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Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Research Article

Does Intra-Articular Injection of Platelet-Rich Plasma Have an Effect on Cartilage Thickness in Patients with Primary Knee Osteoarthritis?

Author(s): Noha M. Abdel Baki*, Zeinab O. Nawito, Nehal M. S. Abdelsalam, Dina Sabry, Hossam Elashmawy, Nagy A. Seleem, Azza Ali Abdel-azeem Taha and Mohamed El Ghobashy

Volume 17, Issue 3, 2021

Published on: 14 January, 2021

Page: [294 - 302] Pages: 9

DOI: 10.2174/1573397117666210114151701

Price: $65

Abstract

Objectives: To determine the effect of intra-articular injection of platelet-rich plasma (PRP) in patients with primary knee osteoarthritis (OA) by clinical evaluation and ultrasonographic (US) assessment of cartilage thickness.

Patients and Methods: A total of 100 patients with mild to severe primary knee OA using the Kellgren- Lawrence (K-L) grading scale were included and divided into two groups. Group I included 50 patients who were given two intra-articular knee injections of PRP, 1 week apart; Group II included 50 patients who received non-steroidal anti-inflammatory drugs (NSAIDs) and chondroprotective drugs. Functional assessment of all OA patients was done using the basal WOMAC score, at 2 and 6 months. US assessment of femoral condylar cartilage thickness was conducted basally and at 6 months.

Results: Improvement of WOMAC score was observed at 2 and 6 months in Group I following PRP injection compared to Group II (p values < 0.001), The improvement of WOMAC in Group I occurred in all severity degrees of OA (p < 0.001). Moreover, a significant increase in cartilage thickness was found at the intercondylar area (ICA) at 6 months relative to baseline assessment by US in Group I (p = 0.041).

Conclusion: Treatment with PRP injections can reduce pain and improve knee function in patients with various degrees of articular degeneration. Further studies are needed to clarify the anabolic effect of PRP on the articular cartilage.

Keywords: Osteoarthritis, platelet-rich plasma, chondroprotective drugs, WOMAC, ultrasonography, cartilage thickness.

