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Hawthorne BC, Engel S, McCarthy MBR, Cote MC, Mazzocca AD, Coyner KJ. Biologic Adjuvants to Rotator Cuff Repairs Induce Anti-inflammatory Macrophage 2 Polarization and Reduce Inflammatory Macrophage 1 Polarization In Vitro. Arthroscopy 2024:S0749-8063(24)00337-2. [PMID: 38735413 DOI: 10.1016/j.arthro.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/18/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To examine the effect of various biologic adjuvants on the polarization of macrophages in an in vitro model for rotator cuff tears. METHODS Tissue was harvested from 6 patients undergoing arthroscopic rotator cuff repair. An in vitro model of the supraspinatus and subacromial bursa was created and treated with control, platelet-rich plasma (PRP), autologous activated serum (AAS), or a combination of PRP+AAS. The effect of treatment on macrophage polarization between M1 proinflammatory macrophages or M2 anti-inflammatory macrophages was measured using gene expression, protein expression, flow cytometry, and nitric oxide production. RESULTS Tendon and bursa treated with PRP, AAS, and PRP+AAS significantly decreased the gene expression of M1 markers interleukin (IL)-12 and tumor necrosis factor-alpha while significantly increasing the expression of M2 markers arginase, IL-10, and transforming growth factor-β (P < .05) compared with treatment with control. Enzyme-linked immunosorbent assay analysis of protein production demonstrated that, compared with control, coculture treated with PRP, AAS, and PRP+AAS significantly decreased markers of M1-macrophages (IL-6, IL-12, and tumor necrosis factor-alpha) while significantly increasing the expression of markers of M2-macrophages (arginase, IL-10, and transforming growth factor-beta) (P < .05). Flow cytometry analysis of surface markers demonstrated that compared with control, tendon and bursa treated with PRP, AAS, and PRP+AAS significantly decreased markers of M1-macrophages (CD80, CD86, CD64, CD16) while significantly increasing the expression of markers of M2-macrophages (CD163 and CD206) (P < .05). Treatment of the coculture with PRP, AAS, and PRP+AAS consistently demonstrated a decrease in nitric oxide production (P < .05) compared with control. AAS and PRP+AAS demonstrated an increased macrophage shift to M2 compared with PRP alone, whereas there was not as uniform of a shift when comparing PRP+AAS with AAS alone. CONCLUSIONS In an in vitro model of rotator cuff tears, the treatment of supraspinatus tendon and subacromial bursa with PRP, AAS, and PRP+AAS demonstrated an increase in markers of anti-inflammatory M2-macrophages and a concomitant decrease in markers of proinflammatory M1-macrophages. AAS and PRP+AAS contributed to a large shift to macrophage polarization to the anti-inflammatory M2 compared with PRP. CLINICAL RELEVANCE The mechanism of biologic adjuvant effects on the rotator cuff remains poorly understood. This study suggests that they may contribute to polarization of macrophages for their proinflammatory (M1) state to the anti-inflammatory (M2) state.
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Affiliation(s)
| | - Sam Engel
- Department of Orthopaedic Surgery, UConn Health, Farmington, Connecticut, U.S.A
| | - Mary Beth R McCarthy
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Mark C Cote
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Katherine J Coyner
- Department of Orthopaedic Surgery, UConn Health, Farmington, Connecticut, U.S.A..
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Dubin J, Leucht P, Murray M, Pezold R. American Academy of Orthopaedic Surgeons Technology Overview Summary: Platelet-Rich Plasma (PRP) for Knee Osteoarthritis. J Am Acad Orthop Surg 2024; 32:296-301. [PMID: 38295392 DOI: 10.5435/jaaos-d-23-00957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/09/2023] [Indexed: 02/02/2024] Open
Abstract
The Platelet-Rich Plasma (PRP) for Knee Osteoarthritis Technology Overview is based on a systematic review of current scientific and clinical research. Through analysis of the current best evidence, this technology overview seeks to evaluate the efficacy of PRP for patients with knee osteoarthritis. The systematic literature review resulted in 54 articles: 36 high-quality and 18 moderate-quality. The findings of these studies were summarized to present findings on PRP versus control/placebo, acetaminophen, non-steroidal anti-inflammatory drugs, corticosteroids, exercise, prolotherapy, autologous conditioned serum, bone marrow aspirate concentrate, hyaluronic acid, and ozone therapy. In addition, the work group highlighted areas that needed additional research when evidence proved lacking on the topic and carefully noted the potential harms associated with an intervention, required resource utilization, acceptability, and feasibility.
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Affiliation(s)
- Jonathan Dubin
- Truman Medical Center, University of Missouri, Columbia, MO (Dubin), Departments of Orthopaedic Surgery and Cell Biology, New York University School of Medicine, NYU Langone Health, New York, NY (Leucht), Harvard Medical School, Boston Children's Hospital, Boston, MA (Murray), American Academy of Orthopaedic Surgeons, Rosemont, IL (Pezold)
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Baird HBG, Ashy CC, Kodali P, Myer GD, Murray IR, Pullen WM, Slone HS. Most Publications Regarding Platelet-Rich Plasma Use in the Knee Are From Asia, Investigate Injection for Osteoarthritis, and Show Outcome Improvement: A Scoping Review. Arthroscopy 2024:S0749-8063(24)00252-4. [PMID: 38537725 DOI: 10.1016/j.arthro.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/12/2024] [Accepted: 03/17/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE To evaluate and synthesize the available literature related to platelet-rich plasma (PRP) treatment of knee pathologies and to provide recommendations to inform future research in the field. METHODS PubMed, CINAHL, and Scopus databases were queried on October 6, 2023. All identified citations were collated and uploaded into Covidence for screening and data extraction. Studies were included if they were human studies published in English with adult cohorts that received PRP as a procedural injection or surgical augmentation for knee pathologies with patient-reported outcome measures (PROMs) and level of evidence Levels I-IV. RESULTS Our search yielded 2,615 studies, of which 155 studies from 2006 to 2023 met the inclusion criteria. Median follow-up was 9 months (±11.2 months). Most studies (75.5%) characterized the leukocyte content of PRP, although most studies (86%) did not use a comprehensive classification scheme. In addition, most studies were from Asia (50%) and Europe (32%) and were from a single center (96%). In terms of treatment, 74% of studies examined PRP as a procedural injection, whereas 26% examined PRP as an augmentation. Most studies (68%) examined treatment of knee osteoarthritis. Many studies (83%) documented significant improvements in PROMs, including 93% of Level III/IV evidence studies and 72% of Level I/II evidence studies, although most studies (70%) failed to include minimal clinically important difference values. The visual analog scale was the most-used PROM (58% of studies), whereas the Short Form Health Survey 36-item was the least-used PROM (5% of studies). CONCLUSIONS Most published investigations of knee PRP are performed in Asia, investigate procedural injection for osteoarthritis, and show significant outcome improvements. In addition, this review highlights the need for better classification of PRP formulations. LEVEL OF EVIDENCE Level IV, scoping Review of level I-IV studies.
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Affiliation(s)
- Henry B G Baird
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A..
| | - Cody C Ashy
- Department of Orthopedic Surgery and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Prudhvi Kodali
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Gregory D Myer
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, U.S.A.; Emory Sports Medicine Center, Atlanta, Georgia, U.S.A.; Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, U.S.A.; The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, U.S.A.; Youth Physical Development Centre, Cardiff Metropolitan University, Wales, United Kingdom
| | - Iain R Murray
- The University of Edinburgh, Edinburgh, United Kingdom
| | - W Michael Pullen
- Department of Orthopedic Surgery and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Harris S Slone
- Department of Orthopedic Surgery and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Lim JJ, Belk JW, Wharton BR, McCarthy TP, McCarty EC, Dragoo JL, Frank RM. Most Orthopaedic Platelet-Rich Plasma Investigations Don't Report Protocols and Composition: An Updated Systematic Review. Arthroscopy 2024:S0749-8063(24)00243-3. [PMID: 38522650 DOI: 10.1016/j.arthro.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE To systematically review the literature to assess the heterogeneity of platelet-rich plasma (PRP) preparation and composition reporting for the treatment of musculoskeletal/orthopaedic pathologies. METHODS A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify Level I and Level II studies from 2016 to 2022 that evaluated the use of PRP therapy for musculoskeletal pathologies. The search phrase used was "platelet-rich plasma clinical studies." Studies were assessed based on their reporting of the PRP preparation methods and reporting of PRP composition. RESULTS One hundred twenty-four studies (in 120 articles) met inclusion criteria for analysis. Of these studies, 15 (12.1%) provided comprehensive reporting, including a clear, well-described, and reproducible preparation protocol that future investigators can follow. Thirty-three studies (26.6%) quantitatively reported the final PRP product composition. CONCLUSIONS Among the studies using PRP for the treatment of musculoskeletal/orthopaedic pathologies, less than 20% provided a clear, well-described, and reproducible PRP preparation protocol, and only one-fourth of studies reported on the final PRP product composition. CLINICAL RELEVANCE A diverse current reporting of PRP composition between studies provides a high heterogeneity of the term "PRP," which becomes a limitation for a comparison of studies using PRP.
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Affiliation(s)
- Joseph J Lim
- University of Colorado Boulder, Boulder, Colorado, U.S.A..
| | - John W Belk
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | | | - Timothy P McCarthy
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Jason L Dragoo
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
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Fucaloro SP, Kang AS, Bragg JT, Krivicich L, Salzler MJ. Return to Sport After Ulnar Collateral Ligament Tears Treated with Platelet-Rich Plasma Injections is Influenced by Length of Rehabilitation and Leukocyte Content of Injections: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00205-6. [PMID: 38508288 DOI: 10.1016/j.arthro.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 02/27/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To analyze the current literature assessing return to sport (RTS) outcomes after platelet-rich plasma (PRP) injections for the nonoperative treatment of ulnar collateral ligament (UCL) injuries. METHODS A systematic review of PubMed, Embase, and Web of Science databases was conducted in June 2023 to identify studies assessing RTS after PRP injections for UCL injuries. Tear severity, leukocyte content of PRP, rehabilitation protocol, and RTS outcomes were collected. Heterogeneity was assessed through proportional random-effects models for RTS and return to preinjury level of play (RTLP) with subgroup analysis by rehabilitation length, leukocyte content of PRP, and tear severity. RESULTS Eight studies with 278 partial-thickness and 44 full-thickness tears were identified. The mean age of patients ranged from 17.3 to 26 years. The mean RTS time after injection ranged from 5.2 to 25.4 weeks. High heterogeneity was observed among studies, with RTS rates ranging from 46% to 100% (I2 = 83%) and RTLP rates ranging from 34% to 100% (I2 = 83%). Studies with the longest rehabilitation programs (12-14 weeks) had RTS rates of 87% to 100% (I2 = 0%). RTS rates among athletes treated with leukocyte-poor and leukocyte-rich PRP ranged from 73% to 100% (I2 = 30%) and 52% to 88% (I2 = 84%), respectively. Subanalysis of RTS by tear severity demonstrated high variability, with partial-thickness rates ranging from 59% to 100% (I2 = 55%) and full-thickness rates ranging from 27% to 100% (I2 = 63.2%). CONCLUSIONS Studies assessing RTS after PRP injections are highly heterogeneous; however, current data suggest nonoperative RTS and RTLP rates ranging from 46% to 100% and 34% to 100%, respectively. Studies with at least 12 weeks of rehabilitation and studies using leukocyte-poor PRP demonstrated low heterogeneity and greater RTS rates. Alternatively, high heterogeneity was observed among both partial- and full-thickness tears. LEVEL OF EVIDENCE Level IV, systematic review of Level III-IV studies.
