Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: A meta-analysis

Analogies Between Platelet-Rich Plasma Versus Hyaluronic Acid Intra-articular Injections in the Treatment of Advanced Knee Arthritis: A Single-Center Study

Background Knee osteoarthritis (KOA), a degenerative joint disease, is a common cause of chronic knee pain and disability in adults. Conservative management options are the first-line approach, but intra-articular injections, such as platelet-rich plasma (PRP) and hyaluronic acid (HA), are considered for advanced cases. This study aims to compare the efficacy of PRP versus HA injections in patients with advanced KOA. Methods A retrospective study was conducted on 145 patients with advanced KOA. Seventy patients received PRP injections, while 75 patients received HA injections. The Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and International Knee Documentation Committee (IKDC) score were employed to evaluate the treatment's efficacy. Adverse events associated with these injections were also recorded. Results Both PRP and HA injections significantly reduced pain and improved joint function in patients with advanced KOA. PRP injections were slightly more effective than HA injections in reducing pain scores. Both treatments showed similar improvements in functional outcomes. Adverse events were minimal and self-limiting for both treatments. Conclusions Both PRP and HA injections effectively ameliorate advanced KOA by reducing pain and improving function. PRP injections showed a slightly greater improvement in pain scores and functional outcomes. The choice between PRP and HA injections may depend on factors like cost, availability, and patient preference. Further research is needed to validate these findings and understand treatment suitability for different patient populations.

Equine Musculoskeletal Pathologies: Clinical Approaches and Therapeutical Perspectives-A Review

Musculoskeletal injuries such as equine osteoarthritis, osteoarticular defects, tendonitis/desmitis, and muscular disorders are prevalent among sport horses, with a fair prognosis for returning to exercise or previous performance levels. The field of equine medicine has witnessed rapid and fruitful development, resulting in a diverse range of therapeutic options for musculoskeletal problems. Staying abreast of these advancements can be challenging, prompting the need for a comprehensive review of commonly used and recent treatments. The aim is to compile current therapeutic options for managing these injuries, spanning from simple to complex physiotherapy techniques, conservative treatments including steroidal and non-steroidal anti-inflammatory drugs, hyaluronic acid, polysulfated glycosaminoglycans, pentosan polysulfate, and polyacrylamides, to promising regenerative therapies such as hemoderivatives and stem cell-based therapies. Each therapeutic modality is scrutinized for its benefits, limitations, and potential synergistic actions to facilitate their most effective application for the intended healing/regeneration of the injured tissue/organ and subsequent patient recovery. While stem cell-based therapies have emerged as particularly promising for equine musculoskeletal injuries, a multidisciplinary approach is underscored throughout the discussion, emphasizing the importance of considering various therapeutic modalities in tandem.

Long term improvement of knee osteoarthritis after injection of single high/very high volume of very pure PRP: A retrospective analysis of patients optimally managed in dedicated centers

Introduction

PRP is gaining increasing interest for pain relief and improvement of joint function in patients with knee osteoarthritis (KOA) but practices and results remain heterogeneous limiting its adoption as standard of care. Current international recommendations are to collect real-life evidence of efficacy with a systematic monitoring of PRP quality and patients' outcomes. We aimed to analyze the response of patients presenting KOA and treated with standardized PRP injection in routine care. We also investigated the potential contributing factors including patient's phenotype and PRP characteristics.

Methods

Patients with symptomatic KOA and that failed first-line therapy received a single injection of a qualified PRP prepared using medical devices allowing to recover a high/very high volume of very pure PRP. Visual analogue scale (VAS) and Western Ontario and McMaster Osteoarthritis Index (WOMAC) score were recorded at baseline and during 18 months follow-up.

Results

431 patients had available follow-up data at 3 months, 291 at 6 months, 137 at 12 months and 44 at 18 months. PRP induced a significant decrease of WOMAC score at all follow up endpoints (29.2 ± 19.2 at 3 months, p < 0.001 and 25.9 ± 19.7 at 12 months, p < 0.01, compared to 39.7 ± 18.9 at baseline). Similar results were observed for pain VAS (38.9 ± 23.3 at 3 months, p < 0.001 and 35.3 ± 24.1 at 12 months, p < 0.05, compared to 56.0 ± 20.7 at baseline). Changes at 12 months were correlated to baseline scores and to the level of improvement at 3 months. The proportion of OMERACT OARSI responders reached 56.2 % for the total cohort and 60.4 % for severe patients at 6 months. Treatment failure occurred for 8.4 % of patients. Age, BMI or Kellgren-Lawrence grade did not impact on efficacy.

Conclusion

This real-life study evidences the clinical benefit of a standardized high or very high-volume injection of very pure PRP in patients with KOA, including those with a severe grade. It opens perspectives in the positioning of such strategy to delay arthroplasty and provide insights on factors able to anticipate long term efficacy.

The efficacy and safety of hydrotherapy in patients with knee osteoarthritis: a meta-analysis of randomized controlled trials

BACKGROUND

Currently, there is poor evidence of the effect of hydrotherapy on patients with knee osteoarthritis (OA). The authors performed a meta-analysis from randomized controlled trials to determine the efficacy and safety of a hydrotherapy program on measures of pain and knee function in individuals living with knee OA.

METHODS

A literature review included PubMed, EMBASE, Cochrane Library, Science Citation Index, ScienceDirect, and Ovid. Studies evaluating the efficacy of hydrotherapy for knee OA up to August 2023 were included. The research was reported based on the preferred reporting items for systematic reviews and meta-analysis guidelines to ensure the reliability and verity of results. Statistical analysis was performed using Stata/SE version 15.0.

RESULTS

A total of six randomized controlled trials were included for data extraction and meta-analysis. The present study revealed that there were significant differences between the two groups regarding the pain intensity at 1 week (WMD=-0.429; 95% CI: -0.679 to -0.179; P =0.001), 4 week (WMD=-0.308; 95% CI: -0.587 to -0.030; P =0.030) and 8 week (WMD=-0.724; 95% CI: -1.099 to -0.348, P <0.001). Furthermore, hydrotherapy was associated with improved outcome of the Western Ontario and McMaster Universities Arthritis index at 1 week (WMD=-3.314; 95% CI: -6.484 to -0.145, P =0.040), 4 week (WMD= -3.630; 95% CI: -6.893 to -0.366, P =0.029) and 8 week (WMD=-3.775; 95% CI: -7.315 to -0.235; P =0.037). No serious adverse events were observed in all patients who received hydrotherapy.

CONCLUSION

Hydrotherapy is efficacious and safe for reducing pain and improving functional status in individuals with knee OA, without increasing the risk of adverse effects.

A Comprehensive Summary of the Meta-Analyses and Systematic Reviews on Platelet-Rich Plasma Therapies for Knee Osteoarthritis

INTRODUCTION

Osteoarthritis (OA), including that of the knee joint, represents a significant proportion of musculoskeletal injuries in the Canadian Armed Forces (CAF) due to the frequent, high-stress physical activity for which member participation is necessary. Platelet-rich plasma (PRP) is a conservative, autologous treatment that has the potential to relieve symptoms and improve functionality of military members to decrease the impact of the disease and ultimately strengthen the CAF.