Graphical Abstract

[1]
Hao Z, Li X, Dai J, Zhao B, Jiang Q. Genetic effects of rs3740199 polymorphism in ADAM12 gene on knee osteoarthritis: a meta-analysis. J Orthop Surg Res 2017; 12(1): 94.
[http://dx.doi.org/10.1186/s13018-017-0594-z] [PMID: 28637509]
[2]
Zhuo Q, Yang W, Chen J, Wang Y. Metabolic syndrome meets osteoarthritis. Nat Rev Rheumatol 2012; 8(12): 729-37.
[http://dx.doi.org/10.1038/nrrheum.2012.135] [PMID: 22907293]
[3]
Dhillon MS, Patel S, John R. PRP in OA knee - update, current confusions and future options. SICOT J 2017; 3(3): 27.
[http://dx.doi.org/10.1051/sicotj/2017004] [PMID: 28322719]
[4]
Dhillon RS, Schwarz EM, Maloney MD. Platelet-rich plasma therapy - future or trend? Arthritis Res Ther 2012; 14(4): 219.
[http://dx.doi.org/10.1186/ar3914] [PMID: 22894643]
[5]
Yu W, Wang J, Yin J. Platelet-rich plasma: a promising product for treatment of peripheral nerve regeneration after nerve injury. Int J Neurosci 2011; 121(4): 176-80.
[http://dx.doi.org/10.3109/00207454.2010.544432] [PMID: 21244302]
[6]
Borrione P, Gianfrancesco AD, Pereira MT, Pigozzi F. Platelet-rich plasma in muscle healing. Am J Phys Med Rehabil 2010; 89(10): 854-61.
[http://dx.doi.org/10.1097/PHM.0b013e3181f1c1c7] [PMID: 20855985]
[7]
Marques LF, Stessuk T, Camargo IC, Sabeh Junior N, dos Santos L, Ribeiro-Paes JT. Platelet-rich plasma (PRP): methodological aspects and clinical applications. Platelets 2015; 26(2): 101-13.
[http://dx.doi.org/10.3109/09537104.2014.881991] [PMID: 24512369]
[8]
Senet P, Bon FX, Benbunan M, et al. Randomized trial and local biological effect of autologous platelets used as adjuvant therapy for chronic venous leg ulcers. J Vasc Surg 2003; 38(6): 1342-8.
[http://dx.doi.org/10.1016/S0741-5214(03)00908-X] [PMID: 14681639]
[9]
Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost 2004; 91(1): 4-15.
[http://dx.doi.org/10.1160/TH03-07-0440] [PMID: 14691563]
[10]
Rayegani SM, Raeissadat SA, Taheri MS, et al. Does intra articular platelet rich plasma injection improve function, pain and quality of life in patients with osteoarthritis of the knee? A randomized clinical trial. Orthop Rev (Pavia) 2014; 6(3): 5405.
[http://dx.doi.org/10.4081/or.2014.5405] [PMID: 25317308]
[11]
Mortada M, Zeid A, Al-Toukhy MA, Ezzeldin N, Elgawish M. Reliability of a Proposed Ultrasonographic Grading Scale for Severity of Primary Knee Osteoarthritis. Clin Med Insights Arthritis Musculoskelet Disord 2016; 9: 161-6.
[http://dx.doi.org/10.4137/CMAMD.S38141] [PMID: 27478389]
[12]
Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16(4): 494-502.
[http://dx.doi.org/10.1136/ard.16.4.494] [PMID: 13498604]
[13]
Altman R, Asch E, Bloch D, et al. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Arthritis Rheum 1986; 29(8): 1039-49.
[http://dx.doi.org/10.1002/art.1780290816] [PMID: 3741515]
[14]
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988; 15(12): 1833-40.
[PMID: 3068365]
[15]
Lee CL, Huang MH, Chai CY, Chen CH, Su JY, Tien YC. The validity of in vivo ultrasonographic grading of osteoarthritic femoral condylar cartilage: a comparison with in vitro ultrasonographic and histologic gradings. Osteoarthritis Cartilage 2008; 16(3): 352-8.
[http://dx.doi.org/10.1016/j.joca.2007.07.013] [PMID: 17920940]
[16]
Dhurat R, Sukesh M. Principles and Methods of Preparation of Platelet-Rich Plasma: A Review and Author’s Perspective. J Cutan Aesthet Surg 2014; 7(4): 189-97.
[http://dx.doi.org/10.4103/0974-2077.150734] [PMID: 25722595]
[17]
Kon E, Buda R, Filardo G, et al. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc 2010; 18(4): 472-9.
[http://dx.doi.org/10.1007/s00167-009-0940-8] [PMID: 19838676]
[18]
