scholarly journals Platelet-rich plasma intra-articular injections as an alternative treatment for knee osteoarthritis: a systematic review

2017 ◽  
Vol 10 (19) ◽  
pp. 46-51
Author(s):  
Elena Sîrbu ◽  
Șerban Gligor ◽  
Corina Pantea
Keyword(s):  
Knee Osteoarthritis ◽  
Platelet Rich Plasma ◽  
Cartilage Degeneration ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Primary Analysis ◽  
Beneficial Effects ◽  
Inappropriate Treatment ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee

Abstract Knee osteoarthritis is a degenerative joint disease characterized by cartilage degeneration and hypertrophic lesions of the epiphyseal bone. It is a disabling condition that causes difficulties of locomotion and severe complications in case of inappropriate treatment. There is growing evidence proving the beneficial effects of using platelet-rich plasma (PRP) in the treatment of knee osteoarthritis. The aim of the present paper is to review the recent scientific literature on the treatment of knee osteoarthritis with platelet-rich plasma presenting the current opinion on this subject. Methods: We analys several studies about PRP who were identified using online databases: EBSCO, ScienceDirect, Scopus and PubMed. Results: After the primary analysis we selected a total of 23 relevant studies. The analysis focused on different PRP administration techniques and methods used in knee osteoarthritis. Conclusions: PRP is most widely used in incipient and moderate symptomatic knee osteoarthritis. Most studies show a significant decrease in pain and significant improvement in joint functionality. These results were mostly obtained after a short follow-up period (6 months-1 year) and also this treatment has a small number of side effects.

scholarly journals Response of osteoarthritis biomarkers after a rehabilitation program: study protocol

2020 ◽  
Vol 7 (1) ◽  
pp. 35
Author(s):  
Eliane Antonioli ◽  
Felipe B. D. Oliveira ◽  
Rosana R. Campedelli ◽  
Alessandro R. Zorzi ◽  
Danielli Specialli ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Knee Osteoarthritis ◽  
High Mobility ◽  
Rehabilitation Program ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Functional Evaluation ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee

<p class="abstract"><strong>Background:</strong> Knee osteoarthritis is a progressive degenerative joint disease and remains a leading cause of pain, physical impairment and decline in health-related quality of life in adults.   Despite its incidence being amongst the highest in chronic diseases, effective biomarkers are not available to assist in its management. The main goal of this study is to identify mediators that serve as biomarkers and investigate if the levels of these biomarkers will be correlated to the efficacy of a rehabilitation program.</p><p class="abstract"><strong>Methods:</strong> This is a prospective cohort study with 65 participants. Patients with mild-to-moderate symptomatic knee osteoarthritis will be recruited. The Rehabilitation Program will consist of three session/week during eight weeks. Assessment about functional evaluation will be performed before and after treatment, using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and EuroQOL-5D (Euro quality of life - five dimension) scales, Visual Analog Scale (VAS), and physical function tests (time up and go, isometric strength testing and kinematic gait analysis). Serum levels of classical pro-inflammatory cytokines, hyaluronan and high mobility group box 1 protein (HMGB-1) will be evaluated. The primary outcome is the change in WOMAC scale from baseline to end. Statistical analyses will be used to determine correlation of physical improvement and serum biomarkers. Adverse events will be monitored throughout the study.</p><p class="abstract"><strong>Conclusions: </strong>This trial expect to study the correlation between the anti-inflammatory effects of rehabilitation program derived factors that may be involved in suppressing cytokine induction via suppressing HMGB-1.</p><p class="abstract"><strong>Trial registration:</strong> Clinicaltrials.gov - NCT02964624.</p>

scholarly journals Alpha-2-Macroglobulin Not Significantly Better Than Regular PRP For Knee Arthritis Symptoms

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0045
Author(s):  
David Klein ◽  
David Bloom ◽  
Kirk Campbell ◽  
Guillem Gonzalez-Lomas ◽  
Michael Alaia ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Platelet Rich Plasma ◽  
Statistical Significance ◽  
The United States ◽  
Joint Disease ◽  
Osteoarthritis Of The Knee ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
Significant Difference ◽  
Patient Reported