MATERIALS AND METHODS

A search of systematic reviews and meta-analyses was conducted to determine the efficacy of PRP injections in treating knee OA. The Scopus database, PubMed database, and Omni academic search tools were scoped for relevant publications. English literature, published up to and including March 2023, that investigated only clinically randomized controlled trials (RCTs) was eligible for inclusion. The results of network meta-analyses were investigated and summarized independent of reviews and non-network meta-analyses.

RESULTS

A total of 225 unique systematic reviews and meta-analyses were initially identified, of which 39 publications, including 7 network meta-analyses, adhered to the defined inclusion and exclusion criteria. PRP was found to significantly alleviate symptoms of pain based on the visual analog scale and Western Ontario and McMaster Universities Arthritis Index pain scores within the 12-month follow-up. Function, activity, sport, quality of life, and stiffness were additionally determined to generally improve to a greater extent from PRP treatment compared to controls, while adverse effects were minor and temporary. PRP placed in the top 3 in 9 reported surface under the cumulative ranking curves, while individually reported rankings of leukocyte-poor and leukocyte-rich PRP both placed in the top 4. The clinical recommendations made were generally positive, with 17 publications acknowledging the benefits of PRP, 3 supporting possible efficacy, and an additional 8 recommending that it be an option for the conservative treatment of knee OA.

CONCLUSION

The results of this review support the efficacy of PRP for relieving symptoms of pain and improving function, stiffness, and quality of life for patients experiencing knee OA within 12 months. As a result, leukocyte-poor-PRP could be considered for members of the CAF with mild to moderate knee OA (Kellgren-Lawrence grades 1-3) to slow the progression of OA and extend the military careers of CAF members. There continues to be a need for future studies to investigate the longer-term effects of PRP to verify sustained benefits at follow-up points greater than 12 months, including findings of improvement in a delayed fashion at the 3- and 6-month timeframe compared to hyaluronic acid treatment.

Interventional Techniques for the Management of Knee Osteoarthritis: A Literature Review

Osteoarthritis of the knee is a prevalent condition that causes pain, discomfort, and disability that can severely impact the quality of life. This literature review aims to review the various interventional pain management techniques available to treat knee osteoarthritis. It analyzes the efficacy of various interventions such as intra-articular corticosteroids, prolotherapy, viscosupplementation, platelet-rich plasma, and genicular nerve blocks with radiofrequency ablation or cryoneurolysis. We searched databases for studies published in the past 20 years. A total of 37 articles were included. The literature supports the idea that a comprehensive treatment plan consisting of the various aforementioned techniques can provide relief for patients while delaying or avoiding joint replacement surgery.

Effects of platelet-rich plasma on subchondral bone marrow edema and biomarkers in synovial fluid of knee osteoarthritis

BACKGROUND

The aim of the study was to investigate the effect of platelet-rich plasma (PRP) on subchondral bone marrow edema (BME) and the level of biomarkers in synovial fluid of the knee osteoarthritis.

METHODS

Eighty-one patients with symptomatic knee osteoarthritis were randomly divided into two groups according to the number of inpatients. Forty-five cases were treated with intra-articular injection of PRP (PRP group), 36 cases were treated with sodium hyaluronate (SH group), and the clinical effects were evaluated using the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. The changes of subchondral BME were assessed by magnetic resonance imaging (MRI) before and after treatment. The levels of TNFα, IL-6, MCP-1, MMP-1, MMP-3, and MMP-9 in synovial fluid were also detected.

RESULTS

All the patients completed the corresponding treatment and were followed up for 12 months without serious complications. After the treatment, the VAS and WOMAC scores of the two groups were significantly decreased, and the difference was statistically significant at different time points (P < 0.05). The VAS and WOMAC scores of the PRP group were better than those of the SH group (P < 0.05). MRI showed that the subchondral bone edema of the two groups were reduced in varying degrees, and the reduction was more noticeable in the PRP group (P < 0.05). The levels of TNFα, IL-6, MCP-1, MMP-1, MMP-3, and MMP-9 in two groups were decreased, and the difference was statistically significant at different time points (P < 0.05). However, the levels of TNFα, IL-6, MCP-1, MMP-1, MMP-3, and MMP-9 in the PRP group were significantly lower than those in the SH group (P < 0.05).

CONCLUSIONS

Intra-articular injection of PRP can significantly reduce the subchondral BME and the level of biomarkers in synovial fluid of the symptomatic knee osteoarthritis.

The value of injectable viscoelastic supplements for joints

Intra-articular viscoelastic supplements are commonly administered by musculoskeletal radiologists for the treatment of symptomatic osteoarthritis (OA). This article provides an overview of the putative mechanism of action of the agents, a brief review of the evidence base underlying the practice, a commentary on some of the major society guidelines regarding the treatment, and a description of the adverse events that are associated with intra-articular hyaluronic acid administration.

Comparative Efficacy of Intra-Articular Injection, Physical Therapy, and Combined Treatments on Pain, Function, and Sarcopenia Indices in Knee Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials

Knee osteoarthritis (KOA) is associated with a high risk of sarcopenia. Both intra-articular injections (IAIs) and physical therapy (PT) exert benefits in KOA. This network meta-analysis (NMA) study aimed to identify comparative efficacy among the combined treatments (IAI+PT) in patients with KOA. Seven electronic databases were systematically searched from inception until January 2023 for randomized controlled trials (RCTs) reporting the effects of IAI+PT vs. IAI or PT alone in patients with KOA. All RCTs which had treatment arms of IAI agents (autologous conditioned serum, botulinum neurotoxin type A, corticosteroids, dextrose prolotherapy (DxTP), hyaluronic acid, mesenchymal stem cells (MSC), ozone, platelet-rich plasma, plasma rich in growth factor, and stromal vascular fraction of adipose tissue) in combination with PT (exercise therapy, physical agent modalities (electrotherapy, shockwave therapy, thermal therapy), and physical activity training) were included in this NMA. A control arm receiving placebo IAI or usual care, without any other IAI or PT, was used as the reference group. The selected RCTs were analyzed through a frequentist method of NMA. The main outcomes included pain, global function (GF), and walking capability (WC). Meta-regression analyses were performed to explore potential moderators of the treatment efficacy. We included 80 RCTs (6934 patients) for analyses. Among the ten identified IAI+PT regimens, DxTP plus PT was the most optimal treatment for pain reduction (standard mean difference (SMD) = -2.54) and global function restoration (SMD = 2.28), whereas MSC plus PT was the most effective for enhancing WC recovery (SMD = 2.54). More severe KOA was associated with greater changes in pain (β = -2.52) and WC (β = 2.16) scores. Combined IAI+PT treatments afford more benefits than do their corresponding monotherapies in patients with KOA; however, treatment efficacy is moderated by disease severity.

Effect of autologous platelet-rich plasma combined with sodium hyaluronate on clinical efficacy and serum inflammatory factors in patients with knee osteoarthritis

OBJECTIVE

To observe the effect of autologous platelet-rich plasma combined with sodium hyaluronate on clinical efficacy and serum inflammatory factor levels in patients with knee osteoarthritis.

METHODS

A retrospective study was conducted on a total of 99 knee osteoarthritis patients who underwent arthroscopic surgery after failed conservative treatment in No. 215 Hospital of Shaanxi Nuclear Industry from January 2019 to January 2022. Among them, 45 patients treated with only sodium hyaluronate injection after arthroscopic debridement were grouped as the control group (CG), and 54 patients treated with platelet-rich plasma combined with intra-articular injection of sodium hyaluronate after arthroscopic debridement were the observation group (OG). Visual analogue scale/score (VAS) and Lysholm knee scale (LKS) were used to evaluate the clinical therapeutic effect before and 5 weeks after treatment, and ELISA was to detect the changes of matrix metalloproteinase-3 (MMP-3), interleukin-1β (IL-1β), high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α) levels in the serum of patients before and 5 weeks after treatment. Risk factors affecting patient outcomes were analyzed by logistic regression.

