org/10.1007/s11926-017-0652-x.

  25. 25.

    Foster T, Puskas B, Mandelbaum B, Gerhardt M, Rodeo S. Platelet-rich plasma. Am J Sports Med. 2009;37:2259–72. https://doi.org/10.1177/0363546509349921.

  26. 26.

    Whitney K, Liebowitz A, Bolia I, Chahla J, Ravuri S, Evans T, et al. Current perspectives on biological approaches for osteoarthritis. Ann N Y Acad Sci. 2017;1410:26–43. https://doi.org/10.1111/nyas.13554.

  27. 27.

    Sundman E, Cole B, Karas V, Della Valle C, Tetreault M, Mohammed H, et al. The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med. 2013;42:35–41. https://doi.org/10.1177/0363546513507766.

  28. 28.

    Chahla J, Mandelbaum B. Biological treatment for osteoarthritis of the knee: moving from bench to bedside—current practical concepts. Arthroscopy. 2018;34:1719–29. https://doi.org/10.1016/j.arthro.2018.01.048.

  29. 29.

    Dhurat R, Sukesh M. Principles and methods of preparation of platelet-rich plasma: a review and author’s perspective. J Cutan Aesthet Surg. 2014;7:189–97. https://doi.org/10.4103/0974-2077.150734.

  30. 30.

    Machlus K, Thon J, Italiano J. Interpreting the developmental dance of the megakaryocyte: a review of the cellular and molecular processes mediating platelet formation. Br J Haematol. 2014;165:227–36. https://doi.org/10.1111/bjh.12758.

  31. 31.

    Spaková T, Rosocha J, Lacko M, Harvanová D, Gharaibeh A. Treatment of knee joint osteoarthritis with autologous platelet-rich plasma in comparison with hyaluronic acid. Am J Phys Med Rehabil. 2012;91:411–7. https://doi.org/10.1097/PHM.0b013e3182aab72.

  32. 32.

    Sánchez-González D, Méndez-Bolaina E, Trejo-Bahena N. Platelet-rich plasma peptides: key for regeneration. Int J Pept. 2012;2012:1–10. https://doi.org/10.1155/2012/532519.

  33. 33.

    Ludwig H, Birdwhistell K, Brainard B, Franklin S. Use of a cyclooxygenase-2 inhibitor does not inhibit platelet activation or growth factor release from platelet-rich plasma. Am J Sports Med. 2017;45:3351–7. https://doi.org/10.1177/0363546517730578.

  34. 34.

    Cole B, Seroyer S, Filardo G, Bajaj S, Fortier L. Platelet-rich plasma: where are we now and where are we going? Sports Health. 2010;2:203–10. https://doi.org/10.1177/1941738110366385.

  35. 35.

    Watson S, Bahou W, Fitzgerald D, Ouwehand W, Rao A, Leavitt A. Mapping the platelet proteome: a report of the ISTH Platelet Physiology Subcommittee. J Thromb Haemost. 2005;3:2098–101. https://doi.org/10.1111/j.1538-7836.2005.01550.x.

  36. 36.

    Xie X, Zhang C, Tuan R. Biology of platelet-rich plasma and its clinical application in cartilage repair. Arthritis Res Ther. 2014;16:204. https://doi.org/10.1186/ar4493.

  37. 37.

    Khoshbin A, Leroux T, Wasserstein D, Marks P, Theodoropoulos J, Ogilvie-Harris D, et al. The efficacy of platelet-rich plasma in the treatment of symptomatic knee osteoarthritis: a systematic review with quantitative synthesis. Arthroscopy. 2013;29:2037–48. https://doi.org/10.1016/j.arthro.2013.09.006.

  38. 38.

    Zhu Y, Yuan M, Meng H, Wang A, Guo Q, Wang Y, et al. Basic science and clinical application of platelet-rich plasma for cartilage defects and osteoarthritis: a review. Osteoarthr Cartil. 2013;21:1627–37. https://doi.org/10.1016/j.joca.2013.07.017.

