Platelet-rich plasma for osteoarthritis treatment

Knop, Eduardo; Paula, Luiz Eduardo de; Fuller, Ricardo

doi:10.1016/j.rbre.2015.07.002

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Revista Brasileira de Reumatologia

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Review article • Rev. Bras. Reumatol. 56 (2) • Mar-Apr 2016 • https://doi.org/10.1016/j.rbre.2015.07.002 copy

Platelet-rich plasma for osteoarthritis treatment

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

We conducted a comprehensive and systematic search of the literature on the use of platelet-rich plasma (PRP) in the treatment of osteoarthritis, using the Medline, Lilacs, Cochrane and SciELO databases, from May 2012 to October 2013.

A total of 23 studies were selected, with nine being controlled trials and, of these, seven randomized, which included 725 patients. In this series, the group receiving PRP showed improvement in pain and joint function compared to placebo and hyaluronic acid. The response lasted up to two years and was better in milder cases.

However it was found that there is no standardization in the PRP production method, neither in the number, timing, and volume of applications. Furthermore, the populations studied were not clearly described in many studies. Thus, these results should be analyzed with caution, and further studies with more standardized methods would be necessary for a more consistent conclusion about the PRP role in osteoarthritis.

Keywords:
Platelet-rich plasma; Cartilage; Osteoarthritis

Study	Mean age (years)	Aspects related to PRP				Study design							Assessments	Results
Study	Mean age (years)	Centrifugation	Injections interval	Volume (ml)	Platelet count	Radiographica grade	Randomization/Method	Double-blind/SHAM procedure	Intention to treat	Treated (N)	Controls (N)	Analyzed parameters	Assessments	Results
Sánchez 201225Sánchez M, Fiz N, Azofra J, Usabiaga J, Recalde EA, Gutierrez AG, 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.	60.5 ± 7.9 (PRP) 58.9 ± 8.2 (HA)	Single 580 g (8 min)	3 injections Weekly (PRP and HA)	2	NS	1–3 (Ahlbäck)	Yes Patients were identified by numbers	Yes Yes	Yes	89	87 HA	WOMAC Lequesne	0 and 24 weeks	PRP reduced WOMAC by 50%. Secondary outcomes with no difference.
Vaquerizo 201326Vaquerizo V, Plasencia MA, Arribas I, Seijas R, Padilla S, Orive G, et al. Comparison of intra-articular injections of plasma rich in growth factors (PRGF-endoret) versus durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a randomized controlled trial. Arthroscopy. 2013;29(10):1635-43.	62.4 ± 6.6 (PRP) 64.8 ± 7.7 (HA)	Single 580 g (8 min)	3 Injections Weekly (PRP) Single (AH)	2	NS	2–4 (K-L)	Yes Through software	No No	Yes	48	48 HA	WOMAC Lequesne OMERACT-OARSI	0, 24 and 48 weeks	PRP better than HA at 24 and 48 weeks.
Li 201128Li M, Changqing Z, Zisheng AI, Ting Y, Yong F, Weitao JIA. Therapeutic effectiveness of intra-knee-articular injection of platelet-rich plasma on knee articular cartilage degeneration. Chinese Journal of Reparative and Reconstructive Surgery. 2011;25(10):1192-6.	57.6 (PRP) 58.2 (H)A	Double 2000 rpm (10 min each)	3 Injections Every 3 weeks (PRP and HA)	3.5	(819.4 ± 136,3) × 10⁶ ml^–1	1–4 (K-L)	Yes NS	NS No	Yes	15	15 HA	IKDC WOMAC Lequesne	3, 4 and 6 months	PRP e HA showed benefit. PRP showed to be better in the final evaluation at 6 months.
Spaková 201229Spaková T, Rosocha J, Lacko M, Harvanová D, Gharaibeh A. Treatment of knee joint osteoarthritis with autologous platelet-rich plasma in comparison with hyaluronic acid. Am J Phys Med Rehabil. 2012;91(5):411-7.	52.8 ± 12.4 (PRP) 53.2 ± 14.5 (HA)	Triple 3200 rpm (15 min) 1500 rpm (10 min) 3200 rpm (10 min)	3 Injections Weekly (PRP e HA)	3	680 ± 132 × 10⁶ ml^–1	1–3 (K-L)	Yes NS	NS Yes	NS	60	60 HA	WOMAC NRS	3 and 6 months	PRP better than HA. Side effects (level of pain) more evident in the PRP group, which remitted in 2 days.
Cerza 201230Cerza F, Carn S, Carcangiu A, Vavo ID, Schiavilla V, Pecora 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.	66.5 ± 1.3 (PRP) 66.2 ± 10.6 (HA)	Double NS	4 Injections Weekly (PRP e HA)	5.5	NS	1–3 (K-L)	Yes NS	No No	Yes	60	60 HA	WOMAC	4, 12 and 24 weeks	PRP better than HA, regardless of grade of osteoarthritis.
Filardo, 201231Cerza F, Carn S, Carcangiu A, Vavo ID, Schiavilla V, Pecora 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.	55 (PRP) 58 (HA)	Double 1480 rpm (6 min) 3400 rpm (15 min)	3 Injections Weekly (PRP e HA)	5	NS	1–3 (K-L)	Yes NS	Yes Yes	Yes	55	54 HA	IKDC EQ-VAS Tegner KOOS	2, 6 and 12 months	No difference between PRP and HA. Tendency of superiority of PRP in lower grades of osteoarthritis
Patel 201333Patel 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;41:356-64.	53.1 ± 11.6 (Group A) 51.6 ± 9.2 (Group B) 53.7 ± 8.2 (Group C)	Single 1500 rpm (15 min)	Group A: Single (PRP) Group B: 2 ijections, one every 3 weeks (PRP) Group C: Single (placebo)	8	31,014 × 10⁶L^–1	1–2 (Ahlbäck)	Yes Through software	Yes Yes	No	26 (Group A) 25 (Group B)	23 saline	WOMAC	6; 12 and 24 weeks	PRP superior to placebo No difference between one or two Injections

