Efficacy and safety profile of a compound composed of platelet-rich plasma and hyaluronic acid in the treatment for knee osteoarthritis (preliminary results)

  • Michele AbateEmail author
  • Sandra Verna
  • Cosima Schiavone
  • Patrizia Di Gregorio
  • Vincenzo Salini
Original Article • KNEE - SPORT



The combined use of hyaluronic acid and platelet-rich plasma has never been reported in the treatment for osteoarthritis. Aim of this paper was to evaluate the efficacy of this association and to compare retrospectively these results with those of a cohort of patients treated with platelet-rich plasma only.

Materials and methods

Subjects with mild-to-moderate knee osteoarthritis were enrolled. After clinical and ultrasound evaluation, patients received a weekly intra-articular injection of 2 ml of hyaluronic acid added with 2 ml of platelet-rich plasma for 3 weeks. Follow-up was performed at 1, 3, and 6 months. The same clinical parameters were retrospectively collected from a cohort of patients treated with 4–5 ml of platelet-rich plasma only.


Forty knees were treated in both groups. The intra-group comparison showed a significant improvement in clinical and functional outcomes at 1, 3, and 6 months, while the infra-group comparison did not show any significant difference.


The association of platelet-rich plasma + hyaluronic acid has the same efficacy of platelet-rich plasma only, administered in higher volume. We may infer that hyaluronic acid works synergically and improves the activity of several molecules contained in platelet-rich plasma.


Knee osteoarthritis Hyaluronic acid Platelet-rich plasma Safety profile 


Compliance with ethical standards

Conflict of interest

The authors disclose any conflicts of interest related to the research or the manuscript or to any previous presentation of the research, manuscript, or abstract. They assure that authorship has been granted only to those individuals who have contributed substantially to the research or manuscript.

Informed consent

The procedure followed was in accordance with the Declaration of Helsinki, and informed written consent was obtained from each patient.