RESULTS

Compared to theCG, the improvement of clinical efficacy in the OG was higher (P < 0.05), as well as its LKS score, while the VAS score after treatment in OG was markedly lower (P < 0.05). After treatment, MMP-3, IL-1β, hs-CRP, and TNF-α in the OG were significantly lower than those in the CG (P < 0.05). There was nodifference in the incidence rate of adverse reactions between the two groups (P > 0.05). Logistic regression analysis showed that younger age and lower BMI were protective factors for efficacy in the patients, while higher LKS and TNF-α were risk factors affecting the efficacy in the patients.

CONCLUSION

Intra-articular injection of platelet-rich plasma combined with sodium hyaluronate in the treatment of knee osteoarthritis can significantly reduce the symptoms of knee joint pain, improving knee joint function and in vivo inflammatory response.

Is platelet-rich plasma better than hyaluronic acid in the treatment of knee osteoarthritis? A meta-analysis of randomized controlled trials

Introduction

Due to the complicated surgical procedure of knee arthroplasty and low effectivity of hyaluronic acid (HA) in the treatment of knee osteoarthritis, various studies highly recommend the use of platelet-rich plasma (PRP). However, some studies also reported lower efficacy and limited use of PRP.

Aim

To analyze systematically the different randomized controlled trials (RCTs) comparing the effectiveness of HA vs. PRP for the treatment of knee osteoarthritis.

Material and methods

A systematic literature review was conducted using Medline and Central databases for RCTs about the comparison of HA vs. PRP for the treatment of knee osteoarthritis. Studies were included as per the PICOS criteria and relevant event data were extracted. Risk of bias was analyzed and a random-effects model was used to calculate the pooled odds ratio and risk ratio using RevMan software.

Results

A total of 14 studies were included in the meta-analysis from year 2000 to 2021 including 613 patients. The current meta-analysis has a low risk of publication bias and we obtained the pooled odds ratio (OR) of 2.55 (95% CI: 1.35-4.84) with a τ ² value of 1.01, χ ² value of 52.79, I² value of 77%, Z value of 2.87 and p-value < 0.00001. The pooled risk ratio was 1.34 (95% CI: 1.09-1.65) with a τ ² value of 0.09, χ ² value of 73.48, I² value of 84%, Z value of 2.80 and p-value < 0.00001.

Conclusions

The current meta-analysis highly recommends the use of PRP for the treatment of knee osteoarthritis.

Interventional Therapies for Osteoarthritis: An Update

Osteoarthritis (OA) is one of the most common diseases worldwide and is expected to increase in incidence as the age of the general population rises. Both oral medications, such as NSAIDs, and surgical treatments used for OA management have limitations. Demand is rising for minimally invasive techniques such as intraarticular injections and percutaneous interventions for use in place of or in conjunction with oral medications and surgical therapies, and the past 2 decades have seen a rapid expanse in both pharmacologic and nonpharmacologic minimally invasive OA treatments. Image guidance with fluoroscopy, CT, or ultrasound is often used in conjunction with these procedures to achieve precise treatment localization to achieve maximal therapeutic effect. The choice of modality used for image guidance is often influenced by clinician experience, patient characteristics, and equipment availability. This article reviews the mechanisms of action, contraindications, complications, and efficacy of conventional and developing minimally invasive OA treatments. The minimally invasive treatment options described in this Review include therapeutic injections such as antiinflammatory agents, viscosupplements, and biologics, as well as nonpharmacologic treatments of subchondroplasty, nerve ablation, genicular artery embolization, intraarticular pulsed radiofrequency therapy, and MRI-guided focused ultrasound therapy.

Effects of Intra-articular Platelet Rich Plasma on Cartilage Thickness, Clinical and Functional Outcomes in Knee Osteoarthritis

BACKGROUND

Osteoarthritis of the knee is one of the most common degenerative diseases and the fourth leading cause of years lived with disability at the global level. This study assessed the efficacy of platelet-rich plasma (PRP) in osteoarthritis of knees as to changes in cartilage thickness and clinical and functional outcomes.

METHODS

Thirty participants with Kellgren-Lawrence grade two and grade three osteoarthritis knee who satisfied the inclusion and exclusion criteria were enrolled in this prospective interventional study after taking written informed consent. Each participant received three doses of two ml intraarticular platelet-rich plasma at an interval of seven days. Clinical assessment was determined using the Visual Analogue Scale (VAS) and Knee Osteoarthritis Outcome Score (KOOS) on Day 0, Day 90, and Day 180. Cartilage thickness (femoral and trochlear cartilage) was measured pre (Day 0) and post-PRP (Day 180) under ultrasound guidance.

RESULTS

The mean VAS score for pain was 7.4 before treatment which changed to 5.3 (p= <0.0001) on Day 90 and 3.37 (p= <0.0001) on Day 180 post-PRP. The mean total KOOS was 19.16 ± 10.73 before treatment which improved to 37.42 ± 9.88 (p= <0.0001) and 49.98 ± 8.82 (p= <0.0001) at 90 days, and 180 days post-injection, respectively. The mean cartilage thickness (femoral and trochlear cartilage) improved from baseline (day 0) to final follow-up on day 180, which was statistically significant and implied cartilage repair following PRP administration.

CONCLUSION

This study supports the efficacy of PRP in the management of osteoarthritis knee by improvement in pain, joint stiffness, and activities of daily living, as well as aids in the repair and regeneration of articular cartilage.

Traditional Chinese medicine ointment combined with tuina therapy in treatment of pain and swelling after total knee arthroplasty

BACKGROUND

The most effective treatment for knee joint pain is total knee arthroplasty (TKA), but the risk of pain and swelling in patients after surgery is high. Ice application, ankle pump exercise and non-steroidal anti-inflammatory painkillers are the primary clinical treatments after surgery. However, long-term use of non-steroidal anti-inflammatory pain relievers can easily cause gastrointestinal damage. Traditional Chinese medicine (TCM) ointments and tuina therapy integrate TCM and manipulation, which effectively promotes the penetration of TCM into the skin lesions, improves local blood circulation and inflammatory reaction and has good long-term effects on patients.

AIM

To evaluate the efficacy of TCM ointment combined with tuina therapy in the treatment of pain and swelling after TKA.

METHODS

The randomized controlled clinical trial enrolled 80 patients who underwent TKA via the same procedure. The patients were randomly divided among the treatment group (n = 40) and the control group (n = 40). The control group was given an analgesia pump in addition to oral painkillers as the postoperative intervention. The treatment group received TCM ointment with tuina therapy in addition to the analgesia pump and oral painkillers in the postoperative period. The following variables were recorded 3 d before surgery and 3 d, 7 d and 14 d after surgery: Visual analogue scale (VAS) score; skin temperature; circumferences at 15 cm above and below the patella; maximum active knee flexion angle; and the knee injury and Osteoarthritis Outcome score (KOOS).

