Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis
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Platelet-rich plasma (PRP) therapy is a simple, low-cost and minimally invasive method that provides a natural concentrate of autologous blood growth factors (GFs) that can be used to enhance tissue regeneration. In a previous analysis of a 12-month follow-up study, promising results were obtained when treating patients affected by knee degeneration with PRP intra-articular injections. The main purpose of this study was to investigate the persistence of the beneficial effects observed.
Of the 91 patients evaluated in the previous 12-month follow-up study, 90 were available for the 2-year follow-up (24 patients presented a bilateral lesion, in a total of 114 knees treated). All of the patients presented a chronic knee degenerative condition and were treated with three intra-articular PRP injections. IKDC and EQ-VAS scores were used for clinical evaluation. Complications, adverse events and patient satisfaction were also recorded.
All of the evaluated parameters worsened at the 24-month follow-up: these parameters were at significantly lower levels with respect to the 12-month evaluation (the IKDC objective evaluation fell from 67 to 59% of normal and nearly normal knees; the IKDC subjective score fell from 60 to 51), even if they remained higher than the basal level. Further analysis showed better results in younger patients (P = 0.0001) and lower degrees of cartilage degeneration (P < 0.0005). The median duration of the clinical improvement was 9 months.
These findings indicate that treatment with PRP injections can reduce pain and improve knee function and quality of life with short-term efficacy. Further studies are needed to confirm these results and understand the mechanism of action, and to find other application modalities, with different platelet and GF concentrations and injection timing, which provide better and more durable results.
KeywordsPRP Cartilage Knee Intra-articular injection
G. Altadonna, F. Balboni, M. Lo Presti, A. Bondi, M. Delcogliano, S. Bassini, A. Montaperto: III Clinic—Biomechanics Lab, Rizzoli Orthopaedic Institute, Bologna, Italy. A. Gabriele, F. Pieretti, M. Vaccari, A.M. Del Vento, M. Zagarella, V. Roverini, I. Brognara, L. D’Amato, S. Ardone: Immunohematology and Transfusion Medicine Service, Rizzoli Orthopaedic Institute, Bologna, Italy. E. Pignotti, K. Smith: Task Force, Rizzoli Orthopaedic Institute, Bologna, Italy.
- 4.Bellamy N, Campbell J, Robinson V et al (2006) Intra-articular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 19:CD005328Google Scholar
- 5.Bosnakovski D, Mizuno M, Kim G, Takagi S, Okumura M, Fujinaga T (2006) Chondrogenic differentiation of bovine bone marrow mesenchymal stem cells (MSCs) in different hydrogels: influence of collagen type II extracellular matrix on MSC chondrogenesis. Biotechnol Bioeng 93:1152–1163PubMedCrossRefGoogle Scholar
- 6.Buckwalter JA, Mankin HJ (1997) Articular cartilage. J Bone Joint Surg 79:600–611Google Scholar
- 7.Buckwalter JA, Mankin HJ (1997) Articular cartilage. Part II: degeneration and osteoarthrosis, repair, regeneration, and tranplantation. J Bone Joint Surg 79:612–632Google Scholar
- 23.Saito M, Takahashi KA, Arai Y, Inoue A, Sakao K, Tonomura H, Honjo K, Nakagawa S, Inoue H, Tabata Y, Kubo T (2009) Intraarticular administration of platelet-rich plasma with biodegradable gelatin hydrogel microspheres prevents osteoarthritis progression in the rabbit knee. Clin Exp Rheumatol 27:201–207PubMedGoogle Scholar
- 29.Tchetina EV, Antoniou J, Tanzer M, Zukor DJ, Poole AR (2006) Transforming growth factor-beta2 suppresses collagen cleavage in cultured human osteoarthritic cartilage, reduces expression of genes associated with chondrocyte hypertrophy and degradation, and increases prostaglandin E(2) production. Am J Pathol 168:131–140PubMedCrossRefGoogle Scholar