  39. 39.

    Nöth U, Rackwitz L, Heymer A, Weber M, Baumann B, Steinert A, et al. Chondrogenic differentiation of human mesenchymal stem cells in collagen type I hydrogels. J Biomed Mater Res A. 2007;83A:626–35. https://doi.org/10.1002/jbm.a.31254.

  40. 40.

    Kon E, Filardo G, Di Martino A, Marcacci M. Platelet-rich plasma (PRP) to treat sports injuries: evidence to support its use. Knee Surg Sports Traumatol Arthrosc. 2010;19:516–27. https://doi.org/10.1007/s00167-010-1306-y.

  41. 41.

    Nasi S, Ea H, So A, Busso N. Revisiting the role of interleukin-1 pathway in osteoarthritis: interleukin-1α and -1β, and NLRP3 inflammasome are not involved in the pathological features of the murine menisectomy model of osteoarthritis. Front Pharmacol 2017;8. https://doi.org/10.3389/fphar.2017.00282.

  42. 42.

    Braun H, Wasterlain A, Dragoo J. The use of PRP in ligament and meniscal healing. Sports Med Arthrosc Rev. 2013;21:206–12. https://doi.org/10.1097/JSA.0000000000000005.

  43. 43.

    Schmidt M, Chen E, Lynch S. A review of the effects of insulin-like growth factor and platelet derived growth factor on in vivo cartilage healing and repair. Osteoarthr Cartil. 2006;14:403–12. https://doi.org/10.1016/j.joca.2005.10.011.

  44. 44.

    Yin W, Xu H, Sheng J, An Z, Guo S, Xie X, et al. Advantages of pure platelet-rich plasma compared with leukocyte- and platelet-rich plasma in treating rabbit knee osteoarthritis. Med Sci Monit. 2016;22:1280–90. https://doi.org/10.12659/MSM.898218.

  45. 45.

    Deasy B, Feduska J, Payne T, Li Y, Ambrosio F, Huard J. Effect of VEGF on the regenerative capacity of muscle stem cells in dystrophic skeletal muscle. Mol Ther. 2009;17:1788–98. https://doi.org/10.1038/mt.2009.136.

  46. 46.

    Filardo G, Kon E, Pereira Ruiz M, Vaccaro F, Guitaldi R, Di Martino A, et al. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach. Knee Surg Sports Traumatol Arthrosc. 2011;20:2082–91. https://doi.org/10.1007/s00167-011-1837-x.

  47. 47.

    Hall MP, Band PA, Meislin RJ, Jazrawi LM, Cardone DA. Platelet-rich plasma: current concepts and application in sports medicine. J Am Acad Orthop Surg. 2009;17:602–8.

  48. 48.

    Sundman E, Cole B, Fortier L. Growth factor and catabolic cytokine concentrations are influenced by the cellular composition of platelet-rich plasma. Am J Sports Med. 2011;39:2135–40. https://doi.org/10.1177/0363546511417792.

  49. 49.

    McCarrel T, Minas T, Fortier L. Optimization of leukocyte concentration in platelet-rich plasma for the treatment of tendinopathy. J Bone Joint Surg. 2012;94:e143. https://doi.org/10.2106/JBJS.L.00019.

  50. 50.

    Anitua E, Troya M, Zalduendo M, Orive G. The effect of different drugs on the preparation and biological outcomes of plasma rich in growth factors. Ann Anat. 2014;196:423–9. https://doi.org/10.1016/j.aanat.2014.06.002.

  51. 51.

    Boswell S, Cole B, Sundman E, Karas V, Fortier L. Platelet-rich plasma: a milieu of bioactive factors. Arthroscopy. 2012;28:429–39. https://doi.org/10.1016/j.arthro.2011.10.018.

  52. 52.

    Braun H, Kim H, Chu C, Dragoo J. The effect of platelet-rich plasma formulations and blood products on human synoviocytes. Am J Sports Med. 2014;42:1204–10. https://doi.org/10.1177/0363546514525593.