RESULTS

After treatment, VAS was significantly lower in the treatment group than the control group at 7 d (t = 7.536, P < 0.001) and 14 d (t = 8.563, P < 0.001). The skin temperature of participants in the treatment group was significantly lower than that in the control group at 7 d (t = 2.968, P = 0.004) and 14 d (t = 4.423, P < 0.001). The circumference values of the two positions in the treatment group were lower than those in the control group at 7 d [t = 2.315, P = 0.023 (above); t = 2.121, P = 0.037 (below)] and 14 d [t = 2.374, P = 0.020 (above); t = 2.095, P = 0.039 (below)]. After 14 d of treatment, the maximum active knee flexion angle and KOOS of the two groups were significantly improved but were significantly higher in the treatment group (P < 0.05 for both).

CONCLUSION

TCM ointment and tuina therapy have significant advantages over standard care in the treatment of pain and swelling after TKA. This additional treatment may improve knee function but additional studies are needed to confirm our observations.

A comprehensive review of intraarticular knee injection therapy, geniculate injections, and peripheral nerve stimulation for knee pain in clinical practice

The knee is the most common joint in adults associated with morbidity. Many pathologies are associated with knee damage, such as gout or rheumathoid arthritis, but the primary condition is osteoarthritis (OA). Not only can osteoarthritis cause significant pain, but it also can result in signficant disability as well. Treatment for this condition varies, starting off with oral analgesics and physical therapy to surgical total knee replacmenet. In the gamut of this various treatments, a conservative approach has included intra articular steroid injections. With time, researchers and clinicians determined that other components injected to the knee may additionally provide relief of this condition. In this investigation, we describe different types of knee injections such as platelet-rich plasma (PRP), hyaluronic acid, stem cells, and prolotherapy. Additionally, we describe the role of geniculate knee injections, radiofrequency, and periopheral nerve stimulation. These treatments should be considered for patients with knee pain refractory to conservative therapies.

Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience

Knee pain is second only to the back as the most commonly reported area of pain in the human body. With an overall prevalence of 46.2%, its impact on disability, lost productivity, and cost on healthcare cannot be overlooked. Due to the pervasiveness of knee pain in the general population, there are no shortages of treatment options available for addressing the symptoms. Ranging from physical therapy and pharmacologic agents to interventional pain procedures to surgical options, practitioners have a wide array of options to choose from – unfortunately, there is no consensus on which treatments are “better” and when they should be offered in comparison to others. While it is generally accepted that less invasive treatments should be offered before more invasive ones, there is a lack of agreement on the order in which the less invasive are to be presented. In an effort to standardize the treatment of this extremely prevalent pathology, the authors present an all-encompassing set of guidelines on the treatment of knee pain based on an extensive literature search and data grading for each of the available alternative that will allow practitioners the ability to compare and contrast each option.

Platelet-Rich Plasma Versus Microfragmented Adipose Tissue for Knee Osteoarthritis: A Randomized Controlled Trial

Background:

Platelet-rich plasma (PRP) has been established as safe and effective for knee osteoarthritis (OA). Another orthobiologic therapy, microfragmented adipose tissue (MFAT), has gained attention because of its heterogeneous cell population (including mesenchymal stem cells). However, prospective comparative data on MFAT are lacking. Because of the safety, efficacy, and simplicity of PRP, new therapeutics such as MFAT should be compared directly with PRP.

Purpose:

To compare patient-reported outcomes of a single injection of PRP versus MFAT for knee OA.

Study Design:

Randomized controlled trial; Level of evidence, 2.

Methods:

A total of 58 patients with symptomatic knee OA (Kellgren-Lawrence grades 1-4) were randomized to receive a single injection of either leukocyte-rich PRP or MFAT under ultrasound guidance. PRP was created by processing 156 mL of whole blood. MFAT was created by harvesting 30 mL of adipose tissue via standard lipoaspiration. Scores for the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and visual analog scale for pain with Activities of Daily Living (VAS-ADL) were recorded at baseline and at 1, 3, and 6 months after the injection. The primary outcome was the KOOS–Pain subscore at 6 months after the injection.

Results:

The PRP group (n = 30) had a mean volume of 5.12 ± 1.12 mL injected. This consisted of a mean platelet count of 2673.72 ± 1139.04 × 10³/µL and mean leukocyte count of 25.36 ± 13.27 × 10³/µL (67.81% lymphocytes, 18.66% monocytes, and 12.33% neutrophils). The MFAT group (n = 28) had a mean volume of 7.92 ± 3.87 mL injected. The mean total nucleated cell count was 3.56 ± 4.62 million/mL. In both groups, KOOS subscale and VAS-ADL scores improved from baseline, and there was no significant difference between the PRP and MFAT groups in the final KOOS–Pain subscore (80.38 ± 16.07 vs 81.61 ± 16.37, respectively; P = .67) or any other outcome score.

Conclusion:

A single injection of either PRP or MFAT resulted in a clinically meaningful improvement for patients with knee OA at 6 months, with no difference between treatment groups.

Registration:

NCT04351087 (ClinicalTrials.gov identifier).

Comparing the Efficacy of Intra-Articular Single Platelet-Rich Plasma(PRP) versus Novel Crosslinked Hyaluronic Acid for Early-Stage Knee Osteoarthritis: A Prospective, Double-Blind, Randomized Controlled Trial

Background and Objectives: For the treatment of knee osteoarthritis (OA), intra-articular platelet-rich plasma (PRP) and novel crosslinked single-dose hyaluronic acid (HA) have both been reported to improve outcomes, but no study has compared them for the treatment of knee OA. We hypothesized patients with early-stage knee OA who received PRP injections would have more WOMAC score changes than those who received HA injections. This is the first prospective, double-blind, parallel, randomized controlled trial comparing the efficacy of intra-articular single-dose PRP versus novel crosslinked HA (HyajointPlus) for treating early-stage knee OA. Materials and Methods: This study analyzed 110 patients randomized into the PRP (n = 54) or HA (n = 56) groups. The primary outcome is the change of WOMAC score at 1-, 3-, and 6-month follow-ups compared to baseline. Results: The data revealed significant improvements in all WOMAC scores in the PRP group at 1-, 3-, and 6-month follow-up visits compared with the baseline level except for the WOMAC stiffness score at the 1-month follow up. In the HA group, significant improvements were observed only in the WOMAC pain score for all the follow-up visits and in WOMAC stiffness, function, and total scores at 6-month follow-up. When comparing the change of WOMAC score at 1-, 3-, and 6-month follow-ups, no significant differences were found between PRP and HA group. Conclusions: This study revealed that both PRP and HA can yield significant improvements in WOMAC scores at 6-month follow-up without any between-group differences at 1-, 3-, and 6-month follow-ups. Thus, both the single-injection regimens of PRP and HA can improve the functional outcomes for treating early-stage knee OA.

Infiltração intraarticular de plasma rico em plaquetas versus ácido hialurônico em pacientes com osteoartrose primária do joelho: Ensaio clínico randomizado com resultados preliminares

Objective  The present study aimed to compare the effects of intraarticular infiltration of platelet-rich plasma with those of hyaluronic acid infiltration in the treatment of patients with primary knee osteoarthritis.

Methods  A randomized clinical trial was conducted with 29 patients who received an intraarticular infiltration with hyaluronic acid (control group) or platelet-rich plasma. Clinical outcomes were assessed using the visual analog scale for pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire before and after the intervention. In addition, the posttreatment adverse effects were recorded. Categorical variables were analyzed using the chi-square and Fisher exact tests, whereas continuous variables were analyzed using the Student t test, analysis of variance, and the Wilcoxon test; all calculations were performed with the Stats package of the R software.

