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Hyaluronic acid and platelet-rich plasma for the management of knee osteoarthritis

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Abstract

Purpose

Symptomatic knee osteoarthritis (OA) remains a substantial cause of pain and disability worldwide and effective management in young patients without indications for total knee arthroplasty remains challenging. Intra-articular injections represent a viable option in the non-operative treatment of knee OA. Hyaluronic acid (HA) and platelet-rich plasma (PRP) are two commonly utilized intra-articular treatment modalities that are of particular clinical interest in the current literature. The purpose of this manuscript is to provide a concise review of the current literature on the use of HA, PRP, and HA-PRP conjugates for the treatment of symptomatic knee OA.

Methods

A review of the literature utilizing PubMed, OVID/Medline, and Cochrane databases on basic science and clinical literature pertaining to preparation, composition, and outcomes of HA, PRP, and HA-PRP conjugates in patients with symptomatic knee OA.

Results

Both HA and PRP have been shown to be efficacious for the treatment of symptomatic knee OA, with HA injections providing limited short-term improvement, while PRP may provide greater therapeutic relief, particularly with the use of leukocyte-poor (LP-PRP) formulations. Despite limited data, the combination of different formulations of HA-PRP conjugates may provide a synergistic effect, resulting in a clinically significant improvement in both pain and function.

Conclusion

In patients with symptomatic knee OA, intra-articular HA and PRP provide short-term improvement in pain and function, while the efficacy of HA-PRP conjugates warrants further study.

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Authors and Affiliations

  1. Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison St, Chicago, IL, 60612, USA

    Ron Gilat, Eric D. Haunschild, Aghogho Evuarherhe Jr, Kevin C. Parvaresh & Brian J. Cole

  2. Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel

    Ron Gilat

  3. Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Derrick M. Knapik

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  1. Ron Gilat
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Contributions

All the authors contributed to the study conception and design. The literature search was performed by Ron Gilat, Eric Haunschild, and Derrick Knapik. The first draft of the manuscript was written by Ron Gilat, Eric Haunschild, Derrick Knapik, and Kevin Parvaresh. Revisions were performed by Ron Gilat, Derrick Knapik, and Aghogho Evuarherhe. Jr. All the authors commented on previous versions of the manuscript and participated in requested revisions. All the authors read and approved the final manuscript.

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Correspondence to Brian J. Cole.

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Conflict of interest

RG: none; EDH: none; DMK: none; KCP: none; BJC: Receives IP royalties and research support from Arthrex and is a paid consultant for Arthrex. In addition, B.J.C. receives research support from Aesculap, National Institutes of Health, and Regentis; receives other financial or material support from Athletico, JRF Ortho, and Smith & Q19 Nephew; receives IP royalties from Elsevier; receives publishing royalties and financial or material support from Operative Techniques in Sports Medicine; receives stock options from Ossio; and is a paid consultant for Regentis, outside the submitted work.

Dr. Cole reports grants, personal fees, and non-financial support from Arthrex Inc., during the conduct of the study; other from Aesculap, other from Athletico, personal fees and other from Elsevier publishing, other from JRF Ortho, other from NIH, personal fees and other from OTSM, personal fees from Ossio, personal fees and other from Regentis, other from Smith and Nephew, outside the submitted work. Dr. Cole reports grants, personal fees and non-financial support from Arthrex Inc., during the conduct of the study; other from Aesculap, other from Athletico, personal fees and other from Elsevier publishing, other from JRF Ortho, other from NIH, personal fees and other from OTSM, personal fees from Ossio, personal fees and other from Regentis, other from Smith and Nephew, outside the submitted work.

All the other authors declare no conflicts of interests.

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Gilat, R., Haunschild, E.D., Knapik, D.M. et al. Hyaluronic acid and platelet-rich plasma for the management of knee osteoarthritis. International Orthopaedics (SICOT) 45, 345–354 (2021). https://doi.org/10.1007/s00264-020-04801-9

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