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Pundkar AG, Shrivastava S, Chandanwale R, Jaiswal A, Patel H. Exploring the Efficacy of Biologics in Knee Osteoarthritis: Ultrasound Evaluation of Cartilage Regeneration Effects. Indian J Orthop 2024; 58:1009-1015. [PMID: 39087051 PMCID: PMC11286903 DOI: 10.1007/s43465-024-01199-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/31/2024] [Indexed: 08/02/2024]
Abstract
Introduction Biologics like growth factors, stem cells, and platelet-rich plasma show potential in stimulating cartilage regrowth and reducing inflammation. By synthesizing preclinical and clinical studies, this study offers insights into how these biologics work and their effectiveness in treating knee osteoarthritis. Methods and Materials Twenty-four participants with knee osteoarthritis (Kellgren - Lawrence grade II or III) were enrolled after obtaining consent. They received three doses of 2 ml intraarticular platelet-rich plasma at 1 month intervals. The clinical assessment involved the oxford knee score (OKS) and visual analogue scale (VAS) for pain on Days 0, 90, and 180. Ultrasound measured femoral and trochlear cartilage thickness pre- (Day 0) and post-PRP (Day 90-180). Results Before treatment, the average pain score was 7.2 (p = 1.03). On Day 90 post-PRP, it decreased to 5 (p = 0.81), and by Day 180, it further reduced to 4.5 (p = 0.97). The initial total OKS was 33.5 (p = 1.76), which increased to 36 (p = 1.71) on Day 90 and 38.5 (p = 1.89) on Day 180. The femoral and trochlear cartilage thickness also showed improvement from baseline (0.92) to Day 90 (0.96) and Day 180 (1.01), indicating significant cartilage healing post-PRP administration. Conclusion Our study highlights the probability of PRP in treating knee OA, highlighting their ability to alleviate symptoms, enhance joint function, and promote articular cartilage regeneration.
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Affiliation(s)
- Aditya Ganesh Pundkar
- Department of Orthopaedics, J.N. Medical College, Datta Meghe Institute of Higher Education, Wardha, Maharashtra India
| | - Sandeep Shrivastava
- Department of Orthopaedics, J.N. Medical College, Datta Meghe Institute of Higher Education, Wardha, Maharashtra India
| | - Rohan Chandanwale
- Department of Orthopaedics, J.N. Medical College, Datta Meghe Institute of Higher Education, Wardha, Maharashtra India
| | - Ankit Jaiswal
- Department of Orthopaedics, J.N. Medical College, Datta Meghe Institute of Higher Education, Wardha, Maharashtra India
| | - Hardik Patel
- Department of Orthopaedics, J.N. Medical College, Datta Meghe Institute of Higher Education, Wardha, Maharashtra India
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Valtetsiotis K, Di Martino A, Brunello M, D'Agostino C, Poluzzi R, Ferri R, Mora P, Traina F, Faldini C. Platelet lysate for the treatment of osteoarthritis: a systematic review of preclinical and clinical studies. Musculoskelet Surg 2024:10.1007/s12306-024-00827-z. [PMID: 38829480 DOI: 10.1007/s12306-024-00827-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/14/2024] [Indexed: 06/05/2024]
Abstract
Intra-articular injection-based therapy is often used aside conservative treatment and lifestyle modifications to manage knee osteoarthritis (KO) patients. Conventional injections contain steroids and hyaluronic acid, while more recently multipotential adult stem cell, platelet-rich plasma (PRP), and platelet lysate (PL) injections have been used to promote cartilage regeneration or repair. The aim of the current study is to analyse current evidence on PL injections for the treatment of KO and to determine if these are effective and how these perform compared to other injection regimens. The databases of Scopus, Embase, PubMed, Web of Science, and Cochrane Library were searched on 30 June 2023. Risk of bias was assessed using the SYRCLE tool for animal studies and Cochrane RoB 2 as well as ROBINS-I tool for human studies. Studies were included if these were in English, any year, and regarded animals with osteoarthritis (OA) or human adult patients with OA. In vitro trials and non-adult human studies were excluded. Results on OA symptom stage and severity, and pain were recorded. The research retrieved three human studies (n = 48, n = 25, n = 58) and four animal studies: one rabbit, two studies, and one rat study. PL was found to decrease KO symptoms at follow-up ≤ 1 year with respect to baseline levels and when compared to hyaluronic acid or platelet-rich plasma. Symptoms returned 6 months-1 year after the final administration, with studies showing peak efficacy at approximately 6 months. Animal studies showed clinical improvements, reduction of lameness, and partial effect on the cartilage regeneration of the seven studies, two had a high risk of bias, four were associated to some concerns, and one had low risk. A major source of bias in these studies was the use of questionnaires and scoring that could be subject to interpretation. Overall, PL was well-tolerated and showed efficacy comparable to PRP; when pain control was assessed, it showed similar efficacy compared to hyaluronic acid. These findings may support its use in clinical trials to confirm these initial findings; future research should also focus on the comparison with other non-surgical treatments, on a more detail of the potential regenerative properties, and to optimise the treatment schedule.