Results  An independent analysis of each group revealed a statistical difference within the first months, with improvement in the pain and function scores, but worsening on the 6 ^th month after the procedure. There was no difference in the outcomes between the groups receiving hyaluronic acid or platelet-rich plasma. There was no serious adverse effect or allergic reaction during the entire follow-up period.

Conclusion  Intraarticular infiltration with hyaluronic acid or platelet-rich plasma in patients with primary knee gonarthrosis resulted in temporary improvement of functional symptoms and pain. There was no difference between interventions.

Publication Frequency and Google Trends Analysis of Popular Alternative Treatments to Arthritis

Background

Public interest in alternative, nonoperative treatments for the management of arthritis has increased. Few have been approved by the Food and Drug Administration. The present study aimed to evaluate trends in public and scientific interest in 4 such treatments by assessing Google Trends and publication frequency data, respectively.

Material and methods

Turmeric, stem cell therapy, platelet-rich plasma (PRP) therapy, and cannabidiol (CBD) were studied. For 2010-2019, Google Trends data and publication frequency data on PubMed were collected by year for arthritis and each of the 4 therapies. Linear, quadratic, and exponential regressions were applied, and the best model of growth was identified.

Results

From 2010 to 2019, Google Trends annual scores for arthritis and turmeric (exponential; R²: 90.5%, P < .001), CBD (exponential; R²: 99.3%, P < .001), stem cell therapy (exponential; R²: 86.7%, P < .001), and PRP therapy (linear; R²: 80.6%, P < .001) increased significantly. Search term frequencies for arthritis and CBD exhibited the highest increase (12,929%). Publications in arthritis and turmeric (linear; R²: 74%, P = .001), stem cell therapy (linear; R²: 94.8%, P < .0001), and PRP therapy (linear; R²: 97.1%, P < .0001) increased from 2010 to 2019. However, publications relating to arthritis and CBD have not increased (P = .122).

Conclusion

Regression analysis indicates that public interest in alternative therapies have had a marked increase. The rise in public interest for CBD, and to a lesser extent, turmeric, stem cell therapy, and PRP, has dramatically outstripped scientific evidence on these therapies. Rigorously designed, clinical studies may be beneficial to keep up with the growing popularity of these treatments, especially CBD.

The Effect of Leukocyte Concentration on Platelet-Rich Plasma Injections for Knee Osteoarthritis: A Network Meta-Analysis

BACKGROUND

It is hypothesized that leukocyte-poor (LP) platelet-rich plasma (PRP) is preferred over leukocyte-rich (LR) PRP for the treatment of knee osteoarthritis (OA).

METHODS

The MEDLINE, Embase, and Cochrane databases were reviewed for all English-language studies comparing LP-PRP or LR-PRP with relevant controls or each other. The follow-up periods were 6 months and 12 months. The primary outcome measure was the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between baseline and follow-up. The secondary outcome measures were changes in the WOMAC pain subscale, visual analog scale (VAS) for pain, and International Knee Documentation Committee (IKDC) subjective score between baseline and follow-up, and the incidence of local adverse reactions. Treatment outcomes were analyzed using the mean difference between treatments for continuous outcomes and the odds ratio for binary outcomes, with 95% credibility intervals. Treatment modalities were ranked using the surface under the cumulative ranking (SUCRA) probabilities. Risk of bias was assessed using the relevant Cochrane tools, RoB 2 (version 2 of the Cochrane risk-of-bias tools) for randomized controlled trials (RCTs) and ROBINS-I (Risk of Bias in Non-Randomized Studies - of Interventions) for prospective comparative studies (PCSs).

RESULTS

This network meta-analysis included 23 studies: 20 RCTs and 3 PCSs, with a total of 2,260 patients and a mean follow-up period of 9.9 months. The overall risk-of-bias assessment of the RCTs revealed that 9 studies had low risk, 7 had some concerns, and 4 had high risk. The overall risk-of-bias assessment of the PCSs revealed that 1 study had low risk and 2 had moderate risk. We found no significant (p < 0.05) difference in all outcome measures and local adverse reactions between LP-PRP and LR-PRP. SUCRA rankings revealed that, for all outcome measures, LP-PRP is preferred to LR-PRP across follow-up periods.

CONCLUSIONS

Leukocyte concentration of PRP does not play a significant role in patient-reported outcome measures for knee OA. LP-PRP is preferred to LR-PRP according to SUCRA rankings, but this preference may not be important in clinical practice.

LEVEL OF EVIDENCE

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Intra-Articular Injections of Autologous Adipose Tissue or Platelet-Rich Plasma Comparably Improve Clinical and Functional Outcomes in Patients with Knee Osteoarthritis

The use of biologic therapies for the management of knee osteoarthritis (OA) has largely increased in recent years. The purpose of this study was to evaluate the efficiency and the therapeutic potential of platelet-rich plasma (PRP) and autologous adipose tissue (AAT) injections as a treatment for knee OA. Sixty participants were enrolled in the study: 20 healthy ones and 40 with minimal to moderate knee OA (KL I-III). The OA patients were randomly assigned either to the PRP or to the AAT group. The PRP samples showed a low expression level of NF-κB-responsive gene CCL5 and high expression levels of classic inflammatory and TNF-l INF responses. The AAT injection product was prepared using a Lipogems device, and its regenerative potential as well as the ability for expansion of mesenchymal stem cells were tested in the cell culture conditions. The patient assessments were carried out five times. Significant improvement was observed regardless of the treatment method in the VAS, KOOS, WOMAC and IKDC 2000 subjective evaluations as well as in the functional parameters. Intra-articular injections of AAT or PRP improved pain, symptoms, quality of life and functional capacity with a comparable effectiveness in the patients with mild to moderate knee osteoarthritis.

Analysis of Clinical Efficacy of Clearing Heat and Dispelling Paralysis Soup in the Treatment of Osteoarthritis of the Knee Joint and Its Effect on Patients' Motor Function

OBJECTIVE

To investigate the effects of clearing heat and dispelling paralysis soup for osteoarthritis of the knee joint on the motor function of the knee joint and the level of inflammation of the organism in patients.

METHODS

One hundred and sixteen patients with knee osteoarthritis admitted from January 2020 to May 2021 were selected and randomly divided into 2 groups, 58 cases in the control group were treated with loxoprofen sodium dispersible tablets, and 58 cases in the experimental group were treated with Qinghe dispel paralysis soup on the basis of the control group and the patients' balance ability analysis, gait parameter change analysis, VAS, JOA, AIMS2-SF scale assessment, and serum index. The treatment effects of the two treatment regimens were analyzed by testing.

RESULTS

The anterior-posterior axis, left-right axis, A2-A6, A4-A8, and circumferential axis of the experimental group were lower than those of the control group after treatment (P < 0.05); the step length of the experimental group was higher than that of the control group after treatment (P < 0.05), and there were no significant differences in step speed, double-support phase, and step width (P > 0.05), but both groups improved significantly compared with those before treatment (P < 0.05); the VAS score of the experimental group was lower than that of the control group after treatment. The VAS scores of the experimental group were lower than those of the control group, and the scores of JOA and AIMS2-SF were higher than those of the control group (P < 0.05); the levels of TIMP-1 in the experimental group were higher than those in the control group, and the levels of TNF-α, TLR4, MMP-3, and IL-1 were lower than those in the control group after treatment (P < 0.05); there was no significant difference in the incidence of adverse reactions between the two groups during treatment (P > 0.05), and the efficiency of the experimental group was higher than that of the control group (P < 0.05).