Studies	Type of study	Joint	Centrifugation	Treated (N)	Controls (N)	Injections (N) interval	Analyzed parameter	Assessment	Results
Say27Say F, Gürler D, Yener K, Bülbül M, Malkoç 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.	Prospective Controlled Non-randomized	Knee	Single	45	45 HA	Injection Single	KOOS VAS	0, 3 and 6 months	PRP superior to HA. Better cost-benefit of PRP
Kon32Kon E, Mandelbaum B, Buda R, Filardo G, Delcogliano M, Timoncini A, 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.	Prospective Controlled Non-randomized	Knee	Double	50	50 HAAP 50 LWHA	3 injections Biweekly	IKDC EQ-VAS	2 and 6 months	PRP showed benefit; Better results in young people and lower degree of degeneration
Sánchez34Sánchez M, Anitua E, Azofra J, Aguirre JJ, Andia I. Intra-articular injection of an autologous preparation rich in growth factors for the treatment of knee OA: a retrospective cohort study. Clin Exp Rheumatol. 2008;26(5):910-3.	Retrospective	Knee	Single	30	30 HA	3 injections Weekly	WOMAC	8 weeks	PRP superior to HA
Kon35Kon E, Filardo G, Buda E, Timoncini A, Di Martino A, Cenacchi A, et al. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010;18:472-9.	Prospective	Knee	Double	100	None	3 injections Every 3 weeks	IKDC EQ-VAS	2, 6 and 12 months	PRP showed benefit; Better results in young people and lower degree of degeneration
Filardo36Filardo G, Kon E, Buda E, Timoncini A, Di Martino A, Cenacchi A, et al. Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2010;19:528-35.	Prospective	Knee	Double	91	None	3 injections Every 3 weeks	IKDC EQ-VAS	2, 6, 12 and 24 months	PRP showed benefit; Decrease in response after 12 months, but higher than the initial scores
Sampson37Sampson 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.	Prospective	Knee	Single	14	None	3 injections Monthly	Brittberg- Peterson VAS KOOS Thickness	2, 5, 11, 18 and 52 weeks	PRP showed benefit; No increase in thickness of cartilage
Ana Wang-Saegusa38Wang-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;131:311-7.	Prospective	Knee	Single	261	None	3 injections Biweekly	VAS SF-36 WOMAC Lequesne	6 months	PRP showed benefit
Napolitano39Napolitano M, Matera S, Bossio M, Crescibene A, Costabile E, Almolla J, et al. Autologous platelet gel for tissue regeneration in degenerative disorders of the knee. Blood Transfus. 2012;10:72-7.	Prospective	Knee	Single	27	None	3 injections Weekly	WOMAC NRS	7 days and 6 months	PRP showed benefit
Sanchez40Sánchez M, Guadilla J, Fiz N, Andia I. Ultrasound-guided platelet-rich plasma injections for the treatment of osteoarthritis of the hip. Rheumatology. 2012;51:144-50.	Prospective	Hip	Single	40	None	3 injections Weekly	WOMAC VAS HHS	6–7 weeks and 6 months	PRP showed benefit
Jang41Jang SJ, Kim JD, Cha SS. Platelet-rich plasma (PRP) injections as an effective treatment for early osteoarthritis. Eur J Orthop Surg Traumatol. 2013;23:573-80.	Prospective	Knee	Double	65	None	Injections single	WOMAC	1, 3,6 9 and 12 months	PRP showed benefit