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Affiliation(s)
- Stephen P Fucaloro
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A.; Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Alex S Kang
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Jack T Bragg
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Laura Krivicich
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Matthew J Salzler
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A.; Tufts University School of Medicine, Boston, Massachusetts, U.S.A..
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Baria M, Barker T, Durgam S, Pedroza A, Flanigan D, Jia L, Kaeding C, Magnussen R. Microfragmented Adipose Tissue Is Equivalent to Platelet-Rich Plasma for Knee Osteoarthritis at 12 Months Posttreatment: A Randomized Controlled Trial. Orthop J Sports Med 2024; 12:23259671241233916. [PMID: 38510323 PMCID: PMC10953019 DOI: 10.1177/23259671241233916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/31/2023] [Indexed: 03/22/2024] Open
Abstract
Background Platelet-rich plasma (PRP) is an effective treatment for knee osteoarthritis (OA). Microfragmented adipose tissue (MFAT) is another orthobiologic that holds promise, but data supporting its use are limited. Previous studies showed that MFAT created using the Lipogems device was equivalent to PRP created via noncommercial laboratory-based processes. Purpose To perform a comparison of commercially available MFAT and PRP systems for treatment of knee OA. Study Design Randomized controlled trial; Level of evidence, 2. Methods A total of 71 patients with symptomatic knee OA (Kellgren-Lawrence grades 1-4) were randomized to receive a single injection of either leukocyte-rich PRP (Angel; Arthrex) or MFAT (Lipogems) under ultrasound guidance. Patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score [KOOS], visual analog scale for pain with activities of daily living [VAS pain], and Tegner activity level) were recorded at baseline and at 1, 3, 6, and 12 months after injection. The primary outcome was the KOOS-Pain subscale score at 12 months after injection. Results Overall, 49 patients completed their 12-month follow-up (PRP group, n = 23; MFAT group, n = 26). All demographic features were similar between groups, except that more men were randomized to the PRP group and more women to the MFAT group. At 12 months posttreatment, KOOS-Pain scores improved in both groups, with no significant group difference (PRP, 78 ± 17.9 vs MFAT, 77.8 ± 19.3; P = .69). Similarly, other KOOS subscales, VAS pain scores, and Tegner scores improved at 12 months, with no differences between treatment groups. Conclusion Both PRP and MFAT injections for knee OA resulted in improved patient-reported outcomes at 12 months posttreatment, with no differences found between treatments. Registration NCT04351087 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Michael Baria
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio, USA
| | - Tyler Barker
- Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Sushmitha Durgam
- College of Veterinary Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Angela Pedroza
- Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - David Flanigan
- Department of Orthopedic Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Liuqing Jia
- Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Christopher Kaeding
- Department of Orthopedic Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Robert Magnussen
- Department of Orthopedic Surgery, The Ohio State University, Columbus, Ohio, USA
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Patel S, Gahlaut S, Thami T, Chouhan DK, Jain A, Dhillon MS. Comparison of Conventional Dose Versus Superdose Platelet-Rich Plasma for Knee Osteoarthritis: A Prospective, Triple-Blind, Randomized Clinical Trial. Orthop J Sports Med 2024; 12:23259671241227863. [PMID: 38410168 PMCID: PMC10896053 DOI: 10.1177/23259671241227863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/18/2023] [Indexed: 02/28/2024] Open
Abstract
Background Confusion persists regarding the ideal dosage of platelet-rich plasma (PRP) injection for knee osteoarthritis (OA). Purpose/Hypothesis The purpose of the study was to compare the efficacy of 2 different single-injection PRP dosages in patients with early knee OA-a conventional 4 mL dose and a superdose of 8 mL. It was hypothesized that 8 mL of PRP would be superior to 4 mL of PRP in this patient population. Study Design Randomized clinical trial; Level of evidence, 1. Methods Patients with early knee OA (Kellgren-Lawrence grades 1 and 2) who met the inclusion criteria were randomly divided into 2 groups: Group A (n = 50 knees) received a 4-mL PRP injection, and group B (n = 49 knees) received an 8-mL PRP injection, both prepared using the same procedure. Patients were evaluated at the baseline, 6 weeks, 3 months, and 6 months using the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the WOMAC-Pain subscale, the visual analog scale for pain, the Knee injury and Osteoarthritis Outcome Score, and patient satisfaction, and results were compared between the groups. Results The baseline characteristics of the 2 groups were comparable (group A: mean age, 51.96 ± 6.93 years; group B: mean age, 49.12 ± 9.8 3 years). Leucocyte-depleted PRP with 3.5 times concentration (final product platelet concentration, 706.74 × 103-μL) was injected. The mean absolute platelet count injected was 2.82 ± 0.0012 billion in group A and 5.65 ± 0.0022 billion in group B. All patient-reported outcome scores improved significantly in both groups from the baseline to the final follow-up (P < .001), with overall trends and results significantly better in group B than in group A (P < .001). Patient satisfaction at the 6-month follow-up was also better in group B (96%) compared with group A (68%). Short (2 to 7 days) self-limiting complications, such as pain and stiffness, occurred more often in group B (P < .001). Conclusion Patients with early knee OA had significantly better improvement in pain and function when treated with an 8-mL injection of PRP compared with a 4-mL injection of PRP. The larger dose of PRP had approximately twice the number of platelets. Registration CTRI/2020/02/023403 (Clinical Trials Registry-India identifier).
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Affiliation(s)
- Sandeep Patel
- Department of Orthopedic Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Shivam Gahlaut
- Department of Orthopedic Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Tarkik Thami
- Department of Orthopedic Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Devendra Kumar Chouhan
- Department of Orthopedic Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ashish Jain
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Mandeep Singh Dhillon
- Department of Orthopedic Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Gupta A, Jain V. Autologous Conditioned Plasma (ACP) and Osteoarthritis of the Knee: A Review of Current Clinical Evidence. Cureus 2024; 16:e52693. [PMID: 38384614 PMCID: PMC10879647 DOI: 10.7759/cureus.52693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
The primary objective of this study is to record the clinical outcomes of autologous conditioned plasma (ACP) for the treatment of knee osteoarthritis (OA) based on published literature. Multiple databases (PubMed, Embase, Web of Science and Scopus) were searched using terms for "knee OA" and the intervention "ACP" for articles published in English to January 4, 2024. All clinical studies using ACP for knee OA were included. Studies not utilizing ACP alone, i.e. used as an adjunct with other modalities or not focusing on the management of knee OA, were excluded. Five studies, three randomized controlled trials (RCTs) and two real-world post-market studies conducted in a clinical practice met the inclusion/exclusion criteria and were included in this study. All studies demonstrated statistically significant improvements in various patient-reported outcome measures (PROMs), however the studies performed in the clinical practice reported non-accomplishment of minimally clinically important difference (MCID). The results demonstrated the potential of ACP for management of knee OA, however the MCID was not achieved in real-world clinical settings. Thus, more adequately powered RCTs with longer follow-up as well as real-world post-market studies are warranted to establish long-term efficacy and justify routine clinical use, respectively, of ACP in patients suffering with knee OA.
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Affiliation(s)
- Ashim Gupta
- Regenerative Medicine, Future Biologics, Lawrenceville, USA
- Regenerative Medicine, BioIntegrate, Lawrenceville, USA
- Orthopaedics, South Texas Orthopaedic Research Institute, Laredo, USA
- Orthopaedics and Regenerative Medicine, Regenerative Orthopaedics, Noida, IND
| | - Vijay Jain
- Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, IND
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Khalid S, Ali A, Deepak FNU, Zulfiqar MS, Malik LU, Fouzan Z, Nasr RA, Qamar M, Bhattarai P. Comparative effectiveness of intra-articular therapies in knee osteoarthritis: a meta-analysis comparing platelet-rich plasma (PRP) with other treatment modalities. Ann Med Surg (Lond) 2024; 86:361-372. [PMID: 38222750 PMCID: PMC10783230 DOI: 10.1097/ms9.0000000000001615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/03/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Knee osteoarthritis (KOA) is a progressive joint disease commonly treated with intra-articular injections, including platelet-rich plasma (PRP), hyaluronic acid (HA), or corticosteroids (CS). This updated meta-analysis aims to enhance the statistical power of the results and provide comprehensive clinical evidence that reflects the most current research. By doing so, the authors aim to suggest a reliable estimate for the development of guidelines, addressing the pressing need for effective and minimally invasive treatment options. Methods PubMed, Scopus, clinicaltrials.gov, Cochrane Central were searched until March 2023, for randomized controlled trials (RCTs) comparing the effectiveness of intra-articular injectable therapies, including PRP, HA, CS, and placebo, in KOA. Data extraction involved baseline characteristics and outcome measures [Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, Visual Analog Scale (VAS) pain scores, KOOS, and IKDC scores] at 1, 3, 6 and 12 months. Statistical analysis, including subgroup analysis, assessment of heterogeneity, and publication bias, was conducted using Review Manager. Results Our meta-analysis of 42 studies involving 3696 patients demonstrated that PRP treatment resulted in significant pain relief compared to HA injections, as evidenced by improved WOMAC pain (MD: -0.74; 95% CI: -1.02 to -0.46; P≤0.00001; I 2=94%) and VAS pain (MD: -0.65; 95% CI: -1.24 to -0.06; P=0.03; I2=97%) outcomes. Similarly, PRP showed greater efficacy in reducing WOMAC pain (MD: -8.06; 95% CI: -13.62 to -2.51: P=0.004; I 2=96%) and VAS pain (MD: -1.11; 95% CI: -1.64 to -0.59; P≤0.0001; I 2=68%) compared to CS injections, with the most significant improvement observed at 6 months. Conclusions PRP is an effective treatment for KOA. It provides symptomatic relief, has the potential to reduce disease progression, and has sustained effects up to 12 months. PRP offers superior pain relief and functional enhancement compared to CS and HA injections.
