INTRAOSSEOUS AND INTRA-ARTICULAR INJECTION OF PLATELET-RICH PLASMA IN THE TREATMENT OF OSTEOARTHRITIS OF THE KNEE JOINT

BackgroundComparative studies of platelet-rich plasma (PRP) and hyaluronic acid show variable results. PurposeA review was conducted to understand the current role of PRP and its efficacy versus hyaluronic acid in osteoarthritis (OA) of the knee joint. MethodsOut of 170 identified studies, 14 studies involving 1575 patients with 637 males and 938 females were selected based on PRISMA flow chart guidelines and were analyzed for the study. ResultsA standard PRP regimen consisting of 2–3 intra-articular injections (IA) of 4–6 mL of leucocyte poor PRP at 1–2 weekly intervals provides a better result than HA during the first 3–6 months, and which may continue up to one year. PRP and HA may have synergistic effect; pain and swelling are the two most com-mon complications with PRP, the incidence is more with leucocyte rich PRP (LP-PRP) and intra-osseous PRP treatment.ConclusionPRP provides hope and is more effective than hyaluronic acid in pain relief and improving the quality of life in mild to moderate osteoarthritis of the knee joint. However, hype, that is effective in all, irrespective of grades of OA, mal-aligned or stiff knee, ligamentous laxity, and can avoid joint replacement is a big hindrance in establishing it as a preferred treatment in OA knee. The author follows the above-mentioned PRP regimen; and recommends to combine leucocyte poor PRP with HA for IA injections & with LP-PRP injections along with the two most common painful points (medial collateral ligament, pesanisernius) in a highly painful OA knee. PRP may not address extra-articular causes of knee pain (mal-alignment, muscle wasting, tendinosis), should be corrected for optimum outcome. Contact sports, running, exercises putting pressure on knee and NSAID should be avoided during PRP treatment. Also, more randomized controlled trials are required to further standardize the PRP preparation, administration, injection interval & proper documentation of efficacy and complications in the regenerative registry.

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Efficacy and safety of platelet rich plasma in primary osteoarthritis of the knee joint

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2020.v6.i3k.2277 ◽

2020 ◽

Vol 6 (3) ◽

pp. 720-723

Author(s):

Dr. Atul Rai Sharma ◽

Harkirat Thind ◽

Ravish Grag ◽

Gurmeen Garg

Keyword(s):

Knee Joint ◽

Platelet Rich Plasma ◽

Osteoarthritis Of The Knee ◽

Efficacy And Safety ◽

Primary Osteoarthritis

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O-4 Efectiveness of platelet-rich plasma in osteoarthritis of the knee joint

British Journal of Sports Medicine ◽

10.1136/bjsports-2016-097120.4 ◽

2016 ◽

Vol 50 (Suppl 1) ◽

pp. A2.2-A3

Author(s):

B Supartono ◽

T Rarasati ◽

S Wiyono ◽

Y Suciati

Keyword(s):

Knee Joint ◽

Platelet Rich Plasma ◽

Osteoarthritis Of The Knee

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Effectiveness of intraosseous infiltration of autologous platelet-rich plasma in the area of the bone marrow edema in osteoarthritis of the knee joint

Bulletin of Russian State Medical University ◽

10.24075/brsmu.2019.053 ◽

2019 ◽

pp. 47-53 ◽

Cited By ~ 1

Author(s):

A.V. Lychagin ◽

A.V. Garkavi ◽

O.I. Islaieh ◽

P.I. Katunyan ◽

D.S. Bobrov ◽

...