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Affiliation(s)
- K Valtetsiotis
- 1st Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - A Di Martino
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40127, Bologna, Italy.
- 1st Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - M Brunello
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40127, Bologna, Italy
- 1st Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - C D'Agostino
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40127, Bologna, Italy
- 1st Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - R Poluzzi
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40127, Bologna, Italy
- 1st Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - R Ferri
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40127, Bologna, Italy
- 1st Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - P Mora
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40127, Bologna, Italy
- 1st Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - F Traina
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40127, Bologna, Italy
- Orthopedics-Traumatology and Prosthetic Surgery and Hip and Knee Revision, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - C Faldini
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40127, Bologna, Italy
- 1st Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
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Zhuang W, Li T, Li Y, Zhang Y, Gao J, Wang X, Ding Q, Li W. The varying clinical effectiveness of single, three and five intraarticular injections of platelet-rich plasma in knee osteoarthritis. J Orthop Surg Res 2024; 19:284. [PMID: 38720362 PMCID: PMC11077828 DOI: 10.1186/s13018-024-04736-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/13/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE To investigate the variations in clinical effectiveness among patients diagnosed with knee osteoarthritis who underwent intra-articular administration of platelet-rich plasma using single, triple, or quintuple injections. METHODS One hundred twenty patients with grade I-III knee osteoarthritis were randomly assigned to three groups: PRP1 group, who received a single injection of platelet-rich plasma; PRP3 group, who received three PRP injections one week apart; PRP5 group, who received five PRP injections one week apart. The patients' conditions were evaluated using the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index-VA3.1 version (WOMAC-VA3.1) at baseline and 6, 12, 24, and 52 weeks 52 weeks follow up. RESULTS Out of the total participants, 106 patients (30 males and 76 females) completed the study. The primary outcome measure, WOMAC pain score, registered significant improvements across all groups when compared to pre-treatment levels. However, the application of 3 and 5 injections of platelet-rich plasma was substantially more effective than that of a single injection in reducing knee pain and stiffness, as well as enhancing physical function in patients with knee osteoarthritis. No statistically discernable difference was observed between PRP3 and PRP5 at all follow-up intervals, and there was no discernable difference between 3 and 5 PRP injections either. Mild side effects occurred in all three groups. CONCLUSIONS The administration of three or five injections of platelet-rich plasma is safe, substantially more effective than single injections, and leads to remarkable clinical improvement by significantly reducing knee pain, improving joint stiffness, and enhancing physical function in patients with grade I-III knee osteoarthritis. Furthermore, no significant difference was observed in the efficacy of three or five injections. Therefore, we recommend using three injections of PRP in the treatment of patients with knee osteoarthritis of grade I-III.
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Affiliation(s)
- Weisheng Zhuang
- Department of Rehabilitation Medicine, Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Tianshu Li
- Department of Rehabilitation Medicine, Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University, Zhengzhou, Henan, 450003, China
- Department of Rehabilitation, The First People's Hospital of Zhengzhou, Zhengzhou, Henan, 450003, China
| | - Yuefang Li
- Department of Rehabilitation Medicine, Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Ying Zhang
- Department of Rehabilitation Medicine, Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Jiahuan Gao
- Department of Rehabilitation Medicine, Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Xu Wang
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, 450003, China
| | - Qixin Ding
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, 450003, China
| | - Wanyue Li
- Department of Rehabilitation Medicine, Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University, Zhengzhou, Henan, 450003, China.