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Affiliation(s)
- Saad Khalid
- Department of Medicine, Dow University of Health Sciences
| | - Abraish Ali
- Department of Medicine, Dow University of Health Sciences
| | - FNU Deepak
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari
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Bagheri K, Krez A, Anastasio AT, Adams SB. The use of platelet-rich plasma in pathologies of the foot and ankle: A comprehensive review of the recent literature. Foot Ankle Surg 2023; 29:551-559. [PMID: 37516651 DOI: 10.1016/j.fas.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/27/2023] [Accepted: 07/23/2023] [Indexed: 07/31/2023]
Abstract
Platelet-rich plasma (PRP) is an autologous serum containing higher concentrations of platelets and growth factors above normal blood. The process of obtaining PRP involves the extraction of blood from the patient which is then centrifuged to obtain a concentrated suspension of platelets. PRP continues to evolve as a potential treatment modality with many applications in orthopaedic surgery. The therapeutic components of PRP possess numerous theoretical regenerative properties. The present manuscript outlines how PRP is prepared, noting the tremendous variability between preparation protocols. Given the growing body of evidence examining the use of PRP in pathologies of the foot and ankle, we assess its efficacy as it relates to our field. Specifically, we evaluate the literature in the past five years regarding the role of PRP in treating plantar fasciitis, Achilles tendinopathy, insertional Achilles tendinitis, Achilles tendon ruptures, osteochondral lesions of the talus, hallux rigidus, and ankle osteoarthritis.
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Affiliation(s)
- Kian Bagheri
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA.
| | | | - Albert T Anastasio
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
| | - Samuel B Adams
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
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Tao X, Aw AAL, Leeu JJ, Bin Abd Razak HR. Three Doses of Platelet-Rich Plasma Therapy Are More Effective Than One Dose of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-analysis. Arthroscopy 2023; 39:2568-2576.e2. [PMID: 37236291 DOI: 10.1016/j.arthro.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
PURPOSE To compare the efficacy of a single dose of platelet-rich plasma (PRP) with multiple doses of PRP therapy in the treatment of knee osteoarthritis (KOA). METHODS The PubMed, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus, and Cochrane Library databases were searched from database inception to May 2022; in addition, the gray literature and bibliographic references were searched. Only randomized controlled trials comparing the effect of a single dose versus multiple doses of PRP for KOA were included. Literature retrieval and data extraction were conducted by 3 independent reviewers. The inclusion and exclusion criteria were based on type of study, research subjects, intervention, outcome, language, and availability of data. Pooled analyses of visual analog scale (VAS) scores, Western Ontario and McMaster Universities Arthritis Index scores, and adverse events were conducted. RESULTS Seven studies (all randomized controlled trials) of high methodologic quality involving 575 patients were included. The ages of the patients included in this study ranged from 20 to 80 years, and the sex ratio was balanced. Triple-dose PRP therapy resulted in significantly better VAS scores compared with single-dose PRP therapy at 12 months (P < .0001), with no significant change in VAS scores between double-dose PRP and single-dose PRP at 12 months. Regarding adverse events, double-dose (P = .28) and triple-dose (P = .24) therapy showed no significant differences in safety from single-dose therapy. CONCLUSIONS Although there is a paucity of large high-quality Level I studies, current best evidence suggests that 3 doses of PRP for KOA are more effective than 1 dose of PRP at providing pain relief up to 1 year after administration. LEVEL OF EVIDENCE Level II, systematic review of Level II studies.
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Affiliation(s)
- Xinyu Tao
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Angeline Ai Ling Aw
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jun Jie Leeu
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Hamid Rahmatullah Bin Abd Razak
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore, Singapore; SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme, Singapore, Singapore.
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Ta CN, Vasudevan R, Mitchell BC, Keller RA, Kent WT. The Influence of Industry Affiliation on Randomized Controlled Trials of Platelet-Rich Plasma for Knee Osteoarthritis. Am J Sports Med 2023; 51:3583-3590. [PMID: 36594496 PMCID: PMC10623604 DOI: 10.1177/03635465221140917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/23/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Industry funding and corporate sponsorship have played a significant role in the advancement of orthopaedic research and technology. However, this relationship raises concerns for how industry association may bias research findings and influence clinical practice. PURPOSE To determine whether industry affiliation plays a role in the outcomes of randomized controlled trials (RCTs) investigating platelet-rich plasma (PRP). STUDY DESIGN Meta-analysis; Level of evidence, 2. METHODS A search of the PubMed, Cochrane, and MEDLINE databases for RCTs published between 2011 and the present comparing PRP versus hyaluronic acid, corticosteroid, or placebo for the treatment of knee osteoarthritis was performed. To determine industry affiliation, the conflict of interest, funding, and disclosure sections of publications were assessed, and all authors were assessed through the American Academy of Orthopaedic Surgeons disclosure database and the Centers for Medicare & Medicaid Services open payments database. Studies were classified as industry affiliated (IA) or non-industry affiliated (NIA). The outcomes of each study were rated as favorable, analogous, or unfavorable according to predefined criteria. RESULTS A total of 37 studies (6 IA and 31 NIA) were available for analysis. Overall, 19 studies (51.4%) reported PRP as favorable compared with other treatment options, while 18 studies (48.6%) showed no significant differences between PRP and other treatment methods. There was no significant difference in qualitative conclusions between the IA and NIA groups, with the IA group having 3 favorable studies and 3 analogous studies and the NIA group having 16 favorable studies and 15 analogous studies (P = .8881). When comparing IA versus NIA studies using 6- and 12-month Western Ontario and McMaster Universities Arthritis Index and International Knee Documentation Committee scores, there were no significant differences in outcomes. CONCLUSION The results of this study demonstrated that qualitative conclusions and outcome scores were found to not be associated with industry affiliation. Although the results of this study suggest that there is no influence of industry involvement on RCTs examining PRP, it is still necessary to carefully evaluate pertinent commercial affiliations when reviewing recommendations from studies before adopting new treatment approaches, such as the use of PRP for knee osteoarthritis.
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Affiliation(s)
- Canhnghi N. Ta
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, California, USA
| | - Rajiv Vasudevan
- School of Medicine, University of California, San Diego, San Diego, California, USA
| | - Brendon C. Mitchell
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, California, USA
| | | | - William T. Kent
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, California, USA
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Ding SL, Ji LF, Zhang MZ, Xiong W, Sun CY, Han ZY, Wang C. Safety and efficacy of intra-articular injection of platelet-rich plasma for the treatment of ankle osteoarthritis: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2023; 47:1963-1974. [PMID: 36943456 DOI: 10.1007/s00264-023-05773-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/10/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of platelet-rich plasma (PRP) intra-articular injective treatments for ankle osteoarthritis (OA). METHODS A systematic literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in PubMed, Scopus, Embase, Google Scholar, and the Cochrane library until May 2022. Both randomized and non-randomized studies were included with the assessment of the risk of bias. We recorded the participant's age, gender, type of PRP, injection volume, the kit used, and activating agent. We subsequently assessed the short-term and long-term efficacy of PRP using the functional scores and visual analog scale (VAS). RESULTS We included four studies with a total of 127 patients, with a mean age of 56.1 years. 47.2% were male (60/127), according to eligibility criteria. There were three cohort studies and one randomized controlled trial (RCT) study, and no study reported severe adverse events. All included studies used the Leukocyte-poor PRP. Short-term follow-up results suggested significant improvement of the American Orthopaedic Foot and Ankle Society (AOFAS) score in the PRP injection group compared to the control group (n = 87 patients; MD: 6.94 [95% CI: 3.59, 10.29]; P < 0.01). Consistently, there was a statistical difference in AOFAS score between PRP injection and control groups in the final follow-up (≥ 6 months) (n = 87 patients; MD: 9.63 [95% CI: 6.31, 12.94]; P < 0.01). Furthermore, we found a significant reduction in VAS scores in the PRP groups at both the short-term follow-up (n = 59 patients; MD, - 1.90 [95% CI, - 2.54, - 1.26]; P < 0.01) and the ≥ six months follow-up (n = 79 patients; MD, - 3.07 [95% CI, - 5.08, - 1.05]; P < 0.01). The improvement of AOFAS and VAS scores at ≥ six months follow-up reached the minimal clinically important difference (MCID). Nevertheless, the treatment effect of AOFAS and VAS scores offered by PRP at short-term follow-up did not exceed the MCID. Substantial heterogeneity was reported at the ≥ six months follow-up in VAS scores (I2: 93%, P < 0.01). CONCLUSION This meta-analysis supports the safety of PRP intra-articular injection for ankle OA. The improvements of AOFAS and VAS scores in the PRP group at short-term follow-up do not exceed the MCID to be clinically significant. PRP injection provides significant improvement of AOFAS score and reduced pain at ≥ six months follow-up. The efficacy of PRP should be interpreted with caution regarding the high heterogeneity and the scarcity of available literature, which urges large-scale RCTs with longer follow-up to confirm the potential efficacy of PRP injection for ankle OA.
