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Platelet-rich plasma injections induce disease-modifying effects in the treatment of osteoarthritis in animal models

  • EXPERIMENTAL STUDY
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The mechanisms of action and disease-modifying potential of platelet-rich plasma (PRP) injection for osteoarthritis (OA) treatment are still not fully established. The aim of this systematic review of preclinical evidence was to determine if PRP injections can induce disease-modifying effects in OA joints.

Methods

A systematic review was performed on animal studies evaluating intra-articular PRP injections as treatment for OA joints. A synthesis of the results was performed investigating the disease-modifying effects of PRP by evaluating studies that compared PRP with OA controls or other injectable products, different PRP formulations or injection intervals, and the combination of PRP with other products. The risk of bias was assessed according to the SYRCLE’s tool.

Results

Forty-four articles were included, for a total of 1251 animals. The publication trend remarkably increased over time. PRP injections showed clinical effects in 80% and disease-modifying effects in 68% of the studies, attenuating cartilage damage progression and reducing synovial inflammation, coupled with changes in biomarker levels. Evidence is limited on the best PRP formulation, injection intervals, and synergistic effect with other injectables. The risk of bias was low in 40%, unclear in 56%, and high in 4% of items.

Conclusion

Intra-articular PRP injections showed disease-modifying effects in most studies, both at the cartilage and synovial level. These findings in animal OA models can play a crucial role in understanding mechanism of action and structural effects of this biological approach. Nevertheless, the overall low quality of the published studies warrants further preclinical studies to confirm the positive findings, as well as high-level human trials to demonstrate if these results translate into disease-modifying effects when PRP is used in the clinical practice to treat OA.

Level of evidence

Level II.

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Acknowledgements

Authors GF, LDG, LL, JM, MS and TT are members of the Orthobiologics Initiative (ORBIT) by the European Society of Sports Traumatology, Knee Surgery & Arthroscopy (ESSKA).

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Authors and Affiliations

  1. Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Angelo Boffa

  2. Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Manuela Salerno, Giulia Merli & Giuseppe Filardo

  3. Orthopaedic Biotechnology Laboratory, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Laura De Girolamo

  4. Department of Orthopaedics, Hillel Yaffe Medical Center (HYMC), Hadera, Israel

    Lior Laver

  5. Arthrosport Clinic, Tel-Aviv, Israel

    Lior Laver

  6. Rappaport Faculty of Medicine, Technion University Hospital (Israel Institute of Technology), Haifa, Israel

    Lior Laver

  7. Cell Therapy Laboratory, Hôpital de la Conception, AP-HM, Marseille, France

    Jérémy Magalon

  8. INSERM, INRA, C2VN, Aix Marseille Univ, Marseille, France

    Jérémy Magalon

  9. SAS Remedex, Marseille, France

    Jérémy Magalon

  10. Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain

    Mikel Sánchez

  11. Advanced Biological Therapy Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain

    Mikel Sánchez

  12. Department of Orthopaedic Surgery, University of Rostock, Rostock, Germany

    Thomas Tischer

  13. Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland

    Giuseppe Filardo

  14. Facoltà di Scienze Biomediche, USI-Università della Svizzera Italiana, Lugano, Switzerland

    Giuseppe Filardo

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  1. Angelo Boffa
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  2. Manuela Salerno
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  3. Giulia Merli
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  4. Laura De Girolamo
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  5. Lior Laver
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  6. Jérémy Magalon
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  7. Mikel Sánchez
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  8. Thomas Tischer
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  9. Giuseppe Filardo
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Correspondence to Giulia Merli.

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JM is a co-founder of Remedex and received honoraria from Fidia Pharmaceuticals, Horiba, and Macopharma. The manufactures had no role in the redaction of this manuscript of its decision for publication. The other authors declare no conflict of interest.

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Boffa, A., Salerno, M., Merli, G. et al. Platelet-rich plasma injections induce disease-modifying effects in the treatment of osteoarthritis in animal models. Knee Surg Sports Traumatol Arthrosc 29, 4100–4121 (2021). https://doi.org/10.1007/s00167-021-06659-9

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