  53. 53.

    • Meheux C, McCulloch P, Lintner D, Varner K, Harris J. Efficacy of intra-articular platelet-rich plasma injections in knee osteoarthritis: a systematic review. Arthroscopy. 2016;32:495–505. https://doi.org/10.1016/j.arthro.2015.08.005 A recent systematic review focusing on level I evidence available for PRP treatment in KOA and indicating significant clinical improvements for up to 12 months post-injection.

  54. 54.

    Bendinelli P, Matteucci E, Dogliotti G, Corsi M, Banfi G, Maroni P, et al. Molecular basis of anti-inflammatory action of platelet-rich plasma on human chondrocytes: mechanisms of NF-κB inhibition via HGF. J Cell Physiol. 2010;225:757–66. https://doi.org/10.1002/jcp.22274.

  55. 55.

    Scanzello C, Goldring S. The role of synovitis in osteoarthritis pathogenesis. Bone. 2012;51:249–57. https://doi.org/10.1016/j.bone.2012.02.012.

  56. 56.

    Cavallo C, Filardo G, Mariani E, Kon E, Marcacci M, Pereira Ruiz M, et al. Comparison of platelet-rich plasma formulations for cartilage healing. J Bone Joint Surg Am. 2014;96:423–9. https://doi.org/10.2106/JBJS.M.00726.

  57. 57.

    Xu Z, Luo J, Huang X, Wang B, Zhang J, Zhou A. Efficacy of platelet-rich plasma in pain and self-report function in knee osteoarthritis. Am J Phys Med Rehabil. 2017;96:793–800. https://doi.org/10.1097/PHM.0000000000000746.

  58. 58.

    Muraglia A, Ottonello C, Spanò R, Dozin B, Strada P, Grandizio M, et al. Biological activity of a standardized freeze-dried platelet derivative to be used as cell culture medium supplement. Platelets. 2013;25:211–20. https://doi.org/10.3109/09537104.2013.803529.

  59. 59.

    Chien C, Ho H, Liang Y, Ko P, Sheu M, Chen C. Incorporation of exudates of human platelet-rich fibrin gel in biodegradable fibrin scaffolds for tissue engineering of cartilage. J Biomed Mater Res B Appl Biomater. 2012;100B:948–55. https://doi.org/10.1002/jbm.b.32657.

  60. 60.

    Wu C, Chen W, Zao B, Lai P, Lin T, Lo H, et al. Regenerative potentials of platelet-rich plasma enhanced by collagen in retrieving pro-inflammatory cytokine-inhibited chondrogenesis. Biomaterials. 2011;32:5847–54. https://doi.org/10.1016/j.biomaterials.2011.05.002.

  61. 61.

    Spreafico A, Chellini F, Frediani B, Bernardini G, Niccolini S, Serchi T, et al. Biochemical investigation of the effects of human platelet releasates on human articular chondrocytes. J Cell Biochem. 2009;108:1153–65. https://doi.org/10.1002/jcb.22344.

  62. 62.

    Akeda K, An H, Okuma M, Attawia M, Miyamoto K, Thonar E, et al. Platelet-rich plasma stimulates porcine articular chondrocyte proliferation and matrix biosynthesis. Osteoarthr Cartil. 2006;14:1272–80. https://doi.org/10.1016/j.joca.2006.05.008.

  63. 63.

    Holmes H, Wilson B, Goerger J, Silverberg J, Cohen I, Zipfel W, et al. Facilitated recruitment of mesenchymal stromal cells by bone marrow concentrate and platelet rich plasma. PLoS One. 2018;13:e0194567. https://doi.org/10.1371/journal.pone.0194567.

  64. 64.

    Smyth N, Murawski C, Fortier L, Cole B, Kennedy J. Platelet-rich plasma in the pathologic processes of cartilage: review of basic science evidence. Arthroscopy. 2013;29:1399–409. https://doi.org/10.1016/j.arthro.2013.03.004.