- Department of Rehabilitation, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, 510000, China.
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Baird HBG, Ashy CC, Kodali P, Myer GD, Murray IR, Pullen WM, Slone HS. Most Publications Regarding Platelet-Rich Plasma Use in the Knee Are From Asia, Investigate Injection for Osteoarthritis, and Show Outcome Improvement: A Scoping Review. Arthroscopy 2024:S0749-8063(24)00252-4. [PMID: 38537725 DOI: 10.1016/j.arthro.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/12/2024] [Accepted: 03/17/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE To evaluate and synthesize the available literature related to platelet-rich plasma (PRP) treatment of knee pathologies and to provide recommendations to inform future research in the field. METHODS PubMed, CINAHL, and Scopus databases were queried on October 6, 2023. All identified citations were collated and uploaded into Covidence for screening and data extraction. Studies were included if they were human studies published in English with adult cohorts that received PRP as a procedural injection or surgical augmentation for knee pathologies with patient-reported outcome measures (PROMs) and level of evidence Levels I-IV. RESULTS Our search yielded 2,615 studies, of which 155 studies from 2006 to 2023 met the inclusion criteria. Median follow-up was 9 months (±11.2 months). Most studies (75.5%) characterized the leukocyte content of PRP, although most studies (86%) did not use a comprehensive classification scheme. In addition, most studies were from Asia (50%) and Europe (32%) and were from a single center (96%). In terms of treatment, 74% of studies examined PRP as a procedural injection, whereas 26% examined PRP as an augmentation. Most studies (68%) examined treatment of knee osteoarthritis. Many studies (83%) documented significant improvements in PROMs, including 93% of Level III/IV evidence studies and 72% of Level I/II evidence studies, although most studies (70%) failed to include minimal clinically important difference values. The visual analog scale was the most-used PROM (58% of studies), whereas the Short Form Health Survey 36-item was the least-used PROM (5% of studies). CONCLUSIONS Most published investigations of knee PRP are performed in Asia, investigate procedural injection for osteoarthritis, and show significant outcome improvements. In addition, this review highlights the need for better classification of PRP formulations. LEVEL OF EVIDENCE Level IV, scoping Review of level I-IV studies.
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Affiliation(s)
- Henry B G Baird
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A..
| | - Cody C Ashy
- Department of Orthopedic Surgery and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Prudhvi Kodali
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Gregory D Myer
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, U.S.A.; Emory Sports Medicine Center, Atlanta, Georgia, U.S.A.; Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, U.S.A.; The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, U.S.A.; Youth Physical Development Centre, Cardiff Metropolitan University, Wales, United Kingdom
| | - Iain R Murray
- The University of Edinburgh, Edinburgh, United Kingdom
| | - W Michael Pullen
- Department of Orthopedic Surgery and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Harris S Slone
- Department of Orthopedic Surgery and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Balusani P, Shrivastava S, Pundkar A, Kale P. Navigating the Therapeutic Landscape: A Comprehensive Review of Platelet-Rich Plasma and Bone Marrow Aspirate Concentrate in Knee Osteoarthritis. Cureus 2024; 16:e54747. [PMID: 38524005 PMCID: PMC10960965 DOI: 10.7759/cureus.54747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
This comprehensive review provides an in-depth analysis of platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) as potential treatments for knee osteoarthritis. It explores their mechanisms of action, clinical efficacy, safety considerations, and the importance of personalised treatment approaches. The review highlights promising findings regarding the ability of PRP and BMAC to alleviate symptoms, improve joint function, and potentially slow disease progression. It emphasises the need for further research into long-term outcomes, direct comparative studies, protocol standardisation, biomarker identification, and cost-effectiveness assessments to enhance clinical practice. While the review does not directly compare PRP and BMAC, it provides valuable insights into their respective roles in knee osteoarthritis management. The review aims to contribute to evidence-based advancements in regenerative therapies for knee osteoarthritis by addressing critical research priorities and refining treatment strategies.