  1. 1.
    Alshami AM (2014) Knee osteoarthritis related pain: a narrative review of diagnosis and treatment. Int J Health Sci (Qassim) 8(1):85–104CrossRefGoogle Scholar
  2. 2.
    Jevsevar DS (2013) Treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg 21(9):571–576CrossRefPubMedGoogle Scholar
  3. 3.
    Andia I, Abate M (2014) Knee osteoarthritis: hyaluronic acid, platelet-rich plasma or both in association? Expert Opin Biol Ther 14(5):635–649CrossRefPubMedGoogle Scholar
  4. 4.
    Musumeci G, Castrogiovanni P, Leonardi R, Trovato FM, Szychlinska MA, DiGiunta A, Loreto C, Castorina S (2014) New perspectives for articular cartilage repair treatment through tissue engineering: a contemporary review. World J Orthop 5(2):80–88PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Petrella R (2005) Hyaluronic Acid for the treatment of knee osteoarthritis: long-term outcomes from a naturalistic primary care experience. Am J Phys Med Rehabil 84(4):278–283CrossRefPubMedGoogle Scholar
  6. 6.
    Rodriguez-Merchan EC (2013) Intraarticular injections of platelet-rich plasma (PRP) in the management of knee osteoarthritis. Arch Bone Jt Surg 1(1):5–8PubMedCentralPubMedGoogle Scholar
  7. 7.
    Cervelli V, Lucarini L, Spallone D, Palla L, Colicchia GM, Gentile P, De Angelis B (2011) Use of platelet-rich plasma and hyaluronic acid in the loss of substance with bone exposure. Adv Skin Wound Care 24(4):176–181CrossRefPubMedGoogle Scholar
  8. 8.
    De Angelis B, Lucarini L, Orlandi F, Agovino A, Migner A, Cervelli V, Izzo V, Curcio C (2013) Regenerative surgery of the complications with Morton’s neuroma surgery: use of platelet rich plasma and hyaluronic acid. Int Wound J 10(4):372–376CrossRefPubMedGoogle Scholar
  9. 9.
    Ramos-Torrecillas J, García-Martínez O, De Luna-Bertos E, Ocaña-Peinado FM, Ruiz C (2015) Effectiveness of platelet-rich plasma and hyaluronic acid for the treatment and care of pressure ulcers. Biol Res Nurs 17(2):152–158CrossRefPubMedGoogle Scholar
  10. 10.
    Vlad V, Iagnocco A (2012) Ultrasound of the knee in rheumatology. Med Ultrason 14(4):318–325PubMedGoogle Scholar
  11. 11.
    Kolarz G, Kotz R, Hochmayer I (2003) Long-term benefits and repeated treatment cycles of intra-articular sodium hyaluronate (Hyalgan) in patients with osteoarthritis of the knee. Semin Arthritis Rheum 32(5):310–319CrossRefPubMedGoogle Scholar
  12. 12.
    Andia I, Maffulli N (2013) Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Nat Rev Rheumatol 9(12):721–730CrossRefPubMedGoogle Scholar
  13. 13.
    Andia I, Abate M (2013) Platelet-rich plasma: underlying biology and clinical correlates. Regen Med 8(5):645–658CrossRefPubMedGoogle Scholar
  14. 14.
    Abate M, Pulcini D, Di Iorio A, Schiavone C (2010) Viscosupplementation with intra-articular hyaluronic acid for treatment of osteoarthritis in the elderly. Curr Pharm Des 16(6):631–640CrossRefPubMedGoogle Scholar
  15. 15.
    Guler O, Mutlu S, Isyar M, Seker A, Kayaalp ME, Mahirogullari M (2015) Comparison of short-term results of intraarticular platelet-rich plasma (PRP) and hyaluronic acid treatments in early-stage gonarthrosis patients. Eur J Orthop Surg Traumatol 25(3):509–513CrossRefPubMedGoogle Scholar
  16. 16.
    Say F, Gürler D, Yener K, Bülbül M, Malkoc M (2013) Platelet-rich plasma injection is more effective than hyaluronic acid in the treatment of knee osteoarthritis. Acta Chir Orthop Traumatol Cech 80(4):278–283PubMedGoogle Scholar
  17. 17.
    Spaková T, Rosocha J, Lacko M, Harvanová D, Gharaibeh A (2012) Treatment of knee joint osteoarthritis with autologous platelet-rich plasma in comparison with hyaluronic acid. Am J Phys Med Rehabil 91(5):411–417CrossRefPubMedGoogle Scholar
  18. 18.
    Sundman EA, Cole BJ, Karas V, Della Valle C, Tetreault MW, Mohammed HO, Fortier LA (2014) The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med 42(1):35–41CrossRefPubMedGoogle Scholar
  19. 19.
    Anitua E, Sanchez M, De la Fuente M, Zalduendo MM, Orive G (2012) Plasma rich in growth factors (PRGF-Endoret) stimulates tendon and synovial fibroblasts migration and improves the biological properties of hyaluronic acid. Knee Surg Sports Traumatol Arthrosc 20(9):1657–1665CrossRefPubMedGoogle Scholar
  20. 20.
    Marmotti A, Bruzzone M, Bonasia DE, Castoldi F, Rossi R, Piras L, Maiello A, Realmuto C, Peretti GM (2012) One-step osteochondral repair with cartilage fragments in a composite scaffold. Knee Surg Sports Traumatol Arthrosc 20(12):2590–2601CrossRefPubMedGoogle Scholar
  21. 21.
    Srinivasan PP, McCoy SY, Jha AK, Yang W, Jia X, Farach-Carson MC, Kirn-Safran CB (2012) Injectable perlecan domain 1-hyaluronan microgels potentiate the cartilage repair effect of BMP2 in a murine model of early osteoarthritis. Biomed Mater 7(2):024109PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France 2015

Authors and Affiliations

  • Michele Abate
    • 1
    Email author
  • Sandra Verna
    • 2
  • Cosima Schiavone
    • 1
  • Patrizia Di Gregorio
    • 2
  • Vincenzo Salini
    • 1
  1. 1.Department of Medicine and Science of AgingUniversity G. d’Annunzio, Chieti-PescaraChieti ScaloItaly
  2. 2.Immunohaematology and Transfusional Medicine Service“SS. Annunziata” HospitalChieti ScaloItaly

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