CONCLUSION

Combined treatment with Qinghe dispel paralysis soup can better promote the recovery of balance, improve motor ability, and reduce the development of inflammation in the organism, with high safety and effectiveness.

Treating Knee Osteoarthritis With Platelet-Rich Plasma and Hyaluronic Acid Combination Therapy: A Systematic Review

BACKGROUND

Platelet-rich plasma (PRP) and hyaluronic acid (HA) are injectable treatments for knee osteoarthritis. The focus of previous studies has compared their efficacy against each other as monotherapy. However, a new trend of combining these 2 injections has emerged in an attempt to have a synergistic effect.

PURPOSE

To systematically review the clinical literature examining the combined use of PRP + HA.

DESIGN

Systematic review.

METHODS

A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed and Embase. The following search terms were used: knee osteoarthritis AND platelet rich plasma AND hyaluronic acid. The review was performed by 2 independent reviewers who applied the inclusion/exclusion criteria and independently extracted data, including methodologic scoring, PRP preparation technique, HA composition, and patient-reported outcomes (PROs).

RESULTS

A total of 431 articles were screened, 12 reviewed in full, and 8 included in the final analysis: 2 case series, 3 comparative, and 3 randomized studies. Average follow-up was 9 months. The modified Coleman Methodology Score was 38.13 ± 13.1 (mean ± SD). Combination therapy resulted in improved PROs in all studies. Of the comparative and randomized studies, 2 demonstrated that combination therapy was superior to HA alone. However, when PRP alone was used as the control arm (4 studies), combination therapy was not superior to PRP alone.

CONCLUSION

Combination therapy with PRP + HA improves PROs and is superior to HA alone but is not superior to PRP alone.

Osteochondral Lesions of the Talus: A Review on Talus Osteochondral Injuries, Including Osteochondritis Dissecans

This is a review on talus osteochondritis dissecans and talus osteochondral lesions. A majority of the osteochondral lesions are associated with trauma while the cause of pure osteochondritis dissecans is still much discussed with a possible cause being repetitive microtraumas associated with vascular disturbances causing subchondral bone necrosis and disability. Symptomatic nondisplaced osteochondral lesions can often be treated conservatively in children and adolescents while such treatment is less successful in adults. Surgical treatment is indicated when there is an unstable cartilage fragment. There are a large number of different operative technique options with no number one technique to be recommended. Most techniques have been presented in level II to IV studies with a low number of patients with short follow ups and few randomized comparisons exist. The actual situation in treating osteochondral lesions in the ankle is presented and discussed.

Injectable therapies for knee osteoarthritis

Knee osteoarthritis is a degenerative arthritis that mainly affects older adults. Over time, osteoarthritis can result in significant and sustained discomfort, pain, and disability. Current treatment focuses on the alleviation of pain and functional impairment. While arthroplasty is the definitive management option, it subjects patients to surgical complications, and the possibility of surgical revisions. In addition, many patients are not surgical candidates. Instead, pharmacological therapy is recommended first-line for most patients. On top of pharmacological therapy, there are a range of non-operative procedural options available. However, leading professional guidelines vary in their recommendations for these agents. Therefore, we present a review of recent randomized controlled trials and meta-analyses on injectable corticosteroids, hyaluronic acid (HA), platelet-rich plasma (PRP), mesenchymal stem cell injections, and ozone therapy. The preliminary data reveal the strongest evidence in favour of corticosteroid injections, although there are promising findings regarding the long-term efficacy of HA and PRP.

Hypertonic Dextrose Prolotherapy, an alternative to intra-articular injections with Hyaluronic Acid in the treatment of knee osteoarthritis: systematic review and meta-analysis

ABSTRACT

Intra-articular injections with hyaluronic acid are recommended in the treatment of knee osteoarthritis (KOA); however, hypertonic dextrose prolotherapy (HDP) has been reported as effective and safe. The aim was to evaluate the effectiveness of HDP for pain reduction and improvement of function in individuals with KOA in comparison with hyaluronic acid by meta - analysis. The search was performed in electronic databases. Six studies were included (395 participants). No statistically significant differences were found between prolotherapy and hyaluronic acid in pain control in the short term, however, in the sub-analysis where included only the studies that used intra-articular injection within the prolotherapy scheme, an effect was found in favor of the prolotherapy groups (d = -1.33, 95% CI -2.50 to -0.16, p (z) 0.03). Also, an effect was found in favor of the prolotherapy group in the improvement in function (d = -1.05, 95% CI -2.03 to -0.08, p (z) 0.03). No major adverse reactions or side effects were reported in any of the studies. HDP appears to be an effective intervention to decrease pain and improve function in KOA, with efficacy similar to intra-articular injections with hyaluronic acid in the short-term follow-up. Nonetheless, better-quality clinical trials are necessary.

American Medical Society for Sports Medicine Position Statement: Principles for the Responsible Use of Regenerative Medicine in Sports Medicine

ABSTRACT

Many sports medicine physicians are currently considering introducing regenerative medicine into their practice. Regenerative medicine and the subclassification of orthobiologics are a complicated topic and have produced widely varying opinions. Although there is concern by government regulators, clinicians, scientists, patient advocacy organizations, and the media regarding the use of regenerative medicine products, there is also excitement about the potential benefits with growing evidence that certain regenerative medicine products are safe and potentially efficacious in treating musculoskeletal conditions. Sports medicine physicians would benefit from decision-making guidance about whether to introduce orthobiologics into their practice and how to do it responsibly. The purpose of this position statement is to provide sports medicine physicians with information regarding regenerative medicine terminology, a brief review of basic science and clinical studies within the subclassification of orthobiologics, regulatory considerations, and best practices for introducing regenerative medicine into clinical practice. This information will help sports medicine physicians make informed and responsible decisions about the role of regenerative medicine and orthobiologics in their practice.

Efficacy evaluation of acupotomy combined with platelet-rich plasma in the treatment of early and middle osteoarthritis

OBJECTIVE

To investigate the efficacy of traditional Chinese medicine acupotomy combined with platelet-rich plasma (PRP) in the treatment of early and middle osteoarthritis.

METHODS

Eighty cases of early and middle knee joint pain patients admitted in our hospital were selected in this retrospective study. They were divided into the control group and observation group according to treatment methods, with 40 cases in each group. The control group was treated with PRP, and the observation group was treated with acupotomy + PRP. Clinical response rate, visual analogue scale (VAS) pain score, Lequesne score, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and SF-36 quality of life score were compared between the two groups.

RESULTS

The total clinical response rate in the observation group was higher than that in control group (P<0.01). VAS pain score, knee joint WOMAC index and Lequesne score in the two groups after treatment were lower than those before treatment, and those in the observation group were lower than those in the control group (all P<0.05). SF-36 quality of life score was significantly higher in the observation group than in the control group (all P<0.001).

CONCLUSION

Acupotomy combined with PRP in the treatment of early and middle osteoarthritis can relieve pain and improve joint function, which is worthy of clinical promotion.