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Affiliation(s)
- Sheng-Long Ding
- Department of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, No.1, Dong Jiao Min Lane, Dong Cheng District, Beijing, 100730, People's Republic of China
| | - Lin-Feng Ji
- Department of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, No.1, Dong Jiao Min Lane, Dong Cheng District, Beijing, 100730, People's Republic of China
| | - Ming-Zhu Zhang
- Department of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, No.1, Dong Jiao Min Lane, Dong Cheng District, Beijing, 100730, People's Republic of China.
| | - Wei Xiong
- Department of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, No.1, Dong Jiao Min Lane, Dong Cheng District, Beijing, 100730, People's Republic of China
| | - Cheng-Yi Sun
- Department of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, No.1, Dong Jiao Min Lane, Dong Cheng District, Beijing, 100730, People's Republic of China
| | - Ze-Yu Han
- Department of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, No.1, Dong Jiao Min Lane, Dong Cheng District, Beijing, 100730, People's Republic of China
| | - Chao Wang
- Department of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, No.1, Dong Jiao Min Lane, Dong Cheng District, Beijing, 100730, People's Republic of China
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Saraf A, Hussain A, Singhal A, Arora V, Bishnoi S. Do age, gender, BMI and disease duration influence the clinical outcomes in patients of knee osteoarthritis treated with serial injections of autologous platelet rich plasma? J Clin Orthop Trauma 2023; 43:102226. [PMID: 37533478 PMCID: PMC10393560 DOI: 10.1016/j.jcot.2023.102226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/30/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023] Open
Abstract
Purpose To study whether age, gender, body mass index(BMI) and disease duration influence the clinical outcomes in kellgren-Lawrence(K-L) grade II,III knee osteoarthritis(KOA) patients treated with serial injections of platelet rich plasma(PRP). Patients and methods 65 patients were given three monthly intra-articular injections of PRP in this prospective interventional study. The patients were divided into subgroups depending on the factor studied: by age(in years) into young <45(n = 7), middle age 45-60(n = 35), and elderly >60(n = 23): by BMI(in kg/m2) into; normal <25(n = 25), overweight 25-30(n = 27) and obese >30(n = 13) and disease duration; less(n = 32) or more than 1 year(n = 33) symptom duration. Visual analogue scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used as outcome measures and assessed before each injection and then at 6 and 9 months post injection. Groups were homogenous with respect to baseline characteristics. Results Mean VAS and WOMAC scores showed a statistically significant improvement (P < 0.0001) across all groups and subgroups (age,gender,BMI,disease duration) at follow up. On intra-subgroup comparison, we found no significant differences(P > 0.05) among age, BMI or gender subgroups, however the scores were significantly better in patients with disease duration of less than 1 year than those with more than 1 year duration at both 6 and 9 months[P < 0.001(RC = 9.630,95% CI = 4.037-15.222,P = 0.001)]. Conclusion PRP injections if given serially can improve the short term subjective scores of VAS and WOMAC scores in patients with K-L grade II and III KOA irrespective of age, gender, BMI or disease duration, however, clinical benefits can be maximized if given early in the disease course.
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Affiliation(s)
| | - Altaf Hussain
- Corresponding author. Department of orthopaedics, 4th floor, hospital building, Teerthanker Mahaveer Medical College & Research Centre, Delhi road. Moradabad, Uttar Pradesh, 244001, India.
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15
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Paget LD, Reurink G, de Vos RJ, Weir A, Moen MH, Bierma-Zeinstra SM, Stufkens SA, Goedegebuure S, Krips R, Maas M, Meuffels DE, Nolte PA, Runhaar J, Kerkhoffs GM, Tol JL. Platelet-Rich Plasma Injections for the Treatment of Ankle Osteoarthritis. Am J Sports Med 2023; 51:2625-2634. [PMID: 37417359 PMCID: PMC10394962 DOI: 10.1177/03635465231182438] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/07/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Ankle osteoarthritis is debilitating and usually affects relatively young people, often as a result of previous ankle traumas, frequently occurring in sports. Platelet-rich plasma (PRP) injections for ankle osteoarthritis have shown no evidence of benefit over the course of 26 weeks. Previous studies on PRP for knee osteoarthritis showed that clinically significant improvements with PRP occurred between 6 to 12 months in the absence of initial benefit. No studies have evaluated the effect of PRP from 6 to 12 months in ankle osteoarthritis. PURPOSE To assess the efficacy of PRP injections in ankle osteoarthritis over the course of 52 weeks. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS In this 52-week follow-up trial, 100 patients with ankle osteoarthritis were randomized to a PRP group or placebo (saline) group. Patients received 2 intra-articular talocrural injections: at inclusion and after 6 weeks. Patient-reported outcome measures were used to assess pain, function, quality of life, and indirect costs over 52 weeks. RESULTS Two patients (2%) were lost to follow-up. The adjusted between-group difference for the patient-reported American Orthopaedic Foot & Ankle Society score over 52 weeks was -2 points (95% CI, -5 to 2; P = .31) in favor of the placebo group. No significant between-group differences were observed for any of the secondary outcome measures. CONCLUSION For patients with ankle osteoarthritis, PRP injections did not improve ankle symptoms and function over 52 weeks compared with placebo injections. REGISTRATION NTR7261 (Netherlands Trial Register).
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Affiliation(s)
- Liam D.A. Paget
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Academic Center for Evidence-based Sports Medicine [ACES], Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports [ACHSS], AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | - Gustaaf Reurink
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; ACES, Amsterdam, the Netherlands; ACHSS, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands; The Sport Physician Group, Department of Sports Medicine, OLVG, Amsterdam, the Netherlands
| | - Robert-Jan de Vos
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Adam Weir
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Aspetar Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Hospital, Doha, Qatar; Sport Medicine and Exercise Clinic Haarlem [SBK], Haarlem, the Netherlands
| | - Maarten H. Moen
- The Sport Physician Group, Department of Sports Medicine, OLVG, Amsterdam, the Netherlands; Department of Sports Medicine, Bergman Clinics, Naarden, the Netherlands
| | - Sita M.A. Bierma-Zeinstra
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sjoerd A.S. Stufkens
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; ACES, Amsterdam, the Netherlands; ACHSS, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | - Simon Goedegebuure
- The Sport Physician Group, Department of Sports Medicine, OLVG, Amsterdam, the Netherlands
| | - Rover Krips
- Department of Orthopaedic Surgery, Flevoziekenhuis, Almere, the Netherlands
| | - Mario Maas
- ACES, Amsterdam, the Netherlands; ACHSS, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Duncan E. Meuffels
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Peter A. Nolte
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands; Department of Oral Cell Biology, Academic Center for Dentistry Amsterdam [ACTA], UvA and VU, Amsterdam, the Netherlands
| | - J. Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; ACES, Amsterdam, the Netherlands; ACHSS, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | - Johannes L. Tol
- ACES, Amsterdam, the Netherlands; ACHSS, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands; Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Investigation performed at Amsterdam UMC, Amsterdam, the Netherlands
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Stothers Rosenberg S, Ng X, Mansfield C, Poulos C, Peay H, Lee TH, Irony T, Ho M. Adaptation of the WOMAC for Use in a Patient Preference Study. Ther Innov Regul Sci 2023; 57:702-711. [PMID: 37061632 PMCID: PMC10105612 DOI: 10.1007/s43441-023-00510-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/07/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVES To adapt a patient-reported outcome (PRO) measure, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), into efficacy attributes for a discrete choice experiment (DCE) survey designed to quantify the relative importance of endpoints commonly used in knee osteoarthritis (KOA) trials. METHODS The adaptation comprised four steps: (1) selecting domains of interest; (2) determining presentation and framing of selected attributes; (3) determining attribute levels; and (4) developing choice tasks. This process involved input from multiple stakeholders, including regulators, health preference researchers, and patients. Pretesting was conducted to evaluate if patients comprehended the adapted survey attributes and could make trade-offs among them. RESULTS The WOMAC pain and function domains were selected for adaption to two efficacy attributes. Two versions of the discrete choice experiment (DCE) instrument were created to compare efficacy using (1) total domain scores and (2) item scores for "walking on a flat surface." Both attributes were presented as improvement from baseline scores by levels of 0%, 30%, 50%, and 100%. Twenty-six participants were interviewed in a pretest of the instrument (average age 60 years; 58% female; 62% had KOA for ≥ 5 years). The participants found both versions of attributes meaningful and relevant for treatment decision-making. They demonstrated willingness and ability to tradeoff improvements in pain and function separately, though many perceived them as inter-related. CONCLUSIONS This study adds to the growing literature regarding adapting PRO measures for patient preference studies. Such adaptation is important for designing a preference study that can incorporate a clinical trial's outcomes with PRO endpoints.
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Affiliation(s)
- Sarah Stothers Rosenberg
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Xinyi Ng
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
| | | | | | - Holly Peay
- RTI International, Research Triangle Park, NC, USA
| | - Ting-Hsuan Lee
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Telba Irony
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Martin Ho
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
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Korpershoek JV, Vonk LA, Filardo G, Kester EC, van Egmond N, Saris DB, Custers RJ. Effect of Autologous Conditioned Plasma Injections in Patients With Knee Osteoarthritis. Orthop J Sports Med 2023; 11:23259671231184848. [PMID: 37529531 PMCID: PMC10387782 DOI: 10.1177/23259671231184848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/13/2023] [Indexed: 08/03/2023] Open
Abstract
Background Autologous conditioned plasma (ACP) is a commercially available platelet concentrate with promising results from clinical trials. Purpose To evaluate the clinical outcome after 3 consecutive injections of ACP in patients with knee osteoarthritis (OA) and study the influence of ACP composition and different patient factors as predictors of treatment effect. Study Design Case series; Level of evidence, 4. Methods This prospective case series included 260 patients (307 knees) who received ACP treatment for knee OA. The mean patient age was 51 ± 10 years. Improvement up to 12 months' follow-up was measured using the Knee injury and Osteoarthritis Outcome Score (KOOS). ACP composition was analyzed in 100 patients. The predictive value of age, sex, history of knee trauma, Kellgren-Lawrence OA grade, body mass index, and ACP composition was evaluated using generalized estimating equations. Results The mean overall KOOS improved from 38 ± 14 at baseline to 45 ± 18 at 3 months, 45 ± 18 at 6 months, and 43 ± 18 at 12 months (all P < .05); 40% of patients achieved an improvement above the minimal clinically important difference (MCID) of 8 after 6 months and 33% after 12 months. The variation in ACP composition did not correlate with KOOS (P > .05). Older age led to a greater clinical benefit (β = 0.27; P = .05), whereas bilateral treatment predicted worse outcomes (β = -5.6; P < .05). Conclusion The improvement in KOOS after treatment with ACP did not reach the MCID in most study patients. Older age was a predictor for better outcomes. The composition of ACP varied between patients but did not predict outcomes within the evaluated range. The study findings show the limited benefit of ACP treatment for knee OA and call for caution with routine use in clinical practice.
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Affiliation(s)
| | - Lucienne A. Vonk
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Esmee C. Kester
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nienke van Egmond
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniël B.F. Saris
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Reconstructive Medicine, University of Twente, Enschede, the Netherlands
| | - Roel J.H. Custers
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
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Abstract
Despite the increasing popularity of total ankle replacement, ankle arthrodesis remains the gold standard for the treatment of end-stage ankle arthritis. Historically, open techniques have been utilized for ankle arthrodesis. There have been many variations and techniques described, including transfibular, anterior, medial, and miniarthrotomy. Inherent disadvantages to these open techniques include postoperative pain, delayed or nonunion, wound complications, shortening, prolonged healing times, and prolonged hospital stays. Arthroscopic ankle arthrodesis provides the foot and ankle surgeon with an alternative to the traditional open techniques. Arthroscopic ankle arthrodesis has demonstrated faster union rates, decreased complications, reduced postoperative pain, and shorter hospital stays.