Kon E, Mandelbaum B, Buda R, et al. Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Arthroscopy 2011; 27(11): 1490-501.
[http://dx.doi.org/10.1016/j.arthro.2011.05.011] [PMID: 21831567]
[19]
Sampson S, Reed M, Silvers H, Meng M, Mandelbaum B. Injection of platelet-rich plasma in patients with primary and secondary knee osteoarthritis: a pilot study. Am J Phys Med Rehabil 2010; 89(12): 961-9.
[http://dx.doi.org/10.1097/PHM.0b013e3181fc7edf] [PMID: 21403592]
[20]
Napolitano M, Matera S, Bossio M, et al. Autologous platelet gel for tissue regeneration in degenerative disorders of the knee. Blood Transfus 2012; 10(1): 72-7.
[PMID: 22044954]
[21]
Hassan AS, El-Shafey AM, Ahmed HS, Hamed MS. Effectiveness of the intra-articular injection of platelet rich plasma in the treatment of patients with primary knee osteoarthritis. Egypt Rheumatol 2015; 37(3): 119-24.
[http://dx.doi.org/10.1016/j.ejr.2014.11.004]
[22]
Cerza F, Carnì S, Carcangiu A, et al. Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis. Am J Sports Med 2012; 40(12): 2822-7.
[http://dx.doi.org/10.1177/0363546512461902] [PMID: 23104611]
[23]
Pourcho AM, Smith J, Wisniewski SJ, Sellon JL. Intraarticular platelet-rich plasma injection in the treatment of knee osteoarthritis: review and recommendations. Am J Phys Med Rehabil 2014; 93(11)(Suppl. 3): S108-21.
[http://dx.doi.org/10.1097/PHM.0000000000000115] [PMID: 24879553]
[24]
Elmorsy GS. intra-articular injection of platelet rich plasma in knee osteoarthritis clinical evaluation. World Journal of Pharmaceutical Research 2017; 6(7): 1885-911.
[25]
Kon E, Filardo G, Di Matteo B, Marcacci M. PRP for the treatment of cartilage pathology. Open Orthop J 2013; 7: 120-8.
[http://dx.doi.org/10.2174/1874325001307010120] [PMID: 23730375]
[26]
Podlipská J, Guermazi A, Lehenkari P, et al. Comparison of Diagnostic Performance of Semi-Quantitative Knee Ultrasound and Knee Radiography with MRI: Oulu Knee Osteoarthritis Study. Sci Rep 2016; 6: 22365.
[http://dx.doi.org/10.1038/srep22365] [PMID: 26926836]
[27]
Wenham CYJ, Grainger AJ, Conaghan PGC. The role of imaging modalities in the diagnosis, differential diagnosis and clinical assessment of peripheral joint osteoarthritis. Osteoarthritis Cartilage 2014; 22(10): 1692-702.
[http://dx.doi.org/10.1016/j.joca.2014.06.005] [PMID: 25278078]
[28]
Roemer FW, Eckstein F, Hayashi D, Guermazi A. The role of imaging in osteoarthritis. Best Pract Res Clin Rheumatol 2014; 28(1): 31-60.
[http://dx.doi.org/10.1016/j.berh.2014.02.002] [PMID: 24792944]
[29]
Koo S, Gold GE, Andriacchi TP. Considerations in measuring cartilage thickness using MRI: factors influencing reproducibility and accuracy. Osteoarthritis Cartilage 2005; 13(9): 782-9.
[http://dx.doi.org/10.1016/j.joca.2005.04.013] [PMID: 15961328]
[30]
Schmitz RJ, Wang H-M, Polprasert DR, Kraft RA, Pietrosimone BG. Evaluation of knee cartilage thickness: A comparison between ultrasound and magnetic resonance imaging methods. Knee 2017; 24(2): 217-23.
[http://dx.doi.org/10.1016/j.knee.2016.10.004] [PMID: 27914723]
[31]
Halpern B, Chaudhury S, Rodeo SA, et al. Clinical and MRI outcomes after platelet-rich plasma treatment for knee osteoarthritis. Clin J Sport Med 2013; 23(3): 238-9.
[http://dx.doi.org/10.1097/JSM.0b013e31827c3846] [PMID: 23238250]
[32]
Marmotti A, Rossi R, Castoldi F, et al. PRP and articular cartilage: a clinical update. BioMed Res Int 2015; 2015: 542502.
[http://dx.doi.org/10.1155/2015/542502] [PMID: 26075244]
[33]
Filardo G, Kon E, Pereira Ruiz MT, et al. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach. Knee Surg Sports Traumatol Arthrosc 2012; 20(10): 2082-91.
[http://dx.doi.org/10.1007/s00167-011-1837-x] [PMID: 22203046]
[34]