Battaglia42Battaglia M, Guaraldi F, Vannini F, Buscio TR, Galletti S, Giannini S. Platelet-rich plasma intra-articular ultrasound-guided injections as a possible treatment for hip osteoarthritis: a pilot study. Clin Exp Rheumatol. 2011;29(4):754	Prospective Pilot study	Hip	Not specified	20	None	3 injections Biweekly	HHS WOMAC	3, 6 and 12 months	PRP showed benefit; Decrease in response after 3 months, but higher than the initial scores. Better results in young people.
Halpern43Halpern B, Chaudhury S, Rodeo SA, Hayter C, Bogner E, Potter HG, et al. Clinical and MRI outcomes after platelet-rich plasma treatment for knee osteoarthritis. Clin J Sport Med. 2013;23:238-9.	Prospective Pilot Study	Knee	Not specified	17	None	Injections Single	VAS WOMAC MRI de knee	1, 3, 6 and 12 months	PRP showed benefit There was no reduction in cartilage thickness in MRI
Gobbi44Gobbi A, Karnatzikos G, Mahajan V, Malchira S. Platelet-rich plasma treatment in symptomatic patients with knee osteoarthritis: preliminary results in group of active patients. Sports Health. 2012;4:162	Prospective	Knee	Single	50	None	2 injections Monthly	KOOS, VAS Tegner IKDC Marx scores	0, 6 and 12 months	PRP showed benefit; There was no difference between patients that were previously approached and patients with no previous intervention.
Hart45Hart R, Safi A, Komzak M, Jajtner P, Puskeiler M, Hartova P. Platelet-rich plasma in patients with tibiofemoral cartilage degeneration. Arch Orthop Trauma Surg. 2013;133:1295-301.	Prospective	Knee	Double	55	None	6 injections Weekly. After maintenance with 3 quarterly injections	Lysholm Tegner IKDC Cincinnati Knee MRI	0 and 12 months	PRP showed benefit There was no reduction in cartilage thickness in MRI
Filardo46Filardo G, Kon E, Ruiz MTP, Vaccaro F, Guitaldi R, Di Martino A, et al. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single-versus double-spinning approach. Knee Surg Sports Traumatol Arthrosc. 2011;20:2082-91.	Prospective	Knee	Double	72 PRGF 72 PRP	None	3 injections Each 3 weeks	IKDC EQ-VAS Tegner scores	2, 6 and 12 months	Similar benefit between methods; Double centrifugation shows more side effects
Dhollander47Dhollander AAM, De Neve F, Almqvist KF, Verdonk R, Lambrecht S, Elewaut D, et al. Autologous matrix-induced chondrogenesis combined with platelet-rich plasma gel: technical description and a five pilot patients report. Knee Surg Sports Traumatol Arthrosc. 2011;19:536-42.	Prospective	Knee	Double	5	None	Injections Single	VAS KOOS Tegner Score MOCART	0, 12 and 24 months	Procedure leads to clinical improvement; No response in the analysis of cartilage in MRI

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[1] *Corresponding author. E-mail:eduardo_knop@hotmail.com (E. Knop).