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Affiliation(s)
- Michael S Lee
- Capital Orthopaedics & Sports Medicine, 12499 University Avenue, Suite 210, Clive, IA 50325, USA.
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Aryazand Y, Buote NJ, Hsieh Y, Hayashi K, Rosselli D. Multifactorial assessment of leukocyte reduced platelet rich plasma injection in dogs undergoing tibial plateau leveling osteotomy: A retrospective study. PLoS One 2023; 18:e0287922. [PMID: 37390083 PMCID: PMC10313002 DOI: 10.1371/journal.pone.0287922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
This study assessed the effects of concurrent intra-articular injection and Tibial Plateau Leveling Osteotomy (TPLO) plate surface treatment with leukoreduced platelet rich plasma (lPRP) on outcomes of dogs undergoing TPLO. A retrospective study of medical records for cases presenting from January 2018 to December 2020 was performed. Client-owned dogs with naturally occurring cranial cruciate ligament rupture that underwent TPLO surgery were divided into two groups. The lPRP group included cases that underwent intra-articular injection and plate surface treatment at the time of their TPLO. The control group (C) underwent TPLO without PRP treatment. Data analyzed included: presence of surgical site infection, implant removal rate, degree of change in OA progression score, lameness score progression and radiographic bone healing. The short- and long-term complication rate, hospitalization and antibiotic therapy were also compared between the groups. Descriptive statistics, comparison analyses (Chi square test, t-test, Fisher's exact test) and multi-level logistic regression models were used for statistical analysis. A total of 110 cases met the study inclusion criteria: 54 = lPRP, 56 = C. There were no significant differences between groups with regard to gender, age, presence of meniscal tear, weight, or body condition score. Significant findings included: improved radiographic healing of the osteotomy in the lPRP group, improved global OA scores in the lPRP group, and improved lameness score at recheck examination in the lPRP group. There was no significant difference between the lPRP and C group with regard to surgical site infection and implant removal rate. Concurrent intra-articular injection and plate surface treatment with leukocyte reduced PRP at the time of TPLO, is beneficial in slowing the progression of OA, hastening the radiographic evidence of osteotomy healing, and improved lameness score on recheck examination. Leukocyte reduced PRP was not a significant factor in reducing SSI or implant removal rate.
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Affiliation(s)
- Yazdan Aryazand
- VCA West Los Angeles, Los Angeles, California, United States of America
| | - Nicole J. Buote
- Department of Clinical Sciences, Small Animal Surgery Section, Cornell University College of Veterinary Medicine, Ithaca, New York, United States of America
| | - YuHung Hsieh
- VCA West Los Angeles, Los Angeles, California, United States of America
| | - Kei Hayashi
- Department of Clinical Sciences, Small Animal Surgery Section, Cornell University College of Veterinary Medicine, Ithaca, New York, United States of America
| | - Desiree Rosselli
- VCA West Los Angeles, Los Angeles, California, United States of America
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Ivković A, Glavčić M, Vuletić F, Janković S. Core Decompression Combined with Intraosseous Autologous Conditioned Plasma Injections Decreases Pain and Improves Function in Patients with Symptomatic Knee Bone Marrow Lesions. Biomedicines 2023; 11:1799. [PMID: 37509439 PMCID: PMC10376709 DOI: 10.3390/biomedicines11071799] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
The purpose of this prospective case series was to determine the effectiveness of using a combination of the core decompression and injection of autologous conditioned plasma (ACP) for the treatment of symptomatic knee bone marrow lesions (BML), as well as to report on the preliminary clinical results based on magnetic resonance imaging (MRI) and patient-reported outcomes (PROMs). Patients with OA-related BML who failed to improve on conservative treatment for three months underwent an identical procedure consisting of arthroscopy, core decompression, and the intraosseous injection of ACP and were followed up for 12 months. A statistically significant reduction in pain and an improvement in function, as measured by the Numeric Pain Rating Scale (NPRS) and Knee Injury and Osteoarthritis Outcome Score (KOOS), was observed at one-week follow-up (8.3 ± 0.8 to 1.5 ± 1.0; p ≤ 0.001 and 33.4 ± 10.6 to 53.9 ± 13.6; p ≤ 0.001 respectively). After six weeks, weight-bearing was allowed, but the trend did not change-the NPRS continued to be low (average 1.4 on 12-month follow-up) and the total KOOS increased 44.6 points from the baseline (average 78.0 on 12-month follow-up). The Whole-Organ Magnetic Resonance Imaging Score improved from 66.1 ± 19.4 prior to surgery to 58.0 ± 15.9 (p < 0.001) after 3 months. In our study, there was no control group, randomisation was not performed, and the sample size was relatively small. A combination of core decompression and the intraosseous injection of ACP into the affected subchondral area proved to be a safe and effective procedure that provides rapid pain relief and a significant increase in joint function up to one year postoperatively.
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Affiliation(s)
- Alan Ivković
- Department of Orthopaedics and Trauma Surgery, University Hospital "Sveti Duh", 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Clinical Medicine, University of Applied Health Sciences, 10000 Zagreb, Croatia
| | - Marin Glavčić
- Department of Orthopaedic and Trauma Surgery, University Hospital "Dubrava", 10000 Zagreb, Croatia
| | - Filip Vuletić
- Department of Orthopaedics and Trauma Surgery, University Hospital "Sveti Duh", 10000 Zagreb, Croatia
| | - Saša Janković
- Department of Orthopaedics and Trauma Surgery, University Hospital "Sveti Duh", 10000 Zagreb, Croatia
- Faculty of Kinesiology, University of Zagreb, 10000 Zagreb, Croatia
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Tschopp M, Pfirrmann CW, Fucentese SF, Brunner F, Catanzaro S, Kühne N, Zwyssig I, Sutter R, Götschi T, Tanadini M, Rosskopf AB. A Randomized Trial of Intra-articular Injection Therapy for Knee Osteoarthritis. Invest Radiol 2023; 58:355-362. [PMID: 36728848 PMCID: PMC10090303 DOI: 10.1097/rli.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/29/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Intra-articular injections are widely used for conservative treatment of knee osteoarthritis (OA). However, rigorous data are lacking regarding the comparative therapeutic effectiveness of these injections. PURPOSE The aim of this study was to compare clinical outcomes after intra-articular injections of glucocorticoid, hyaluronic acid, platelet-rich plasma (PRP), or placebo in patients with mild or moderate OA of the knee. MATERIALS AND METHODS In a double-blinded, placebo-controlled, single-center trial, we randomly assigned knees with early- to middle-stage knee OA (Kellgren-Lawrence grade 1-3) to an intra-articular injection with one of these substances: glucocorticoid, hyaluronic acid, PRP, or placebo. Primary outcome was pain reduction within 6 months after the injection, assessed with the numeric rating scale (NRS; range, 0-100). Secondary outcome parameters included WOMAC scores, Tegner Activity Scale, knee mobility, and adverse events. Finally, a linear mixed-effects model was calculated and corrected for possible patient and covariate effects. RESULTS One hundred twenty knees (30 knees per treatment group) in 95 patients (41 female) were included in the final analysis. The median age of patients was 60 years (interquartile range, 54.0-68.0). There was no evidence that the drug effects of primary and secondary outcome parameters differed over time. The median pain at baseline was 32.5 (interquartile range, 15.00-50.00) on NRS. The changes in pain level during the first 6 months compared with baseline were small (within ±5 points on NRS), whereas the intrapatient variability was large between -20 and +20 points. Secondary outcome parameters did not differ significantly among the groups. Kellgren-Lawrence grade did not have a statistically significant effect on pain reduction ( P = 0.61). CONCLUSIONS There is no evidence that knee injections with glucocorticoid, PRP, or hyaluronic acid have superior short- or long-term effects in patients with low pain level at baseline and early- to middle-stage knee OA when compared with placebo.
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Affiliation(s)
- Marcel Tschopp
- From the Department of Physical Medicine and Rheumatology, Balgrist University Hospital
| | | | - Sandro F. Fucentese
- University of Zurich, Faculty of Medicine
- Orthopedic Surgery, Balgrist University Hospital
| | - Florian Brunner
- From the Department of Physical Medicine and Rheumatology, Balgrist University Hospital
- University of Zurich, Faculty of Medicine
| | | | | | - Iwan Zwyssig
- Unit for Clinical and Applied Research, Balgrist Campus
| | - Reto Sutter
- University of Zurich, Faculty of Medicine
- Departments of Radiology
| | - Tobias Götschi
- Unit for Clinical and Applied Research, Balgrist Campus
- Institute for Biomechanics, Swiss Federal Institute of Technology
| | - Matteo Tanadini
- Zurich Data Scientists, c/o Impact Hub Zurich AG, Zurich, Switzerland
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Baria MR, DiBartola AC, Woods K, Valentas L, Vasileff WK, Durgam S. Creating 2 Unique Platelet-rich Plasma Products From a Single Batch of Whole Blood With a Single Processing Kit. Tech Orthop 2023. [DOI: 10.1097/bto.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Costa LAV, Lenza M, Irrgang JJ, Fu FH, Ferretti M. How Does Platelet-Rich Plasma Compare Clinically to Other Therapies in the Treatment of Knee Osteoarthritis? A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:1074-1086. [PMID: 35316112 DOI: 10.1177/03635465211062243] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There has been an increase in interest in the use of biological therapies in orthopaedic conditions such as knee osteoarthritis. Platelet-rich plasma (PRP) is one of these therapies, but it still lacks consistent results. PURPOSE To evaluate the effects (benefits and harms) of PRP intra-articular injection compared with other nonsurgical methods for the treatment of knee osteoarthritis. STUDY DESIGN Systematic review and meta-analysis of randomized and quasi-randomized controlled trials; Level of evidence, 2. METHODS Three electronic databases were searched to identify relevant studies published before January 2021. The primary outcomes were pain, function, and failure of treatment. Risks of bias of all trials were assessed using a Cochrane risk of bias tool. The Grading of Recommendations Assessment, Development and Evaluation System was used to assess the quality of evidence of included studies. RESULTS A total of 40 studies with 3035 participants were included. Analysis of this review focused on comparing PRP with hyaluronic acid, corticosteroid, and saline, as we believe they are the most relevant comparisons with the most studies available. At 6-month follow-up, PRP was as effective as and in some studies more effective than other therapies regarding pain, function, and stiffness. However, current evidence is of low or very low quality and is based on trials with high risk of bias and great heterogeneity among them. No significant difference among treatments was found concerning major adverse events and treatment failure. CONCLUSION Although studies suggest that PRP may be more effective than or at least as effective as other modalities of nonsurgical treatment for knee osteoarthritis in terms of pain, function, and adverse events, serious limitations and methodological flaws are considerable in the current literature. Therefore, the authors are not able to make recommendations for clinical practice regarding PRP for knee osteoarthritis.