  65. 65.

    Sakata R, McNary S, Miyatake K, Lee C, Van den Bogaerde J, Marder R, et al. Stimulation of the superficial zone protein and lubrication in the articular cartilage by human platelet-rich plasma. Am J Sports Med. 2015;43:1467–73. https://doi.org/10.1177/0363546515575023.

  66. 66.

    Quicke J, Foster N, Thomas M, Holden M. Is long-term physical activity safe for older adults with knee pain?: a systematic review. Osteoarthr Cartil. 2015;23:1445–56. https://doi.org/10.1016/j.joca.2015.05.002.

  67. 67.

    Juhl C, Christensen R, Roos E, Zhang W, Lund H. Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheum. 2014;66:622–36. https://doi.org/10.1002/art.38290.

  68. 68.

    Bricca A, Juhl C, Steultjens M, Wirth W, Roos E. Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials. Br J Sports Med. 2018. https://doi.org/10.1136/bjsports-2017-098661.

  69. 69.

    Felson DT, Zhang Y, Anthony JM, Naimark Anderson JJ. Weight loss reduces the risk for symptomatic knee osteoarthritis in woman. The Framingham Study. Ann Intern Med. 1992;116:535–9.

  70. 70.

    Laudy A, Bakker E, Rekers M, Moen M. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br J Sports Med. 2014;49:657–72. https://doi.org/10.1136/bjsports-2014-094036.

  71. 71.

    Lazaridou A, Martel M, Cornelius M, Franceschelli O, Campbell C, Smith M, et al. The association between daily physical activity and pain among patients with knee osteoarthritis: the moderating role of pain catastrophizing. Pain Medicine. 2018. https://doi.org/10.1093/pm/pny129.

  72. 72.

    Baxter S, Hale L, Stebbings S, Gray A, Smith C, Treharne G. Walking is a feasible physical activity for people with rheumatoid arthritis: a feasibility randomized controlled trial. Musculoskeletal Care. 2015;14:47–56. https://doi.org/10.1002/msc.1112.

  73. 73.

    Harden R, Wallach G, Gagnon C, Zereshki A, Mukai A, Saracoglu M, et al. The osteoarthritis knee model: psychophysical characteristics and putative outcomes. J Pain. 2013;14:281–9. https://doi.org/10.1016/j.jpain.2012.11.009.

  74. 74.

    Rosemann T, Laux G, Szecsenyi J, Wensing M, Grol R. Pain and osteoarthritis in primary care: factors associated with pain perception in a sample of 1,021 patients. Pain Med. 2008;9:903–10. https://doi.org/10.1111/j.1526-4637.2008.00498.x.

  75. 75.

    Saccomanno M, Donati F, Careri S, Bartoli M, Severini G, Milano G. Efficacy of intra-articular hyaluronic acid injections and exercise-based rehabilitation programme, administered as isolated or integrated therapeutic regimens for the treatment of knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2015;24:1686–94. https://doi.org/10.1007/s00167-015-3917-9.

  76. 76.

    Campbell K, Saltzman B, Mascarenhas R, Khair M, Verma N, Bach B, et al. 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. 2015;31:2213–21. https://doi.org/10.1016/j.arthro.2015.03.041.

  77. 77.

    Clegg D, Reda D, Harris C, Klein M, O'Dell J, Hooper M, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006;354:795–808. https://doi.org/10.1056/NEJMoa052771.

  78. 78.

    Michael J, Schlüter-Brust K, Eysel P. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int. 2010;107(9):152–62. https://doi.org/10.3238/arztebl.2010.0152.

  79. 79.

    Bert J, Bert T. Nonoperative treatment of unicompartmental arthritis. Clin Sports Med. 2014;33:1–10. https://doi.org/10.1016/j.csm.2013.08.002.

  80. 80.