Ornetti P, Nourissat G, Berenbaum F, Sellam J, et al. under the aegis of the Osteoarthritis Section of the French Society for Rheumatology (Société Française de Rhumatologie, SFR). Does plateletrich plasma have a role in the treatment of osteoarthritis? Joint Bone Spine 2016; 83: 31-6.
[http://dx.doi.org/10.1016/j.jbspin.2015.05.002] [PMID: 26162636]
[35]
Shahid M, Kundra R. Platelet-rich plasma (PRP) for knee disorders. EFORT Open Rev 2017; 2(1): 28-34.
[http://dx.doi.org/10.1302/2058-5241.2.160004] [PMID: 28607768]
[36]
Yamaguchi R, Terashima H, Yoneyama S, Tadano S, Ohkohchi N. Effects of platelet-rich plasma on intestinal anastomotic healing in rats: PRP concentration is a key factor. J Surg Res 2012; 173(2): 258-66.
[http://dx.doi.org/10.1016/j.jss.2010.10.001] [PMID: 21074782]
[37]
Rodeo SA, Arnoczky SP, Delos D. What is platelet-rich plasma? Oper Tech Sports Med 2011; 19(3): 142-8.
[http://dx.doi.org/10.1053/j.otsm.2010.12.001]
[38]
Lei H, Gui L, Xiao R. The effect of anticoagulants on the quality and biological efficacy of platelet-rich plasma. Clin Biochem 2009; 42(13-14): 1452-60.
[http://dx.doi.org/10.1016/j.clinbiochem.2009.06.012] [PMID: 19560449]
[39]
Dhillon M, Patel S, Bali K. Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2011; 19(5): 863-4.
[http://dx.doi.org/10.1007/s00167-010-1339-2] [PMID: 21161706]
[40]
Riboh JC, Saltzman BM, Yanke AB, Fortier L, Cole BJ. Effect of leukocyte concentration on the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis. Am J Sports Med 2016; 44(3): 792-800.
[http://dx.doi.org/10.1177/0363546515580787] [PMID: 25925602]
[41]
Blajchman MA. Novel platelet products, substitutes and alternatives. Transfus Clin Biol 2001; 8(3): 267-71.
[http://dx.doi.org/10.1016/S1246-7820(01)00127-6] [PMID: 11499975]
[42]
Roffi A, Filardo G, Assirelli E, et al. Does platelet-rich plasma freeze-thawing influence growth factor release and their effects on chondrocytes and synoviocytes? BioMed Res Int 2014; 2014: 692913.
[http://dx.doi.org/10.1155/2014/692913] [PMID: 25136613]
[43]
Sánchez M, Fiz N, Azofra J, et al. A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Arthroscopy 2012; 28(8): 1070-8.
[http://dx.doi.org/10.1016/j.arthro.2012.05.011] [PMID: 22840987]
[44]
Pujol JP, Chadjichristos C, Legendre F, et al. Interleukin-1 and transforming growth factor-beta 1 as crucial factors in osteoarthritic cartilage metabolism. Connect Tissue Res 2008; 49(3): 293-7.
[http://dx.doi.org/10.1080/03008200802148355] [PMID: 18661363]
[45]
Say F, Gürler D, Yener K, Bülbül M, Malkoc M. Platelet-rich plasma injection is more effective than hyaluronic acid in the treatment of knee osteoarthritis. Acta Chir Orthop Traumatol Cech 2013; 80(4): 278-83.
[PMID: 24119476]
[46]
Wu YT, Hsu KC, Li TY, Chang CK, Chen LC. Effects of platelet-rich plasma on pain and muscle strength in patients with knee osteoarthritis. Am J Phys Med Rehabil 2018; 97(4): 248-54.
[http://dx.doi.org/10.1097/PHM.0000000000000874] [PMID: 29210705]
[47]
Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med 2013; 41(2): 356-64.
[http://dx.doi.org/10.1177/0363546512471299] [PMID: 23299850]
[48]
Wang-Saegusa A, Cugat R, Ares O, Seijas R, Cuscó X, Garcia-Balletbó M. Infiltration of plasma rich in growth factors for osteoarthritis of the knee short-term effects on function and quality of life. Arch Orthop Trauma Surg 2011; 131(3): 311-7.
[http://dx.doi.org/10.1007/s00402-010-1167-3] [PMID: 20714903]
[49]
Kavadar G, Demircioglu DT, Celik MY, Emre TY. Effectiveness of platelet-rich plasma in the treatment of moderate knee osteoarthritis: a randomized prospective study. J Phys Ther Sci 2015; 27(12): 3863-7.
[http://dx.doi.org/10.1589/jpts.27.3863] [PMID: 26834369]

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