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Affiliation(s)
| | - Mário Lenza
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mário Ferretti
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Saraf A, Hussain A, Bishnoi S, Habib H, Garg A. Serial intraarticular injections of growth factor concentrate in knee osteoarthritis: A placebo controlled randomized study. J Orthop 2023; 37:46-52. [PMID: 36974096 PMCID: PMC10039117 DOI: 10.1016/j.jor.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 03/29/2023] Open
Abstract
Objective To evaluate and compare clinical efficacy and effect on specific serum biomarker with serial injections of growth factor concentrate (GFC) for knee osteoarthritis (KOA) in a randomized triple blinded placebo controlled interventional study. Methods Final assessment was done on 58 patients. Patients with Kellgren-Lawrence grade II, III knee osteoarthritis were administered monthly intraarticular injections(3 injections) of GFC(n = 31) or saline(n = 27) and evaluated clinically with visual analogue scale(VAS) and Western Ontario and McMaster Universities Arthritis Index(WOMAC) at 3,6 and 12 months post therapy. Biochemical analysis was done with serum biomarker of cartilage degeneration, Collagen 2-1 (Coll2-1), estimated at baseline and at final follow up. Results Both the groups exhibited statistically significant improvements (P < 0.05) in VAS at 3,6 and 12 months. WOMAC improvement reached statistical significance for GFC group at every evaluation (P < 0.001) but only at 12 months in NS group (P = 0.029). The improvements were clinically meaningful only in GFC group throughout follow up (Minimal clinically important differences >12% of baseline in WOMAC and >2 cm difference in mean for VAS). Intergroup comparison revealed GFC to be much better for both scores at every evaluation (95% CI of 0.2-1.5,[P = 0.008], 1.4-2.9,[P < 0.0001], and 2.7-4.2,[P < 0.0001] for VAS, 7.3-16.0 [P < 0.001], 11.6-21.9 [P < 0.001] and 18.1-31.1[P < 0.001] for WOMAC). Statistically significant decrease in serum Coll2-1 levels were observed for GFC group only. No serious complications were seen. Conclusion Serial(three) monthly GFC injections result in clinically meaningful improvement of subjective pain and function outcome scores, sustaining up to 12 months in KOA grade II and III. GFC also lead to significant reduction in serum levels of cartilage degradation biomarker coll2-1.
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Affiliation(s)
- Amit Saraf
- Department of Orthopaedics, Teerthanker Mahaveer Medical College & Research Centre, Delhi Road. NH 24, Bagadpur, Moradabad, Uttar Pradesh, 244001, India
| | - Altaf Hussain
- Department of Orthopaedics, Teerthanker Mahaveer Medical College & Research Centre, Delhi Road. NH 24, Bagadpur, Moradabad, Uttar Pradesh, 244001, India
| | - Sandeep Bishnoi
- Department of Orthopaedics, Teerthanker Mahaveer Medical College & Research Centre, Delhi Road. NH 24, Bagadpur, Moradabad, Uttar Pradesh, 244001, India
| | - Hamza Habib
- Department of Orthopaedics, Teerthanker Mahaveer Medical College & Research Centre, Delhi Road. NH 24, Bagadpur, Moradabad, Uttar Pradesh, 244001, India
| | - Abhishek Garg
- Department of Orthopaedics, Teerthanker Mahaveer Medical College & Research Centre, Delhi Road. NH 24, Bagadpur, Moradabad, Uttar Pradesh, 244001, India
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The use of platelet-rich plasma in studies with early knee osteoarthritis versus advanced stages of the disease: a systematic review and meta-analysis of 31 randomized clinical trials. Arch Orthop Trauma Surg 2023; 143:1393-1408. [PMID: 35043252 DOI: 10.1007/s00402-021-04304-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/07/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Reports have concluded that platelet-rich plasma (PRP) is an effective and safe biological approach to treating knee osteoarthritis (OA). However, the effectiveness of PRP in advanced stages of the disease is not entirely clear. The purpose of this study was to evaluate whether the use of PRP would be as effective in studies with early-moderate knee OA patients compared to studies including patients with end-stage OA, based on the Kellgren-Lawrence classification. MATERIALS AND METHODS A comprehensive search in MEDLINE, EMBASE, Scopus, and Web of Science databases was conducted to identify randomized controlled trials (RCTs) comparing the effect of PRP injections versus other intra-articular treatments on pain and functionality. A meta-analysis was conducted using a random-effects model and the generic inverse variance method. RESULTS We included 31 clinical trials that reported data of 2705 subjects. Meta-analysis revealed an overall significant improvement of both pain [MD, - 1.05 (95% CI - 1.41 to - 0.68); I2 = 86%; P ≤ 0.00001] and function [SMD, - 1.00 (95% CI - 1.33, to - 0.66); I2 = 94%; P ≤ 0.00001], favoring PRP. Subanalysis for pain and functional improvement showed a significant pain relief in studies with 1-3 and 1-4 Kellgren-Lawrence OA stages and a significant functional improvement in studies with 1-2, 1-3 and 1-4 knee OA stages, favoring PRP. CONCLUSION Our results indicate that including patients with advanced knee OA does not seem to affect the outcomes of clinical trials in which the effectiveness of the PRP in knee OA is assessed.
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Muacevic A, Adler JR, Bukhari A, Shaikh A, Rutherford J, Barkatali B. Do Platelet-Rich Plasma Injections for Knee Osteoarthritis Work? Cureus 2023; 15:e34533. [PMID: 36751575 PMCID: PMC9897683 DOI: 10.7759/cureus.34533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recent evidence suggests a benefit in platelet-rich plasma injections (PRP) for the knee in the management of mild to moderate osteoarthritis (OA). There is a reported reduction in pain, stiffness, and improved function. However, there is very little level-one literature available that supports this practice and conclusively proves a benefit gained throughout the course. Three main randomized control trials (RCTs) conducted in North America are often referenced and cited to prove their efficacy. This study aimed to look at the outcomes of patients having undergone this treatment to determine if there was any benefit. AIMS This study aimed to determine if PRP injections administered in patients with knee OA over a six to eight-week time period demonstrated any benefit. METHODS The Western Ontario and McMaster Universities arthritis index (WOMAC) tool was used before each of the three PRP injections over the six to eight-week period, and six weeks after the final injection in 31 patients. Each injection was given spaced two to three weeks apart. The outcomes observed were pain, stiffness, and physical function, and the total WOMAC score was calculated. RESULTS The third injection showed a reduction in total WOMAC score, pain, stiffness, and physical function by 16.36%, 16.37%, 5.12%, and 18.03%, respectively. However, all scores returned close to baseline at the sixth-week follow-up post treatment. CONCLUSION Results showed a trend of reduction in the WOMAC score. However, they are overall indicative of a placebo effect from the injections. Further studies are needed to explore whether the grade of OA and patients' weight have a significant impact on the results.
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Surakanti A, Demory Beckler M, Kesselman MM. Surgical Versus Non-Surgical Treatments for the Knee: Which Is More Effective? Cureus 2023; 15:e34860. [PMID: 36923205 PMCID: PMC10010196 DOI: 10.7759/cureus.34860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/11/2023] [Indexed: 02/13/2023] Open
Abstract
Osteoarthritis is a degenerative joint disease that is extremely prevalent in society. It affects more than 25% of Americans above the age of 18 years. According to July 2020 publication by the Centers for Disease Control (CDC), osteoarthritis affects approximately 325 million Americans. One of the organs that is most affected by osteoarthritis is the knee. Over the years, we have developed non-surgical treatments, such as physical therapy (PT) and injections, and surgical treatments, such as total knee arthroplasty (TKA) and arthroscopic lavage, for knee osteoarthritis (KOA). If a patient fails with non-surgical options, which are tried first to avoid the risks of surgery, the patient may be considered for knee surgery. This article will investigate the different non-surgical options and TKA as treatment options for KOA based on current literature. The goal of this paper is to be a comprehensive resource for physicians and patients with KOA to make an informed decision. A systematic literature search was conducted using PubMed. The search terms were based on the type of treatments for KOA. To find articles that compared TKA to non-surgical treatments, the terms included "osteoarthritis", "total knee", and "non-surgical treatments," in combination. For other non-surgical treatments such as PT, weight reduction, and injections, a combination of the treatment, "osteoarthritis", and "knee" were included in the search. For the tier 1 process, any randomized controlled trials were included. Any case reports, observational studies, and cross-sectional studies were eliminated from the search. For the tier 2 review process, any articles that did not have relevance to the topic were eliminated after reading the abstracts of the articles. After review of the literature, the data seem to suggest that TKA with 12 weeks of non-surgical treatment improved pain and functionality of the knee more than just 12 weeks of non-surgical treatment when followed up at 12 and 24 months. However, non-surgical treatment before TKA delays the need for surgery. Supervised PT, either in a group or individual format, has been shown to delay TKA in 95% patients in the group that received PT at the end of one year. In addition, weight reduction has been shown as an effective strategy to improve pain and functionality in KOA patients, which decreases the urgency for surgery. Furthermore, platelet-rich plasma (PRP) injections have been shown to have long-term symptomatic relief for KOA compared to hyaluronic acid (HA) and corticosteroid injections. However, HA and corticosteroid injections are beneficial in treating KOA more than receiving no treatment. Physicians often have difficulty deciding whether to pursue conservative or surgical treatment for patients with KOA. The non-surgical treatments explored in this review - PT, injections, and weight reduction - can provide symptomatic relief and, in some cases, delay the need for surgical intervention. However, based on some randomized clinical trials mentioned in the article, patients receiving TKA have more relief, better quality of life, and improved functionality compared to non-surgical therapy. However, a critical review of this important field of debate shows that there are limited randomized controlled studies comparing the effectiveness of TKA and non-surgical treatments for KOA. We believe that this controversial topic needs further clinical investigation.