Objectives: Osteoarthritis, a degenerative and debilitating joint disease, is one of the most prevalent diseases in the United States. Despite the significant burden osteoarthritis can place on an individual and society, nonoperative treatment options are still very limited. Little clinical data exists on the use of injectable macromolecules for the treatment of osteoarthritis of the knee. Alpha-2-macroglobulin (A2M), a naturally occurring macromolecule, inhibits the many endogenous and exogenous proteinases presenting in the pathogenesis of osteoarthritis. To date, no studies exist evaluating the effectiveness of A2M with other intra-articular injectables. The purpose of this study is to compare the clinical effectiveness of intra-articular injection of A2M against both platelet-rich plasma (PRP) and corticosteroids. Methods: This prospective randomized control trial was conducted at a single medical center. Seventy-five patients with symptomatic knee osteoarthritis with Kellgren-Lawrence grade 2 or 3 were randomized into one of three cohorts receiving intra-articular injection. One group was given PRP, one group was given A2M, and one group was given corticosteroids. All groups had blood drawn to simulate A2M preparation. Patient reported outcomes were collected prior to injection, 6 weeks and 12 weeks following injection. Several measures were used for clinical assessment including the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm, and Tegner scores. Results: Seventy-five patients with a mean age of 61.08 (± 8.48) were enrolled between June 2018 and February 2019. At six weeks, the A2M group had the greatest decrease in VAS (-1.60) and WOMAC (-10.9), however, the differences were not statistically significant. Between the injection and the twelve week visit, the A2M group had a statistically significant difference in WOMAC score compared with PRP (-18.43 vs -5.70, p <0.02). Overall, both corticosteroid (-1.57) and A2M (-1.70) had a similar improvement in VAS when compared with PRP (-0.61). These differences were also not statistically significant. Conclusions: Our study demonstrates Alpha 2 Macroglobulin shows similar effectiveness to corticosteroids in the treatment of knee osteoarthritis. Both A2M and corticosteroids appear to show marginally better effectiveness than PRP injection, however the differences are small and did not reach statistical significance in most outcome measures.

scholarly journals AB0862 CONSENSUS STATEMENT ON INTRA-ARTICULAR INJECTIONS OF PLATELET-RICH PLASMA FOR THE MANAGEMENT OF KNEE OSTEOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1738.3-1738
Author(s):  
F. Eymard ◽  
P. Ornetti ◽  
J. Maillet ◽  
E. Noel ◽  
P. Adam ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Task Force ◽  
Platelet Rich Plasma ◽  
Symptomatic Treatment ◽  
Future Research ◽  
List Type ◽  
Clinical Practices ◽  
Efficient Treatment ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee

Background:There has been much debate regarding the use of intra-articular injections of platelet-rich plasma (PRP) as symptomatic treatment for knee osteoarthritis. The heterogeneity of the preparation and injection protocols limits the extrapolation of data from randomized controlled trials and meta-analyses.Objectives:The objective of this expert consensus was to develop the first clinical practice recommendations for PRP injections in knee osteoarthritis.Methods:Fifteen physicians (10 rheumatologists, 4 specialists in rehabilitation and sport medicine and 1 interventional radiologist) from different countries were selected given to their expertise in the fields of PRP and osteoarthritis. Twenty-five recommendations were finally retained after several meetings using the modified Delphi method to establish clinical consensus. All experts voted their agreement or not for each recommendation using a score between 1 (totally inappropriate) and 9 (totally appropriate). Depending on the median value and extreme scores, recommendations were judged as appropriated or unappropriated with a strong or relative agreement but could also be judged as uncertain due to indecision or absence of consensus.Results:The main recommendations are listed below:- Intra-articular injections of PRP constitute an efficient treatment of early or moderate symptomatic knee osteoarthritis. Median = 8 [6-9] – Appropriate. Relative agreement.- Intra-articular injections of PRP may be useful in severe knee osteoarthritis (Kellgren-Lawrence grade IV). Median = 7 [6-7] – Appropriate. Relative agreement.- Intra-articular injections of PRP in knee osteoarthritis should be proposed as second-line therapy, after failure of non-pharmacological and pharmacological (oral and topic) symptomatic treatment. Median = 9 [5-9] – Appropriate. Relative agreement.- Intra-articular injections of PRP should not be performed in osteoarthritis flare-up with significant effusion. Median = 7 [5-9] – Appropriate. Relative agreement.- Intra-articular PRP treatment may include 1 to 3 consecutive injections. Median = 9 [7-9] – Appropriate. Strong agreement.- Leukocyte-poor PRP should be preferred for knee OA treatment. Median = 8 [5-9] – Appropriate. Relative agreement.- PRP injections should be performed under ultrasound or fluoroscopic guidance. Median = 8 [3-9] – Uncertain. No consensus.- PRP should not be mixed with injectable anesthetic or corticosteroid. Median = 9 [6-9] – Appropriate. Relative agreement.Conclusion:Twenty-five recommendations were discussed by an international multidisciplinary task force group in order to provide a basis for standardization of clinical practices and future research protocols.Disclosure of Interests:Florent Eymard Consultant of: Regenlab, Paul Ornetti: None declared, Jérémy Maillet Consultant of: Regenlab, Eric Noel Consultant of: Regenlab, Philippe Adam Consultant of: Regenlab, Virginie Legré Boyer Consultant of: Regenlab, Thierry Boyer Consultant of: Regenlab, Fadoua Allali: None declared, Vincent Grémeaux Bader: None declared, Jean-François Kaux: None declared, Karine Louati: None declared, Martin Lamontagne Consultant of: Pendopharm, Fabrice Michel: None declared, Pascal Richette: None declared, Hervé Bard Consultant of: Regenlab