    Simental-Mendía M, Vílchez-Cavazos J, Peña-Martínez V, Said-Fernández S, Lara-Arias J, Martínez-Rodríguez H. Leukocyte-poor platelet-rich plasma is more effective than the conventional therapy with acetaminophen for the treatment of early knee osteoarthritis. Arch Orthop Trauma Surg. 2016;136:1723–32. https://doi.org/10.1007/s00402-016-2545-2.

  81. 81.

    Osterman C, McCarthy M, Cote M, Beitzel K, Bradley J, Polkowski G, et al. Platelet-rich plasma increases anti-inflammatory markers in a human coculture model for osteoarthritis. Am J Sports Med. 2015;43:1474–84. https://doi.org/10.1177/0363546515570463.

  82. 82.

    Richards M, Maxwell J, Weng L, Angelos M, Golzarian J. Intra-articular treatment of knee osteoarthritis: from anti-inflammatories to products of regenerative medicine. Phys Sportsmed. 2016;44:101–8. https://doi.org/10.1080/00913847.2016.1168272.

  83. 83.

    Jüni P, Hari R, Rutjes A, Fischer R, Silletta M, Reichenbach S et al. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev. 2015. Issue 10. Art. No.: CD005328. https://doi.org/10.1002/14651858.CD005328.pub3.

  84. 84.

    MacMahon P, Eustace S, Kavanagh E. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology. 2009;252:647–61. https://doi.org/10.1148/radiol.2523081929.

  85. 85.

    Raynauld J, Buckland-Wright C, Ward R, Choquette D, Haraoui B, Martel-Pelletier J, et al. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2003;48:370–7. https://doi.org/10.1002/art.10777.

  86. 86.

    McAlindon T, LaValley M, Harvey W, Price L, Driban J, Zhang M, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis. JAMA. 2017;317:1967–75. https://doi.org/10.1001/jama.2017.5283.

  87. 87.

    Joshi Jubert N, Rodríguez L, Reverté-Vinaixa M, Navarro A. Platelet-rich plasma injections for advanced knee osteoarthritis: a prospective, randomized, double-blinded clinical trial. Orthop J Sports Med. 2017;5(2):232596711668938. https://doi.org/10.1177/2325967116689386.

  88. 88.

    Forogh B, Mianehsaz E, Shoaee S, Ahadi T, Raissi GR, Sajadi S. Effect of single injection of platelet-rich plasma in comparison with corticosteroid on knee osteoarthritis: a double-blind randomized clinical trial. J Sports Med Phys Fitness. 2016;56(7–8):901–8.

  89. 89.

    Saltzman B, Leroux T, Meyer M, Basques B, Chahal J, Bach B, et al. The therapeutic effect of intra-articular normal saline injections for knee osteoarthritis: a meta-analysis of evidence level 1 studies. Am J Sports Med. 2016;45:2647–53. https://doi.org/10.1177/0363546516680607.

  90. 90.

    Vannabouathong C, Bhandari M, Bedi A, Khanna V, Yung P, Shetty V, et al. Nonoperative treatments for knee osteoarthritis. JBJS Reviews. 2018;6(7):e5. https://doi.org/10.2106/JBJS.RVW.17.00167.

  91. 91.

    Görmeli G, Görmeli C, Ataoglu B, Çolak C, Aslantürk O, Ertem K. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc. 2015;25:958–65. https://doi.org/10.1007/s00167-015-3705-6.

  92. 92.

    Patel S, Dhillon M, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis. Am J Sports Med. 2013;41:356–64. https://doi.org/10.1177/0363546512471299.

  93. 93.

    • Smith P. Intra-articular autologous conditioned plasma injections provide safe and efficacious treatment for knee osteoarthritis. Am J Sports Med. 2016;44:884–91. https://doi.org/10.1177/0363546515624678 FDA-regulated, double-blind, placebo-controlled study demonstrating significantly greater improvements in patients treated with LP-PRP compared to saline up to 12 months.

  94. 94.