Keyword(s):

Bone Marrow ◽

Knee Joint ◽

Bone Marrow Edema ◽

Platelet Rich Plasma ◽

Pain Syndrome ◽

Osteoarthritis Of The Knee ◽

Autologous Platelet Rich Plasma ◽

Autologous Platelet ◽

Marrow Edema

Osteoarthritis (OA) affects both elderly people, for whom it is one of the main causes of disability, and people of active working age and is an urgent clinical and social problem of resistance of pain syndrome to therapy. The disease is characterized by both destruction of intra-articular and paraarticular structures, such as subchondral bone. While OA is an important sign of pathological changes believe the bone marrow edema (BME). This work examines the effect of BME on development osteoarthritis, and therapeutic approaches to the management of patients with OA. The aim of the study was to develop a method of treatment of BME in OA of the knee joint by locally intraosseous injection of autologous thrombotic-rich plasma (PRP) into the edema zone. In this study 17 patients with the diagnosis: Osteoarthritis II-IV Grade. according to the classification of Kellgren–Lawrence, in which areas of local inflammation in the form of BME were detected on MRI in the subchondral zone in accordance with the international classification of WORMS (Whole Organ Magnetic Resonance Imaging Score). The mean age of patients was 41,7 ± 14,3 years, 10 of them were women and 7 men. Patients were treated with autological platelet-rich plasma under x-ray control injected from extra-articular intraosseous access in the area of BME. Evaluation of effectiveness of treatment performed by VAS, WOMAC and KOOS scales, before the introduction of autoplasma, after 1 and 3 months after the start of treatment. Three months after the manipulation, there was a statistically significant decrease in the intensity of inflammatory syndrome: for WOMAC by 17.5%, for KOOS by 19.4% and for VAS by 33,1% (p < 0,01). Thus, the efficiency of intraosseous Infiltration of autologous platelet-rich plasma in the treatment of patients with OA, accompanied by edema of the bone marrow in the subchondral zone, was proved.

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Osteoarthritis of the knee in the elderly: is knee replacement always justified?

Bulletin of Russian State Medical University ◽

10.24075/brsmu.2019.020 ◽

2019 ◽

pp. 70-75

Author(s):

A. V. Lychagin ◽

A. V. Garkavi ◽

V. A. Meshcheryakov ◽

V. S. Kaykov

Keyword(s):

Knee Joint ◽

Knee Osteoarthritis ◽

Knee Replacement ◽

Elderly Population ◽

Platelet Rich Plasma ◽

Treatment Options ◽

The Elderly ◽

Osteoarthritis Of The Knee ◽

Total Knee ◽

Grading Scale

Osteoarthritis is a condition that mostly affects the elderly population and tends to be localized to the knee joint. At old age, active treatment options are limited by co-morbidities and a higher risk for surgical complications. Therefore, the search for strategies that could become a temporary alternative to knee replacement is a pressing concern. The aim of this study was to analyze how justifiable is total knee replacement in elderly patients with knee osteoarthritis and to propose a less aggressive therapeutic alternative to this surgery. The study included 178 patients over 60 years of age with clinically established knee osteoarthritis who had been previously recommended knee replacement but chosen not to undergo it. The choice of a treatment strategy tested in the study was based on the original grading scale for the evaluation of the knee joint dislocation syndrome. The treatment consisted of therapeutic arthroscopy and intraarticular injections of hyaluronic acid and platelet-rich plasma (PRP). The data were processed in Statistica 12. Data analysis revealed that 39.3% of the participants did not have compelling indications for knee replacement. The proposed combination therapy with intraarticular PRP injections and arthroscopy allowed all the patients to delay knee replacement for at least a year; unaided by arthroscopy, intraarticular injections worked well for only 40%.

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Bone metabolism marker in an elderly patient with osteoarthritis of the knee joint

Bone Reports ◽

10.1016/j.bonr.2021.101052 ◽

2021 ◽

Vol 14 ◽

pp. 101052

Author(s):

Hiroshi Yonezu

Keyword(s):

Elderly Patient ◽

Knee Joint ◽

Bone Metabolism ◽

Osteoarthritis Of The Knee ◽

Bone Metabolism Marker

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Evaluation and Validation of a Joint Stress Test to Induce Activity-Related Knee Joint Discomfort — a Prospective Case-Control Study

Sports Medicine - Open ◽

10.1186/s40798-021-00317-7 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Christiane Schön ◽

Claudia Reule ◽

Katharina Knaub ◽

Antje Micka ◽

Manfred Wilhelm ◽

...