Clinical Efficacy of Platelet-Rich Plasma Injection and Its Association With Growth Factors in the Treatment of Mild to Moderate Knee Osteoarthritis: A Randomized Double-Blind Controlled Clinical Trial As Compared With Hyaluronic Acid

2021 ◽  
Vol 49 (2) ◽  
pp. 487-496
Author(s):  
Yong-Beom Park ◽  
Jun-Ho Kim ◽  
Chul-Won Ha ◽  
Dong-Hyun Lee
Keyword(s):  
Hyaluronic Acid ◽  
Growth Factors ◽  
Knee Osteoarthritis ◽  
Clinical Outcomes ◽  
Clinical Efficacy ◽  
Global Assessment ◽  
Platelet Rich Plasma ◽  
Patient Global Assessment ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee

Background: Although platelet-rich plasma (PRP) has potential as a regenerative treatment for knee osteoarthritis, its efficacy varies. Compositional differences among types of PRP could affect clinical outcomes, but the biological characterization of PRP is lacking. Purpose: To assess the efficacy of intra-articular PRP injection in knee osteoarthritis as compared with hyaluronic acid (HA) injection and to determine whether the clinical efficacy of PRP is associated with its biological characteristics. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 110 patients with symptomatic knee osteoarthritis received a single injection of leukocyte-rich PRP (1 commercial kit) or HA. Clinical data were assessed at baseline and at 6 weeks and 3 and 6 months after injection. The primary endpoint was an improvement in the International Knee Documentation Committee (IKDC) subjective score at 6 months, and the secondary endpoints were improvements in scores based on the Patient Global Assessment, the visual analog scale (VAS) for pain, the Western Ontario and McMaster Universities Osteoarthritis Index, and the Samsung Medical Center patellofemoral score. Cell counts and concentrations of growth factors and cytokines in the injected PRP were assessed to determine their association with clinical outcomes. Results: PRP showed significantly improvement in IKDC subjective scores at 6 months (11.5 in the PRP group vs 6.3 in the HA group; P = .029). There were no significant differences between groups in other clinical outcomes. The Patient Global Assessment score at 6 months was better in the PRP group ( P = .035). The proportion of patients who scored above the minimal clinically important difference (MCID) for VAS at 6 months was significantly higher in the PRP group ( P = .044). Within the PRP group, the concentrations of platelet-derived growth factors were high in patients with a score above the MCID for VAS at 6 months. The incidence of adverse events did not differ between the groups ( P > .05). Conclusion: PRP had better clinical efficacy than HA. High concentrations of growth factors were observed in patients who scored above the MCID for clinical outcomes in the PRP group. These findings indicate that concentration of growth factors needs to be taken into consideration for future investigations of PRP in knee osteoarthritis. Registration: NCT02211521 (ClinicalTrials.gov identifier).

scholarly journals The use of cellular matrix in symptomatic knee osteoarthritis

2019 ◽  
Author(s):  
Abir Aly Abbassy ◽  
Suad Trebinjac ◽  
Nehad Kotb
Keyword(s):  
Pilot Study ◽  
Knee Osteoarthritis ◽  
Platelet Rich Plasma ◽  
Knee Joints ◽  
Active Components ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
Wear And Tear ◽  
And Function ◽  
Cellular Matrix

Knee osteoarthritis is a degenerative "wear and tear" disorder affecting mainly population over 50 years old. It can also present in younger people, especially after an injury or as a part of other diseases. While many therapeutic options exist for knee osteoarthritis, none of them has the potential to cure this condition. Cellular Matrix represents a combination of natural non-crosslinked hyaluronic acid (HA), thixotropic cell separation gel, and sodium citrate anticoagulant solution. A combination of Cellular Matrix with autologous platelet-rich plasma (A-PRP) is a novel therapeutic approach to the management of knee osteoarthritis. It is assumed that the active components HA and PRP have a synergistic effect contributing to a better therapeutic outcome in patients with knee osteoarthritis. Physiotherapy could provide an additional benefit. This is a retrospective pilot study assessing the potential benefit of Cellular Matrix and A-PRP combined with physiotherapy in the management of chronic knee osteoarthritis. Twenty-five patients were enrolled in the study and injected with three doses of Cellular Matrix combined with A-PRP with a time span of 2 weeks between each injection. All patients received standardized physiotherapy. The results showed that 68% of patients achieved more than 50% improvement in pain, stiffness, and function of the knee joints. There were no adverse reactions. This retrospective pilot study confirmed the positive effect of PRP and HA combination in the management of mild and moderate knee osteoarthritis. These preliminary results need to be verified in randomized control trials.