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Affiliation(s)
- Prashanth Balusani
- Orthopaedics and Traumatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, Wardha, IND
| | - Sandeep Shrivastava
- Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, Wardha, IND
| | - Aditya Pundkar
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, Wardha, IND
| | - Prathamesh Kale
- Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, Wardha, IND
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Hosono Y, Kuwasawa A, Toyoda E, Nihei K, Sato S, Watanabe M, Sato M. Multiple intra-articular injections with adipose-derived stem cells for knee osteoarthritis cause severe arthritis with anti-histone H2B antibody production. Regen Ther 2023; 24:147-153. [PMID: 37415681 PMCID: PMC10320024 DOI: 10.1016/j.reth.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/09/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Osteoarthritis (OA) is the most common form of arthritis. OA results from the breakdown of cartilage, which leads to deterioration of the entire joint and the connective tissue that holds the joint together, and gradually and irreversibly worsens over time. Adipose-derived stem/stromal cells (ADSCs) have been used in the treatment of knee OA. However, the safety and efficacy of ADSC treatment of OA remain unclear. In this study, we investigated the pathophysiology of severe knee arthritis that occurred after ADSC treatment by screening for autoantibodies in synovial fluid from patients who received ADSC treatment. Methods Adult Japanese patients with OA who received ADSC treatment at Saitama Cooperative Hospital between June 2018 and October 2021 were enrolled. Antibodies (Abs) were screened using immunoprecipitation (IPP) with [35S]-methionine-labeled HeLa cell extracts. The detected protein was identified by liquid chromatography coupled with time-of-flight mass spectrometry (MS) and ion trap MS, and the corresponding proteins were confirmed as autoantigens using immunoblotting. Ab titers were measured using an enzyme-linked immunosorbent assay. Results A total of 113 patients received ADSC treatment, and 75% (85/113) received ADSC injection at least twice with a 6-month interval between. No obvious abnormalities were observed in any patient after their first treatment; by contrast, 53% (45/85) of patients who received their second or third ADSC injection showed severe knee arthritis. IPP detected a common anti-15 kDa Ab in synovial fluid of 62% (8/13) of the samples analyzed from patients who showed severe arthritis. This Ab was not detected in synovial fluid obtained from the same joints before treatment. The corresponding autoantigen was identified as histone H2B. All available synovial samples from patients who tested positive for anti-histone H2B Ab were newly positive after the treatment; that is, none had been positive for anti-histone H2B Ab before treatment. Conclusions Multiple ADSC injections for OA induced severe arthritis in a high percentage of patients, particularly after the second injection. Synovial fluid from some patients with knee arthritis contained Ab to histone H2B that appeared only after ADSC treatment. These findings provide new insights into the pathogenesis of ADSC treatment-induced severe arthritis.
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Affiliation(s)
- Y. Hosono
- Division of Rheumatology, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya Isehara, Kanagawa, 259-1193 Japan
| | - A. Kuwasawa
- Saitama Cooperative Hospital, 1371 Kisoro, Kawaguchi, Saitama, 333-0831, Japan
| | - E. Toyoda
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193 Japan
- Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, 143 Shimokasuya, Isehara, Kanagawa, 259-1193 Japan
| | - K. Nihei
- Saitama Cooperative Hospital, 1371 Kisoro, Kawaguchi, Saitama, 333-0831, Japan
| | - S. Sato
- Division of Rheumatology, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya Isehara, Kanagawa, 259-1193 Japan
| | - M. Watanabe
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193 Japan
- Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, 143 Shimokasuya, Isehara, Kanagawa, 259-1193 Japan
| | - M. Sato
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193 Japan
- Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, 143 Shimokasuya, Isehara, Kanagawa, 259-1193 Japan
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Rodriguez-Merchan EC. Intra-articular injection of platelet-rich plasma in patients with hemophilia and painful knee joint cartilage degeneration. Expert Rev Hematol 2023:1-10. [PMID: 36609192 DOI: 10.1080/17474086.2023.2166922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Knee arthropathy causes pain to people with hemophilia (PWH). One of the current controversies is whether injections of intra-articular platelet-rich plasma (PRP) are effective in relieving the knee pain of PWH. AREAS COVERED A narrative literature review was conducted on the efficacy of PRP injections in the knees of PWH. EXPERT OPINION Intra-articular PRP knee injections are widely used in patients with knee osteoarthritis to relieve pain and delay total knee arthroplasty. Although numerous publications have supported the use of PRP in knee osteoarthritis, there is still major controversy regarding its true usefulness, given that a number of studies with a high degree of evidence have failed to show the efficacy of PRP. With respect to painful hemophilic arthropathy, the use of PRP injections is even more controversial, as there are only four publications on the subject supporting the use of PRP in hemophilia, all of them with a low degree of evidence. A publication with grade 1 evidence recommended against the use of PRP in hemophilic arthropathy because its efficacy has not been demonstrated. My opinion is that intra-articular PRP injections should not be used in hemophilia until there is more evidence of its benefits.