Keyword(s):

Knee Joint ◽

Healthy Subjects ◽

Stress Test ◽

Osteoarthritis Of The Knee ◽

Time Interval ◽

Short Time Interval ◽

Joint Stress ◽

Joint Health ◽

The Impact ◽

Health Function

Abstract Background The assessment of improvement or maintenance of joint health in healthy subjects is a great challenge. The aim of the study was the evaluation of a joint stress test to assess joint discomfort in subjects with activity-related knee joint discomfort (ArJD). Results Forty-five subjects were recruited to perform the single-leg-step-down (SLSD) test (15 subjects per group). Subjects with ArJD of the knee (age 22–62 years) were compared to healthy subjects (age 24–59 years) with no knee joint discomfort during daily life sporting activity and to subjects with mild-to-moderate osteoarthritis of the knee joint (OA, Kellgren score 2–3, age 42–64 years). The subjects performed the SLSD test with two different protocols: (I) standardization for knee joint discomfort; (II) standardization for load on the knee joint. In addition, range of motion (ROM), reach test, acute pain at rest and after a single-leg squat and knee injury, and osteoarthritis outcome score (KOOS) were assessed. In OA and ArJD subjects, knee joint discomfort could be reproducibly induced in a short time interval of less than 10 min (200 steps). In healthy subjects, no pain was recorded. A clear differentiation between study groups was observed with the SLSD test (maximal step number) as well as KOOS questionnaire, ROM, and reach test. In addition, a moderate to good intra-class correlation was shown for the investigated outcomes. Conclusions These results suggest the SLSD test is a reliable tool for the assessment of knee joint health function in ArJD and OA subjects to study the improvements in their activities. Further, this model can be used as a stress model in intervention studies to study the impact of stress on knee joint health function.

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Effect of Platelet-Rich Plasma on M1/M2 Macrophage Polarization

International Journal of Molecular Sciences ◽

10.3390/ijms22052336 ◽

2021 ◽

Vol 22 (5) ◽

pp. 2336

Author(s):

Ryoka Uchiyama ◽

Eriko Toyoda ◽

Miki Maehara ◽

Shiho Wasai ◽

Haruka Omura ◽

...

Keyword(s):

Culture Media ◽

Platelet Rich Plasma ◽

Point Of Care ◽

Macrophage Polarization ◽

Osteoarthritis Of The Knee ◽

M2 Macrophage ◽

Related Factors ◽

Humoral Factors ◽

M1 Macrophage ◽

M2 Macrophage Polarization

Osteoarthritis of the knee (OAK) is a chronic degenerative disease and progresses with an imbalance of cytokines and macrophages in the joint. Studies regarding the use of platelet-rich plasma (PRP) as a point-of-care treatment for OAK have reported on its effect on tissue repair and suppression of inflammation but few have reported on its effect on macrophages and macrophage polarization. Based on our clinical experience with two types of PRP kits Cellaid Serum Collection Set P type kit (leukocyte-poor-PRP) and an Autologous Protein Solution kit (APS leukocyte-rich-PRP), we investigated the concentrations of humoral factors in PRPs prepared from the two kits and the effect of humoral factors on macrophage phenotypes. We found that the concentrations of cell components and humoral factors differed between PRPs purified using the two kits; APS had a higher concentration of M1 and M2 macrophage related factors. The addition of PRP supernatants to the culture media of monocyte-derived macrophages and M1 polarized macrophages revealed that PRPs suppressed M1 macrophage polarization and promoted M2 macrophage polarization. This research is the first to report the effect of PRPs purified using commercial kits on macrophage polarization.

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