    Duymus T, Mutlu S, Dernek B, Komur B, Aydogmus S, Kesiktas F. Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options. Knee Surg Sports Traumatol Arthrosc. 2016;25:485–92. https://doi.org/10.1007/s00167-016-4110-5.

  95. 95.

    • Cole B, Karas V, Hussey K, Merkow D, Pilz K, Fortier L. Hyaluronic acid versus platelet-rich plasma: a prospective, double-blind randomized controlled trial comparing clinical outcomes and effects on intra-articular biology for the treatment of knee osteoarthritis. Am J Sports Med. 2016;45:339–46. https://doi.org/10.1177/0363546516665809 Demonstrated increased efficacy of LP-PRP compared to HA in regards to patient-reported outcomes, and demonstrated a trend toward decreased inflammatory cytokines in LP-PRP compared to HA at 12 weeks.

  96. 96.

    Balazs EA, Denlinger JL. Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol Suppl. 1993;39:3–9.

  97. 97.

    Cerza F, Carnì S, Carcangiu A, Di Vavo I, Schiavilla V, Pecora A, et al. Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis. Am J Sports Med. 2012;40:2822–7. https://doi.org/10.1177/0363546512461902.

  98. 98.

    Vaquerizo V, Plasencia M, Arribas I, Seijas R, Padilla S, Orive G, et al. Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a randomized controlled trial. Arthroscopy. 2013;29:1635–43. https://doi.org/10.1016/j.arthro.2013.07.264.

  99. 99.

    Ahmad H, Farrag S, Okasha A, Kadry A, Ata T, Monir A, et al. Clinical outcomes are associated with changes in ultrasonographic structural appearance after platelet-rich plasma treatment for knee osteoarthritis. Int J Rheum Dis. 2018;21:960–6. https://doi.org/10.1111/1756-185X.13315.

  100. 100.

    Louis M, Magalon J, Jouve E, Bornet C, Mattei J, Chagnaud C, et al. Growth factors levels determine efficacy of platelets rich plasma injection in knee osteoarthritis: a randomized double blind noninferiority trial compared with viscosupplementation. Arthroscopy. 2018;34:1530–1540.e2. https://doi.org/10.1016/j.arthro.2017.11.035.

  101. 101.

    Montañez-Heredia E, Irízar S, Huertas P, Otero E, del Valle M, Prat I, et al. Intra-articular injections of platelet-rich plasma versus hyaluronic acid in the treatment of osteoarthritic knee pain: a randomized clinical trial in the context of the Spanish National Health Care System. Int J Mol Sci. 2016;17:1064. https://doi.org/10.3390/ijms17071064.

  102. 102.

    Raeissadat S, Rayegani S, Hassanabadi H, Fathi M, Ghorbani E, Babaee M, et al. Knee osteoarthritis injection choices: platelet- rich plasma (PRP) versus hyaluronic acid (a one-year randomized clinical trial). Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2015;8:1–8. https://doi.org/10.4137/CMAMD.S17894.

  103. 103.

    Filardo G, Di Matteo B, Di Martino A, Merli M, Cenacchi A, Fornasari P, et al. Platelet-rich plasma intra-articular knee injections show no superiority versus viscosupplementation. Am J Sports Med. 2015;43:1575–82. https://doi.org/10.1177/0363546515582027.

  104. 104.

    Sánchez M, Fiz N, Azofra J, Usabiaga J, Aduriz Recalde E, Garcia Gutierrez A, et al. A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Arthroscopy. 2012;28:1070–8. https://doi.org/10.1016/j.arthro.2012.05.011.

  105. 105.

    Sampson S, Reed M, Silvers H, Meng M, Mandelbaum B. Injection of platelet-rich plasma in patients with primary and secondary knee osteoarthritis. Am J Phys Med Rehabil. 2010;89:961–9. https://doi.org/10.1097/PHM.0b013e3181fc7edf.

  106. 106.

    Filardo G, Kon E, DI Matteo B, DI Marino A, Sessa A, Merli ML, et al. Leukocyte-poor PRP application for the treatment of knee osteoarthritis. Joints. 2014;1(3):112–20 eCollection 2013 Jul-Sep.