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Affiliation(s)
- E Carlos Rodriguez-Merchan
- Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain.,Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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Gadagoli B, Nitish K, Kubsad S, Sharath JS, Manjunath S, Suresha B, Pai H. Evaluation of the effect of platelet-rich plasma in early osteoarthritis knee using the oxford knee score: A short-term outcome. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2023. [DOI: 10.4103/jodp.jodp_41_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Abbadi W, Kara Beit Z, Al-Khanati NM. Arthrocentesis, Injectable Platelet-Rich Plasma and Combination of Both Protocols of Temporomandibular Joint Disorders Management: A Single-Blinded Randomized Clinical Trial. Cureus 2022; 14:e31396. [DOI: 10.7759/cureus.31396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 11/15/2022] Open
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Pretorius J, Nemat N, Alsayed A, Mustafa A, Hammad Y, Shaju T, Nadeem S. Double-Blind Randomized Controlled Trial Comparing Platelet-Rich Plasma With Intra-Articular Corticosteroid Injections in Patients With Bilateral Knee Osteoarthritis. Cureus 2022; 14:e29744. [PMID: 36324362 PMCID: PMC9617571 DOI: 10.7759/cureus.29744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Platelet-rich plasma (PRP) intra-articular injections have gained popularity and are suggested to be more effective and longer lasting than corticosteroid or visco-supplementation therapy. There are few studies comparing PRP with corticosteroid injections and none comparing PRP in patients with bilateral knee osteoarthritis with the patient acting as their own control. Methods We performed a double-blind randomized controlled trial including 29 patients (58 knees) with radiologically confirmed mild-to-moderate bilateral knee osteoarthritis. They were randomized to receive an intra-articular PRP injection into one knee and a methylprednisolone injection with a local anesthetic into the contralateral knee. The primary outcome was measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) before the treatment and at six weeks, three months, and six months. Secondary outcome was measured pain with the visual numerical pain rating scale (VNS). Results Corticosteroids and PRP were both effective in improving pain, stiffness, and function at all time points, with maximal improvements at six weeks and three months. PRP scored slightly better than steroid injections at six months; nevertheless, there was no statistically significant difference between corticosteroids and PRP injections (F2,139=0.173, p=0.84). The secondary outcome also delivered the same result with improvement at all time points but no statistically significant difference (F2,139=0.168, p=0.85). Conclusions Both corticosteroids and PRP interventions are effective in improving pain, stiffness, and function in patients with bilateral knee osteoarthritis up to six months with no statistically significant difference between the two.
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Intra-Articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Review of Their Current Molecular Mechanisms of Action and Their Degree of Efficacy. Int J Mol Sci 2022; 23:ijms23031301. [PMID: 35163225 PMCID: PMC8836227 DOI: 10.3390/ijms23031301] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 12/24/2022] Open
Abstract
Knee osteoarthritis (OA) is estimated to affect more than 10% of the population, with a lifetime risk of 45%. Contemporary guidelines advise control of body weight, therapeutic physical exercise, drug treatment (oral non-steroidal anti-inflammatory drugs, paracetamol, opioids), and mechanical aids (walking aids, braces, orthoses). Nevertheless, these treatments typically have only short-term benefits. Intra-articular corticosteroids are typically advised, but only for short-term pain alleviation, given that their benefits last only a few weeks. The efficacy of hyaluronic acid is controversial. When the aforesaid options fail, total knee arthroplasty is generally recommended as an efficacious treatment. However, it is costly and can involve medical and postoperative complications. Therefore, determining alternate safe and effective treatments for knee OA is paramount. Platelet-rich plasma (PRP) has lately been investigated for the treatment of knee OA. This article reviews recent knowledge concerning PRP’s molecular mechanisms of action. The effectiveness of intra-articular PRP injections in the knee joint remains controversial, although most recent publications show pain alleviation in the short term. Orthopedic surgeons treating people with knee OA are becoming increasingly interested in PRP, despite indecisive clinical data and basic science information. Further studies comparing PRP with placebo are required.