Effect of Shujin Xiaotong capsules combined with ultrashort wave therapy on pain and inflammatory cytokines in patients with chronic knee osteoarthritis

OBJECTIVE

To investigate the effect of Shujin Xiaotong capsules combined with ultrashort wave therapy on pain, high-sensitivity C-reactive protein (hs-CRP) level and inflammatory cytokines in patients with chronic knee osteoarthritis.

METHODS

One hundred and eighteen patients with chronic knee osteoarthritis included in this study were randomly divided into the control group (n=59) and the experimental group (n=59). The patients in the control group were treated with Shujin Xiaotong capsules, and the patients in the experimental group were treated with Shujin Xiaotong capsules combined with ultrashort wave therapy. The knee motion before and after treatment, pain and curative effect were evaluated by the Lysholm Scale, Mc-Gee Scale and Japanese Orthopaedic Association (JOA) Score, respectively. Color Doppler ultrasonography was performed to observe the blood flow in the synovium of knee joint. Serum inflammatory cytokines and oxidative stress indicators were measured using corresponding kits. The quality of life of the patients was measured using the World Health Organization Quality of Life-BREF Scale.

RESULTS

There was no significant difference in the scores of the Lysholm, Mc-Gee and JOA, synovial blood flow signal distribution, levels of hs-CRP, inflammatory cytokines, superoxide dismutase, malondialdehyde and nitric oxide as well as quality of life of patients between the two groups before treatment (all P>0.05). After treatment, the scores of Lysholm, JOA and World Health Organization Quality of Life-BREF as well as levels of superoxide dismutase in both groups were improved, while the scores of Mc-Gee as well as levels of hs-CRP, inflammatory cytokines, malondialdehyde and nitric oxide in both groups were decreased (all P<0.05). After treatment, compared with the control group, the proportion of synovial blood flow signal distribution and quality of life of patients in the experimental group were higher, while the levels of hs-CRP, inflammatory cytokines, superoxide dismutase, malondialdehyde and nitric oxide were lower (all P<0.05).

CONCLUSION

Shujin Xiaotong capsules combined with physical ultrashort wave therapy can significantly reduce serum inflammation cytokines and hs-CRP expression and pain, as well as improve serum oxidative stress levels, knee joint function and quality of life in patients with chronic knee osteoarthritis.

Platelet-rich plasma for tendinopathy and osteoarthritis: a narrative review

Background

Musculoskeletal disorders include a wide range of degenerative and inflammatory problems, which can affect any part of the muscular and skeletal system. Platelet-rich plasma (PRP) has been a breakthrough in musculoskeletal medicine, especially with its effects to speed up soft tissue, cartilage, and bone healing. It is now thought that stem cells are able to reverse the degenerative process and promote rapid healing. Platelet-rich plasma (PRP) has received special attention in treating tendinopathy and osteoarthritis. This review aims to do a comprehensive review of the scientific evidence for the efficiency of PRP application in tendinopathy and osteoarthritis.

Main body of the abstract

In osteoarthritis treatment, platelet-rich plasma is thought to influence the whole joint environment by increasing chondrocyte proliferation. The injection of autologous PRP into the joint space and surrounding soft tissues delivers a concentrated dose of these growth factors, which accelerate the healing process and reduce pain.

Short conclusion

Many studies report some benefits in regard to pain and functionality, especially in tendinopathy, but further investigations are needed to incorporate PRP into clinical practice and be a common form of therapy for tendinopathy and osteoarthritis. Caution should be applied with any treatment we use in clinical practice, especially with PRP and other forms of injections.

Efficacy of Platelet-Rich Plasma on Pain and Function in the Treatment of Knee Osteoarthritis: A Prospective Cohort Study

Background

Osteoarthritis (OA) is a degenerative disease commonly affecting the knee joints. It affects patients socially, psychologically and economically and rates of the disease have been increasing due to obesity and old age. Regardless of choosing a medically conservative approach, it is a challenge in the long term to provide OA patients efficient treatment with minimal side effects and long-term efficiency. Platelet-rich plasma (PRP) is a convenient, low-cost and affordable treatment technique used in treating knee OA with encouraging efficient and safe outcomes. In this study we will investigate the effect of PRP on knee OA.

Methods

This is a prospective cohort study involving 252 patients with different OA grades. The Kellgren and Lawrence (K&L) system was used in classifying the affected knee by degenerative cartilage lesions as well as early and severe OA. All patients with a diagnosis of knee OA were screened in every visit before the injection, the pain was assessed by the 0-10 Numeric Rating Scale (NRS), and knee range of motion including flexion and extension was assessed by goniometer. Follow-up appointments were done on three-month intervals for a total of three visits for evaluation. Injection of PRP was given to all the patients with a maximum of four injections. The results were evaluated statistically according to the total number of follow-up visits.

Results

In grade II patients, the pain improved with the visits and the maximum improvement in flexion degree was noticed in patients who came for a total of three follow-up visits. In grade III patients, the most improvement in pain was in patients who came for three follow-up visits, while the most improvement in flexion degree was in patients who came for a total of two follow-up visits. Patients with grade IV who came for three follow-up visits showed the most improvement in pain and degree of flexion.

Conclusions

Intra-articular injections gave significant pain and flexion improvement in grades II, III and IV in OA patients, especially with multiple injection in the short-term follow-up. As a result, recommendation of repeated multiple injections up to four times is efficient in providing long time relief in knee OA.

Comprehensive Review of Knee Osteoarthritis Pharmacological Treatment and the Latest Professional Societies' Guidelines

Osteoarthritis is the most common musculoskeletal progressive disease, with the knee as the most commonly affected joint in the human body. While several new medications are still under research, many symptomatic therapy options, such as analgesics (opioid and non-opioid), nonsteroid anti-inflammatory drugs, symptomatic slow-acting drugs in osteoarthritis, and preparations for topical administration, are being used, with a diverse clinical response and inconsistent conclusions across various professional societies guidelines. The concept of pharmacogenomic-guided therapy, which lies on principles of the right medication for the right patient in the right dose at the right time, can significantly increase the patient’s response to symptom relief therapy in knee osteoarthritis. Corticosteroid intra-articular injections and hyaluronic acid injections provoke numerous discussions and disagreements among different guidelines, even though they are currently used in daily clinical practice. Biological options, such as platelet-rich plasma and mesenchymal stem cell injections, have shown good results in the treatment of osteoarthritis symptoms, greatly increasing the patient’s quality of life, especially when combined with other therapeutic options. Non-inclusion of the latter therapies in the guidelines, and their inconsistent stance on numerous therapy options, requires larger and well-designed studies to examine the true effects of these therapies and update the existing guidelines.

Mesenchymal Stem Cells: A New Choice for Nonsurgical Treatment of OA? Results from a Bayesian Network Meta-Analysis

Objective

Osteoarthritis (OA) is the most common degenerative joint disease, causing joint pain, stiffness, and even disability. Guidelines recommend intra-articular injections as an alternative treatment to relieve OA symptoms for patients who demonstrate poor tolerability or compliance to oral administration of drugs. Mesenchymal stem cells (MSCs) are a potential treatment for of OA. We conducted this network meta-analysis to comprehensively compare the efficacy and safety between hyaluronic acid (HA), corticosteroids (GCs), platelet-rich plasma (PRP), and MSCs.

Design

Systematic review and Bayesian network meta-analysis. Data Sources. Relevant studies, published from January 2000 to January 2020, in the PubMed, Cochrane library, EMBASE, and CKNI databases.