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Affiliation(s)
- Amulya Surakanti
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Michelle Demory Beckler
- Microbiology and Immunology, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Marc M Kesselman
- Rheumatology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
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Simental-Mendía M, Ortega-Mata D, Tamez-Mata Y, Olivo CAA, Vilchez-Cavazos F. Comparison of the clinical effectiveness of activated and non-activated platelet-rich plasma in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Clin Rheumatol 2022; 42:1397-1408. [PMID: 36502442 DOI: 10.1007/s10067-022-06463-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/03/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION/OBJECTIVES Platelet-rich plasma (PRP) has shown to be clinically effective in the treatment of knee osteoarthritis (OA). Notwithstanding, some inconsistences remain due to methodological differences in PRP preparation such as the use (or not) of activation strategies. We aimed to evaluate whether the use of non-activated PRP would be as effective as activated PRP in patients with knee OA. METHOD All randomized, placebo-controlled trials were identified through a search in MEDLINE, EMBASE, Scopus, and Web of Science up to June 2022. Pre- and post-injection pain and function scores were collected. The meta-analysis was conducted with a random-effects model and generic inverse variance method. Effect sizes were estimated using standardized mean differences (SMD). RESULTS Fourteen clinical trials involving 1292 subjects were included for meta-analysis. Exogenous activation of PRP revealed a significant pain relief (SMD, - 1.05 [95% CI - 1.58 to - 0.52]; p = 0.0001) and a significant functional improvement (SMD, - 1.21 [95% CI - 1.75 to - 0.67]; p < 0.0001) unlike studies describing the use of a non-activated PRP. The sensitivity analysis indicated that the effect size for both outcomes was not influenced by a single study. CONCLUSIONS The results of this systematic review suggest that the use of an exogenously activated PRP is more effective in improving both pain and functional scores in patients with knee OA. Key Points • Results from meta-analysis suggest that exogenously activated PRP is clinically more effective than non-activated PRP. • The use of an activated PRP was more frequently reported by the included studies. • The most frequent method for activation was the use of calcium chloride (CaCl2).
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Affiliation(s)
- Mario Simental-Mendía
- Orthopedic Trauma Service, School of Medicine and University Hospital "Dr. José Eleuterio González", Universidad Autonoma de Nuevo Leon, Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, Monterrey, Nuevo León, México
| | - Daniela Ortega-Mata
- Orthopedic Trauma Service, School of Medicine and University Hospital "Dr. José Eleuterio González", Universidad Autonoma de Nuevo Leon, Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, Monterrey, Nuevo León, México
| | - Yadira Tamez-Mata
- Orthopedic Trauma Service, School of Medicine and University Hospital "Dr. José Eleuterio González", Universidad Autonoma de Nuevo Leon, Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, Monterrey, Nuevo León, México
| | - Carlos A Acosta Olivo
- Orthopedic Trauma Service, School of Medicine and University Hospital "Dr. José Eleuterio González", Universidad Autonoma de Nuevo Leon, Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, Monterrey, Nuevo León, México
| | - Félix Vilchez-Cavazos
- Orthopedic Trauma Service, School of Medicine and University Hospital "Dr. José Eleuterio González", Universidad Autonoma de Nuevo Leon, Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, Monterrey, Nuevo León, México.
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Delanois RE, Sax OC, Chen Z, Cohen JM, Callahan DM, Mont MA. Biologic Therapies for the Treatment of Knee Osteoarthritis: An Updated Systematic Review. J Arthroplasty 2022; 37:2480-2506. [PMID: 35609847 DOI: 10.1016/j.arth.2022.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/05/2022] [Accepted: 05/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Use of "orthobiologics" continues to expand for patients who have knee osteoarthritis (OA). We sought to perform a systemic review of biologic therapies relative to comparative groups, including the following: (1) platelet-rich plasma (PRP); (2) bone marrow-derived mesenchymal stem cells (BMSCs); (3) adipose-derived mesenchymal stem cells (ADSCs); and (4) amniotic-derived mesenchymal stem cells (AMSCs). We assessed the following: (1) study methodologies; (2) cell preparations and formulations; (3) patient-reported outcome scores (PROMs); and (4) structural changes. METHODS PubMed, Cochrane Library, and Embase databases were queried (2013-2021) to conduct a systematic review of biologic therapies for knee OA, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eighty-two studies were included: PRP (51); BMSC (15); ADSC (11); and AMSC (5). Study evaluations were made using the Modified Coleman Methodology Score. PROMs included the Western Ontario and McMaster Universities Arthritis Index and the Visual Analog Scale. Structural change evaluations included ultrasounds, radiographs, or magnetic resonance imaging. RESULTS PRP comprised a majority of the studies (n = 51), most with "fair" to "good" Modified Coleman Methodology Score. Studies had variable cell preparations and formulations, with comparison study results leading to inconsistent PROMs, and structural changes. A limited number of studies were included for BMSC, ADSC, and AMSC, all with similar findings to PRP. CONCLUSION Available literature evaluating "orthobiologics" for knee OA remain nonsuperior to comparison cohorts. Higher level studies with larger sample sizes and improved methodologies are warranted to suggest differences. Despite a growth of "orthobiologics" in clinics, this updated systematic review highlights the uncertain efficacy for use in knee OA.
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Affiliation(s)
- Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Oliver C Sax
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jacob M Cohen
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Daniel M Callahan
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Richter M, Zech S, Meissner S, Naef I. Autologous matrix induced chondrogenesis plus peripheral blood concentrate (AMIC+PBC) in chondral lesions at the ankle as part of a complex surgical approach - 5-year follow-up. Foot Ankle Surg 2022; 28:1321-1326. [PMID: 35803836 DOI: 10.1016/j.fas.2022.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/16/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of the study was to assess 5-year-follow-up (5FU) after Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in chondral lesions at the ankle as part of a complex surgical approach. METHODS In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral lesion at the ankle treated with AMIC+PBC from July 17, 2016 to May 31, 2017 were included. Size and location of the chondral lesions, the Visual-Analogue-Scale Foot and Ankle (VAS FA) and the EFAS Score before treatment and at 5FU were analysed and compared with previous 2-year-follow-up (2FU). Peripheral Blood Concentrate (PBC) was used to impregnate a collagen I/III matrix (Chondro-Gide, Wolhusen, Switzerland) that was fixed into the chondral lesion with fibrin glue. RESULTS One hundred and twenty-nine patients with 136 chondral lesions were included in the study. The chondral lesions were located as follows (n (%)), medial talar shoulder only, 62 (46); lateral talar shoulder only, 42 (31); medial and lateral talar shoulder, 7 (10); tibia, 18 (13). The average for lesion size was 1.8 cm2, for VAS FA 45.7 and for EFAS Score 9.8. 2FU/5FU was completed in 105 (81 %)/104(81 %) patients with 112/111 previous chondral lesions. VAS FA improved to 79.8/84.2 and EFAS Score to 20.3/21.5 (2FU/5FU). No parameter significantly differed 2FU and 5FU. CONCLUSIONS AMIC+PBC as part of a complex surgical approach led to improved and high validated outcome scores at 2FU/5FU. 2FU and 5FU did not differ.
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Affiliation(s)
- Martinus Richter
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany.
| | - Stefan Zech
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
| | - Stefan Meissner
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
| | - Issam Naef
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
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Richter M, Zech S, Meissner SA, Naef I. Autologous matrix induced chondrogenesis plus peripheral blood concentrate (AMIC+PBC) in chondral defects of the first metatarsophalangeal joint - 5-year follow-up. Foot Ankle Surg 2022; 28:1366-1371. [PMID: 35850950 DOI: 10.1016/j.fas.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/09/2022] [Accepted: 07/04/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of the study was to assess the 5-year-follow-up (5FU) after Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in chondral defects at the first metatarsophalangeal joint (MTP1). MATERIAL AND METHODS In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral lesion at MTP1 that were treated with AMIC+PBC from July 17, 2016 to May 31, 2017 were included. Size and location of the chondral lesions, the Visual-Analogue-Scale Foot and Ankle (VAS FA) and the EFAS Score before treatment and at 5FU were analysed and compared with previous 2-year-follow-up (2FU). Peripheral Blood Concentrate (PBC) was used to impregnate a collagen I/III matrix (Chondro-Gide, Wolhusen, Switzerland) that was fixed into the chondral lesion with fibrin glue. RESULTS One hundred and ninety-eight patients with 238 chondral defects were included. In 21 % of patients no deformities in the forefoot were registered. The average degree of osteoarthritis was 2.2. The chondral defect size was 1.0 cm2 on average. The most common location was metatarsal dorsal (33 %), and in most patients one defect was registered (74 %). Corrective osteotomy of the first metatarsal was performed in 79 %. 176 (89 %)/164 (83 %) patients completed 2FU/5FU. VAS FA/EFAS Score were preoperatively 46.8/11.9 and improved to 74.1/17.1 at 2FU and 75.0/17.3 at 5FU on average. No parameter significantly differed between 2FU and 5FU. CONCLUSIONS AMIC+PBC as treatment for chondral defects at MTP1 as part of joint preserving surgery led to improved and high validated outcome scores at 2FU and 5FU. The results between 2FU and 5FU did not differ.
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Affiliation(s)
- Martinus Richter
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany.
| | - Stefan Zech
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
| | | | - Issam Naef
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
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Sax OC, Chen Z, Mont MA, Delanois RE. The Efficacy of Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis Symptoms and Structural Changes: A Systematic Review and Meta-Analysis. J Arthroplasty 2022; 37:2282-2290.e2. [PMID: 35537610 DOI: 10.1016/j.arth.2022.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/30/2022] [Accepted: 05/04/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Platelet-rich plasma (PRP) usage in orthopedics continues to rise, despite guidelines suggesting non-superiority to comparative cohorts. Therefore, we performed a systematic review and meta-analysis on PRP efficacy using two clinical assessments: (1) Visual Analog Scale and (2) Western Ontario and McMaster Universities Osteoarthritis Index. We assessed consistency and clinical relevancy by determining study heterogeneity (eg, sample sizes, ages, body mass index, arthritic severities, etc.). Comparative cohorts were: (A) hyaluronic acid (HA); (B) corticosteroid (CS); (C) normal saline (NS); and (D) exercise therapy. We performed sub-analyses of structural changes assessed on ultrasound, radiograph, or magnetic resonance imaging . METHODS We utilized PubMed, Cochrane Library, and Embase databases up to December 1, 2021, according to Preferred Reporting Items for Systematic-Reviews and Meta-Analyses guidelines. Twenty-four studies met criteria, with comparisons to: HA (n = 11); CS (n = 6); NS (n = 5); and exercise therapy (n = 3). Seven studies assessed structural changes. Evaluations utilized a methodological scoring system. I2 statistics and forest plots pooled analyses and delineated study results. RESULTS PRP led to Visual Analog Scale and Western Ontario and McMaster Universities Osteoarthritis Index improvements in most studies when compared to HA, CS, and NS (P ≤ .05). Comparison to exercise therapy resulted in inconclusive findings (P ≥ .05). However, substantial heterogeneity (I2 ≥ 76%) was reported due to study variability. No differences were found when assessing structural changes or cartilage thickness by magnetic resonance imaging (standardized mean difference -0.01 [-0.19, 0.18], P = .91). CONCLUSIONS PRP may be associated with pain and functional improvements but was not clinically relevant (inconsistent study- and patient-metrics). In addition, PRP did not confer superiority when assessing knee-related structural changes.