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Riewruja K, Phakham S, Sompolpong P, Reantragoon R, Tanavalee A, Ngarmukos S, Udomsinprasert W, Suantawee T, Dechsupa S, Honsawek S. Cytokine Profiling and Intra-Articular Injection of Autologous Platelet-Rich Plasma in Knee Osteoarthritis. Int J Mol Sci 2022; 23:ijms23020890. [PMID: 35055075 PMCID: PMC8779764 DOI: 10.3390/ijms23020890] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/30/2021] [Accepted: 01/13/2022] [Indexed: 12/28/2022] Open
Abstract
Osteoarthritis (OA) is a degenerative joint disease leading to joint pain and stiffness. Due to lack of effective treatments, physical and psychological disabilities caused by OA have a detrimental impact on the patient’s quality of life. Emerging evidence suggests that intra-articular injection of platelet-rich plasma (PRP) may provide favorable results since PRP comprises not only a high level of platelets but also a huge amount of cytokines, chemokines, and growth factors. However, the precise mechanism and standardization method remain uncertain. This study aimed to examine cytokine profiling in both PRP and platelet-poor plasma (PPP) of knee OA patients and to determine the effects of PRP on OA chondrocytes and knee OA patients. PRP contained a wide variety of cytokines, chemokines, growth factors, and autologous intra-articular PRP injection resulted in favorable outcomes in knee OA patients. Significant increases in levels of IL-1, IL-2, IL-7, IL-8, IL-9, IL-12, TNF-α, IL-17, PDGF-BB, bFGF, and MIP-1β were detected in PRP compared to PPP (p < 0.001). An in vitro study showed a marked increase in proliferation in OA chondrocytes cultured with PRP, compared to PPP and fetal bovine serum (p < 0.001). In a clinical study, knee OA patients treated with PRP showed improvement of physical function and pain, assessed by physical performance, Western Ontario and McMaster Universities Arthritis Index and visual analog scale. Our findings from both in vitro and clinical studies suggest that intra-articular PRP injection in knee OA patients may be a potential therapeutic strategy for alleviating knee pain and delaying the need for surgery.
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Affiliation(s)
- Kanyakorn Riewruja
- Osteoarthritis and Musculoskeleton Research Unit, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; (K.R.); (S.P.); (P.S.); (S.D.)
| | - Suphattra Phakham
- Osteoarthritis and Musculoskeleton Research Unit, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; (K.R.); (S.P.); (P.S.); (S.D.)
- Program in Medical Science, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Patlapa Sompolpong
- Osteoarthritis and Musculoskeleton Research Unit, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; (K.R.); (S.P.); (P.S.); (S.D.)
| | - Rangsima Reantragoon
- Immunology Division, Center of Excellence in Immunology and Immune-Mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Aree Tanavalee
- Vinai Parkpian Orthopaedic Research Center, Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; (A.T.); (S.N.)
| | - Srihatach Ngarmukos
- Vinai Parkpian Orthopaedic Research Center, Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; (A.T.); (S.N.)
| | - Wanvisa Udomsinprasert
- Department of Biochemistry, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand;
| | - Tanyawan Suantawee
- Department of Nutrition and Dietetics, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Sinsuda Dechsupa
- Osteoarthritis and Musculoskeleton Research Unit, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; (K.R.); (S.P.); (P.S.); (S.D.)
| | - Sittisak Honsawek
- Osteoarthritis and Musculoskeleton Research Unit, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; (K.R.); (S.P.); (P.S.); (S.D.)
- Correspondence: ; Tel.: +66-2-256-4482; Fax: +66-2-256-4482
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