Methods

Bayesian network and conventional meta-analyses were conducted. Pain relief, functional improvement, improvement in joint stiffness, and risk of adverse effects (AEs) were assessed.

Results

Twenty-five articles with 4642 patients were included. Overall, MSC therapy was the most effective treatment for pain relief (standardized mean difference compared with placebo = 3.61, 95% CI [1.87 to 5.35]). Both MSC and PRP therapies improved every symptom of OA effectively and have an advantage over HA and GCs which are recommended by guidelines. MSCs, PRP, HA, and GCs are tolerated well for patients in long-term treatment of OA compared with placebo.

Conclusions

The results show that MSCs relieve pain, stiffness, and dysfunction due to OA better than PRP, HA, and GCs and are not statistically correlated with greater safety concerns. More high-quality trials are needed to reconfirm the findings of this study, however, standardization of preparation of MSCs and PRP should be investigated in the future.

Impact of the numbers of injections of platelet rich plasma on the clinical outcomes in patients with knee osteoarthritis: A protocol for an updated network meta-analysis

BACKGROUND

Two published meta-analyses have investigated the effects of the number of injections of platelet rich plasma (PRP) on clinical outcomes in knee osteoarthritis patients, however conflicting findings were generated.

METHODS

We will systematically search PubMed, Embase, and China National Knowledgement Infrastructure (CNKI) to capture additional eligible studies. After screening citations, extracting essential data, assessing the risk of bias, we will use RevMan software and Open BUGS to perform head-to-head and network meta-analysis of pain alleviation and improvement of joint functionality, respectively.

DISCUSSION

Knee joint osteoarthritis (KOA) is the main cause of joint degeneration in elderly, which seriously reduces patients quality of life. Although intra-articular PRP has been extensively prescribed to treat KOA, a definitive conclusion about the appropriate number of injections has not yet been generated in published meta-analyses. The present updated network meta-analysis will comprehensively answer this question.

ETHICS AND DISSEMINATION

We will communicate our findings through participating in academic conferences or submiting it to be considered for publication in peer reviewed scholar journal.

INPLASY REGISTRATION NUMBER

We registered this protocol in International Plateform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) platform and obtained an identifier of INPLASY2020110043 (https://inplasy.com/inplasy-2020-11-0043/).

Effects of platelet-rich plasma injection for pain control and cartilage repair in knee osteoarthritis: A protocol for the systematic review and meta-analysis of randomized controlled trials in animal models

BACKGROUND

Knee osteoarthritis (KOA) is a common disabling condition and a heavy financial burden to the society. Platelet-rich plasma (PRP) is considered to be an effective method in the repair and regeneration of cartilage and alleviate pain in KOA. But the utilising of PRP to treat KOA in clinical has shown variable results from many studies. The objective of this protocol is to determine the efficacy of PRP in pain control and cartilage repair in KOA animal models.

METHOD

We will search the following three electronic databases: MEDLINE, EMBASE and Web of Science. The primary outcome will include the histological score of cartilage and pain score. The secondary outcomes will be the behavioural assessments and cartilage thickness. SYRCLE's risk of bias tool will be used to assessment the risk of bias of including studies. The standardized mean difference and 95% confidence interval will be used to calculate the effect of PRP treatment. The I2 inconsistency values will be used to calculated the heterogeneity between studies.

RESULTS

The results of this paper will be submitted to a peer-reviewed journal for publication.

CONCLUSION

This research will determine the efficacy of PRP of the treatment of knee osteoarthritis model.

PROSPERO REGISTRATION NUMBER

CRD42020181589.

PRP in wound healing applications

Platelets play a crucial role in hemostasis, tissue regeneration and host defense. Based on these settings, platelet-rich plasma (PRP) and its derivatives are therapeutically used to promote wound healing in several scenarios. This review summarizes the biological mechanisms underlying the most traditional as well as innovative applications of PRP in wound healing. These mechanisms involve the combined action of platelet-derived growth factors and cytokines, together with the role of plasma-derived fibrillar, antioxidant and homeostatic factors. In addition, regenerative treatments with PRP consist of personalized and non-standardized methods. Thus, the quality of PRP varies depending on endogenous factors (e.g., age; gender; concomitant medication; disease-associated systemic factors; nutrition) and exogenous factors (anticoagulants and cellular composition). This review also analyses whether these factors affect the biological mechanisms of PRP in wound healing applications.

Efficacy of Autologous Conditioned Serum (ACS), Platelet-Rich Plasma (PRP), Hyaluronic Acid (HA) and Steroid for Early Osteoarthritis Knee: A Comparative Analysis

BACKGROUND

Intra-articular injection therapy constituting corticosteroids, viscosupplements and blood-derived products are considered to have a key role in non-operative management of osteoarthritis knee. While corticosteroids and viscosupplements have proven short-term efficacy in early osteoarthritis; orthobiologics are gaining increased attention in osteoarthritis management. The aim of present study was thus to compare two commonly used biologics (platelet-rich plasma/PRP and autologous conditioned serum/ACS) to each other and to established therapies.

METHODS

After required institutional clearances, all patients presenting with early primary osteoarthritis knee who had failed initial conservative management and received only unilateral knee injection were included. Patients in the PRP group were compared to the other groups (comprising the HA/hyaluronic acid group, steroid group, and a matched cohort who had been administered ACS for the same indication earlier). Clinical outcome was evaluated using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire and Visual Analogue scale (VAS) pre-injection and at 6 months.

RESULTS

ACS and PRP did not have any significant difference in terms of either WOMAC score (p = 0.154) or VAS score at 6 months (p = 0.850). The scores for both these orthobiologics were better than the control groups (HA group and Steroid group). Between the two control groups, HA group had better VAS scores as compared to the Steroid group (p = 0.008).

CONCLUSION

The clinical outcomes following intra-articular injection of ACS and PRP are better than controls (HA and steroid), but a difference between the two orthobiologics could not be demonstrated.

LEVEL OF EVIDENCE

3b.

Platelet-rich plasma injections delay the need for knee arthroplasty: a retrospective study and survival analysis

PURPOSE

The biological action of platelet-rich plasma (PRP) could slow down the osteoarthritis progression, resulting in a delay of joint replacement. This work aims to evaluate the ability of PRP to postpone and even avoid knee replacement in patients with knee osteoarthritis (KOA) analyzing, on the one hand, the time of delay and on the other hand the percentage of patients without undergoing total knee arthroplasty (TKA).

METHODS

A retrospective analysis and a survival analysis were conducted. KOA patients who underwent knee replacement between 2014 and 2019 and previously received PRP infiltrations were included in the retrospective analysis. Regarding survival analysis, KOA patients who received PRP treatment during 2014 and with follow-up until 2019 were included. The dates of PRP treatment and TKA, KOA severity, age of the patients, number of PRP cycles, and administration route were analyzed.

RESULTS

This work included 1084 patients of which 667 met the inclusion criteria. 74.1% of the patients in the retrospective study achieved a delay in the TKA of more than 1.5 years, with a median delay of 5.3 years. The survival analysis showed that 85.7% of the patients did not undergo TKA during the five year follow-up. The severity degree, age, PRP cycles, and administration route had a statistically significant influence on the efficacy of PRP in delaying surgery.

CONCLUSION

These data suggest that the application of PRP in KOA patients is a treatment that could delay TKA, although further studies are needed to understand and improve this therapy.