Role of ultrasound guided injection of platelet rich plasma (PRP) in knee osteoarthritis patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Emad Mahdy Mohamed ◽  
Mohamed Sobhy Hassan ◽  
Mohamed Gamal Eldin AbdelMotelib
Keyword(s):  
Knee Osteoarthritis ◽  
Platelet Rich Plasma ◽  
Oxford Knee Score ◽  
Reduction Ratio ◽  
Knee Score ◽  
Ultrasound Guided ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
The Mean

Abstract Background Multiple promising researches were done regarding using platelet rich plasma (PRP) injection aiming at establishing new minimally invasive treatment option for knee OA and avoiding surgical procedures hazards which could be an option in advanced cases. Thus, our study will be directed towards ultrasound guided injecting of PRP trying to confirm the efficacy of the procedure as a therapeutic option. Objective The study aims to assess of the role of ultrasound guided PRP injection in cases of knee osteoarthritis and follow up of the symptoms outcome. Methods and material Twenty patients with different knee osteoarthritis grades were injected with PRP under ultrasound guidance and the symptoms outcome were followed up by using visual analogue scale (VAS), WOMAC osteoarthritis index, OXFORD knee score, LYSHOLM knee scoring scale at periods of , and weeks post procedure. Results A total of patients were included with the age ranging from - years old, the mean was . years old (SD ± . ). Among them patients ( ) were females and patients ( ) were males. There was statistically significant difference between the different knee pain scoring scales , and weeks after the procedure compared to before injection, where according to VAS score the mean score was . . pre procedure and became . . , . . and . . after , and weeks respectively with mean reduction ratio of . % after months. The extent of the difference over the periods through WOMAC in knee osteoarthritis patients was . . ,. . and . . after , and weeks respectively, compared to . . before the procedure with a mean reduction ratio of . % after months. While according to OXFORD knee score, the patient’s scores were . . before the procedure Vs . . , . . and . . at , and weeks after injection with symptoms mean reduction ratio of . %. According to LYSHOLM knee scoring scale, the mean score was . . pre procedure and became . . , . . and . . after , and weeks respectively with months mean reduction ratio of . %. Conclusion PRP injection in symptomatic knee osteoarthritis patients cause statistically significant improvement of the symptoms.

scholarly journals Efficacy and Safety of Phyllanthus Amarus Cream Treatment in Knee Osteoarthritis

2020 ◽  
Vol 13 (1) ◽  
pp. 97-104
Author(s):  
Decha Pinkaew ◽  
Kanokwan Kiattisin ◽  
Khanittha Wonglangka ◽  
Pisittawoot Awoot
Keyword(s):  
Knee Osteoarthritis ◽  
Skin Permeation ◽  
Skin Irritation ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Phyllanthus Amarus ◽  
Human Volunteers ◽  
Symptomatic Knee ◽  
Irritation Test ◽  
And Function

Background: Knee osteoarthritis (OA) is a chronic degenerative joint disease and inflammatory pain which decreases daily activities. Objective: The aim of the present investigation was to examine skin permeation and skin irritation test of Phyllanthus Amarus (PA) cream including the effects of four weeks of treatment with PA cream in patients with osteoarthritis (OA) of the knee. Methods: The permeation study of PA cream was determined by Franz diffusion cells using a stillborn piglet skin. The primary irritation test was evaluated in rabbits and human volunteers following the Draize test. The study included sixty respondents diagnosed with symptomatic knee OA (12 males, 48 females). All the respondents volunteered to participate and randomly allocated into 3 groups including (n =20 in each group), followed by the placebo group and Phyllanthus Amarus (PA) cream group and NSAIDs cream group. They used a cream twice per day for four weeks. The patients were tested on 3 occasions; before two weeks and four weeks for the treatment period. The respondents were completely assessed for pain and function assessment by the visual analog scale (VAS) and the Western Ontario and McMaster Universities O-osteoarthritis Index questionnaire (WOMAC), respectively. Results: The PA cream showed good skin permeation after 10 hours. It had a high accumulative amount in the dermis and the receiving chamber more than the stratum corneum. Therefore, it could help to relieve pain and prolong the effect. The PA cream did not irritate the skin of rabbits and human volunteers. It is safe to be used in clinical treatment. The VAS and total WOMAC scores significantly decreased after 2 weeks (P < 0.001) and 4 weeks (P < 0.001) of intervention compared with before treatment in both the PA cream and NSAIDs groups in OA knee. However, the VAS and total WOMAC score of PA cream were not significantly compared with the NSAIDs groups. Conclusion: The Phyllanthus amarus cream is a new choice, and effective method for OA of the knee treatment. These data indicate that the treatment through Phyllanthus amarus cream improves pain relief and function.

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