  107. 107.

    Hurley E, Yasui Y, Gianakos A, Seow D, Shimozono Y, Kerkhoffs G, et al. Limited evidence for adipose-derived stem cell therapy on the treatment of osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2018. https://doi.org/10.1007/s00167-018-4955-x.

  108. 108.

    Chahla J, Piuzzi N, Mitchell J, Dean C, Pascual-Garrido C, LaPrade R, et al. Intra-articular cellular therapy for osteoarthritis and focal cartilage defects of the knee. J Bone Joint Surg. 2016;98:1511–21. https://doi.org/10.2106/JBJS.15.01495.

  109. 109.

    Pas H, Winters M, Haisma H, Koenis M, Tol J, Moen M. Stem cell injections in knee osteoarthritis: a systematic review of the literature. Br J Sports Med. 2017;51:1125–33. https://doi.org/10.1136/bjsports-2016-096793.

  110. 110.

    Koh Y, Choi Y. Infrapatellar fat pad-derived mesenchymal stem cell therapy for knee osteoarthritis. Knee. 2012;19:902–7. https://doi.org/10.1016/j.knee.2012.04.001.

  111. 111.

    Kim J, Lee G, Jung G, Kim C, Kim T, Park J, et al. Clinical outcome of autologous bone marrow aspirates concentrate (BMAC) injection in degenerative arthritis of the knee. European Journal of Orthopaedic Surgery & Traumatology. 2014;24:1505–11. https://doi.org/10.1007/s00590-013-1393-9.

  112. 112.

    Centeno C, Pitts J, Al-Sayegh H, Freeman M. Efficacy of autologous bone marrow concentrate for knee osteoarthritis with and without adipose graft. Biomed Res Int. 2014;2014:1–9. https://doi.org/10.1155/2014/370621.

  113. 113.

    Shaw B, Darrow M, Derian A. Short-term outcomes in treatment of knee osteoarthritis with 4 bone marrow concentrate injections. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2018;11:117954411878108. https://doi.org/10.1177/1179544118781080.

  114. 114.

    • Shapiro S, Kazmerchak S, Heckman M, Zubair A, O’Connor M. A prospective, single-blind, placebo-controlled trial of bone marrow aspirate concentrate for knee osteoarthritis. Am J Sports Med. 2016;45:82–90. https://doi.org/10.1177/0363546516662455 Placebo-controlled trial finding no significant improvement between patients treated with saline and BMAC in KOA.

  115. 115.

    Piuzzi NS, Ng M, Chughtai M, Khlopas A, Ng K, Mont MA, et al. The stem-cell market for the treatment of knee osteoarthritis: a patient perspective. J Knee Surg. 2018;31(6):551–6. https://doi.org/10.1055/s-0037-1604443.

  116. 116.

    • Chahla J, Cinque M, Piuzzi N, Mannava S, Geeslin A, Murray I, et al. A call for standardization in platelet-rich plasma preparation protocols and composition reporting. J Bone Joint Surg Am. 2017;99:1769–79. https://doi.org/10.2106/JBJS.16.01374 An important statement to researchers involving the importance of standardization in PRP protocols, methods, and reporting.

Download references

Author information

Correspondence to Patrick A. Smith.

Ethics declarations

Conflict of Interest

Dr. Smith is a consultant for Arthrex and receives research support from them.

Dr. Cook has no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Protein-Rich Plasma: From Bench to Treatment of Arthritis

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cook, C.S., Smith, P.A. Clinical Update: Why PRP Should Be Your First Choice for Injection Therapy in Treating Osteoarthritis of the Knee. Curr Rev Musculoskelet Med 11, 583–592 (2018). https://doi.org/10.1007/s12178-018-9524-x

Download citation


  • Knee
  • Osteoarthritis
  • PRP
  • Platelet-rich plasma
  • Intra-articular