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Affiliation(s)
- Oliver C Sax
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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DARWISH AS, ELNAGGAR OA, ZAKI AA, KAMEL NM, DAHAB MM, EL-SAYEM K. Role of autologous platelet rich plasma in hypospadias repair. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.20.05217-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yurtbay A, Say F, Çinka H, Ersoy A. Multiple platelet-rich plasma injections are superior to single PRP injections or saline in osteoarthritis of the knee: the 2-year results of a randomized, double-blind, placebo-controlled clinical trial. Arch Orthop Trauma Surg 2022; 142:2755-2768. [PMID: 34705072 DOI: 10.1007/s00402-021-04230-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/13/2021] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The primary purposes of this study were to prove the efficacy of PRP injection therapy on knee pain and functions by comparing patients with mild to moderate OA with a placebo control group, and also to understand the effectiveness of multiple doses compared to a single dose. It was hypothesized that PRP would lead to more favorable results than the placebo at 1, 3, 6, 12 and 24 months after treatment. MATERIALS AND METHODS 237 patients diagnosed with OA were randomly separated into 4 groups, who were administered the following: single dose of PRP (n: 62), single dose of sodium saline (NS) (n: 59), three doses of PRP (n: 63), and three doses of NS (n: 53). Clinical evaluations were made pre-treatment and at 1, 3, 6, 12 and 24 months post-treatment, using the Knee Injury and Osteoarthritis Result Score (KOOS), Kujala Patellofemoral Score, knee joint range of motion (ROM), measurements of knee circumference (KC), and mechanical axis angle (MAA) and a Visual Analog Scale (VAS) for the evaluation of pain. RESULTS The better score values in the groups were recorded at 3 and 6 months. Patients treated with PRP maintained better scores at 3, 6 and 12 months compared to the NS groups (p < 0.05). Multiple doses of PRP were seen to be more effective than single-dose PRP at 6 and 12 months (p < 0.05). At the end of 24 months, there was no significant score difference across all the groups. The most positive change in scores was found in stage 2 OA, and the most positive change in ROM was in stage 3 OA patients. In the PRP groups, KC decreased more at 1 and 6 months (p < 0.05). Compared to other age groups, patients aged 51-65 years scored better at 6 months (p < 0.05). A negative correlation was determined with MAA scores (r = - 0.508, p < 0.001). CONCLUSION In comparison to the placebo (NS), leukocyte-rich PRP treatment was determined to be effective in the treatment of OA. Multiple doses of PRP increase the treatment efficacy and duration. Of all the patients treated with PRP, the best results were obtained by patients aged 51-65 years, with lower MAA, and by K/L stage 2 OA patients. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. REGISTRATION NCT04454164 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Alparslan Yurtbay
- Department of Orthopaedics and Traumatology, Samsun Training and Research Hospital, İlkadım, 55139, Samsun, Turkey.
| | - Ferhat Say
- Department of Orthopaedics and Traumatology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Hikmet Çinka
- Department of Orthopaedics and Traumatology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Ahmet Ersoy
- Department of Orthopaedics and Traumatology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Saraf A, Hussain A, Bishnoi S, Azam G, Habib H. Serial Platelet-Rich Plasma Intra-articular Injections in Kellgren and Lawrence Grade IV Knee Joint Osteoarthritis: A Prospective Blinded Placebo-Controlled Interventional Study. Indian J Orthop 2022; 56:1722-1728. [PMID: 36187584 PMCID: PMC9485312 DOI: 10.1007/s43465-022-00730-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/20/2022] [Indexed: 02/04/2023]
Abstract
Purpose The purpose of this study was to evaluate whether serial intra-articular (IA) Platelet-Rich Plasma (PRP) injections improve pain and function in patients of Kellgren-Lawrence (K-L) Grade IV primary knee osteoarthritis (KOA), not willing for arthroplasty or having relative contraindications to surgery. Methods 90 patients (84 available at final follow-up) of Grade IV KOA were given 3 PRP or Normal Saline injections at 1-month interval. Pain and functional assessment was done with Visual analog scale (VAS) and Western Ontario and McMaster universities osteoarthritis index (WOMAC) respectively, at baseline and then at three and six months of follow-up. Both groups were homogenous with similar baseline characteristics. Results Both groups showed statistically significant improvements in the outcome scores but only PRP showed minimal clinically important difference (25% in WOMAC and > 2 cm difference of mean in VAS at follow-up). For inter-group comparison, PRP showed better results as there was statistically significant difference in WOMAC at 3 months (Difference = - 9.220, 95% CI = - 13.1945 to - 5.2455, P < 0.0001) and at 6 months (Difference = - 10.360, 95% CI = - 14.5358 to - 6.1842, P < 0.0001). Similar results were seen for VAS also (Difference = - 0.580, 95% CI = - 1.1412 to - 0.0188, P = 0.04 at 3 months, Difference = - 0.870, 95% CI - 1.3993 to - 0.3407, P = 0.001 at 6 months). Outcome scores significantly correlated with age and sex but not with body mass index (BMI). Conclusion Serial Intra-articular Injections of autologous PRP mildly improve short-term subjective pain and knee function scores in patients of Grade IV KOA without any major complications.
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Affiliation(s)
- Amit Saraf
- Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Delhi Road, NH 24, Bagadpur, Moradabad, Uttar Pradesh 244001 India
| | - Altaf Hussain
- Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Delhi Road, NH 24, Bagadpur, Moradabad, Uttar Pradesh 244001 India
- Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Hospital Building, H.O.D Office, Delhi Road, 4th Floor, Uttar Pradesh 244001 Moradabad, India
| | - Sandeep Bishnoi
- Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Delhi Road, NH 24, Bagadpur, Moradabad, Uttar Pradesh 244001 India
| | - Goushul Azam
- Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Delhi Road, NH 24, Bagadpur, Moradabad, Uttar Pradesh 244001 India
| | - Hamza Habib
- Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Delhi Road, NH 24, Bagadpur, Moradabad, Uttar Pradesh 244001 India
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Hunter CW, Deer TR, Jones MR, Chang Chien GC, D'Souza RS, Davis T, Eldon ER, Esposito MF, Goree JH, Hewan-Lowe L, Maloney JA, Mazzola AJ, Michels JS, Layno-Moses A, Patel S, Tari J, Weisbein JS, Goulding KA, Chhabra A, Hassebrock J, Wie C, Beall D, Sayed D, Strand N. Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience. J Pain Res 2022; 15:2683-2745. [PMID: 36132996 PMCID: PMC9484571 DOI: 10.2147/jpr.s370469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Corey W Hunter
- Ainsworth Institute of Pain Management, New York, NY, USA.,Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | | | | | - Ryan S D'Souza
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | | | - Erica R Eldon
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Johnathan H Goree
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lissa Hewan-Lowe
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jillian A Maloney
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Anthony J Mazzola
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Jeanmarie Tari
- Ainsworth Institute of Pain Management, New York, NY, USA
| | | | | | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | | - Chris Wie
- Interventional Spine and Pain, Dallas, TX, USA
| | - Douglas Beall
- Comprehensive Specialty Care, Oklahoma City, OK, USA
| | - Dawood Sayed
- Department of Anesthesiology, Division of Pain Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Baria M, Pedroza A, Kaeding C, Durgam S, Duerr R, Flanigan D, Borchers J, Magnussen R. Platelet-Rich Plasma Versus Microfragmented Adipose Tissue for Knee Osteoarthritis: A Randomized Controlled Trial. Orthop J Sports Med 2022; 10:23259671221120678. [PMID: 36147791 PMCID: PMC9486262 DOI: 10.1177/23259671221120678] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
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).
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Affiliation(s)
- Michael Baria
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio, USA
| | - Angela Pedroza
- Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | | | - Sushmitha Durgam
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Robert Duerr
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - David Flanigan
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - James Borchers
- Department of Family and Community Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Robert Magnussen
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
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Safety of intra-articular platelet rich plasma injections for large joint osteoarthritis: a review article. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Berkani S, Courties A, Eymard F, Latourte A, Richette P, Berenbaum F, Sellam J, Louati K. Time to Total Knee Arthroplasty after Intra-Articular Hyaluronic Acid or Platelet-Rich Plasma Injections: A Systematic Literature Review and Meta-Analysis. J Clin Med 2022; 11:3985. [PMID: 35887749 PMCID: PMC9322631 DOI: 10.3390/jcm11143985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 02/05/2023] Open
Abstract
Intra-articular (IA) hyaluronic acid (HA) and platelet-rich plasma (PRP) injections are increasingly being prescribed for knee osteoarthritis (KOA). However, failure of the medical treatment may result in total knee arthroplasty (TKA). We wondered if IA HA or PRP injections (intervention) may delay the time to TKA (outcome) among KOA patients (population), compared to KOA patients not receiving these injections (comparator). For this systematic literature review (SLR) and meta-analysis, we selected observational studies with at least one group of patients receiving IA HA or PRP and with TKA data available. The main outcome was time from the diagnosis of KOA to TKA. We included 25 articles in the SLR (2,824,401 patients) and four in the meta-analysis. The mean strengthening the reporting of observational studies in epidemiology (STROBE) score was 63%. For patients receiving versus not receiving HA injections, the delay between a declared diagnosis of KOA to TKA was increased by 9.8 months (95% CI (8.2-11.4)). As compared with standard of care, the effect size of HA injections for this outcome was 0.57 (95% CI (0.36-0.76)). Only one study described a median time from PRP injections to TKA of 4.1 years (range 0.3-14.7). IA HA injections were associated with increased time to TKA. Causality cannot be concluded because of missing confounder factors as comorbidities. Data were insufficient to conclude any effect of PRP injections on TKA delay.
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Affiliation(s)
- Sabryne Berkani
- Rheumatology Department, Inserm UMRS_938, (AP-HP) Saint-Antoine Hospital, Sorbonne Université, 75012 Paris, France; (S.B.); (A.C.); (F.B.)
| | - Alice Courties
- Rheumatology Department, Inserm UMRS_938, (AP-HP) Saint-Antoine Hospital, Sorbonne Université, 75012 Paris, France; (S.B.); (A.C.); (F.B.)
| | - Florent Eymard
- Rheumatology Department, AP-HP Henri Mondor Hospital, 94000 Créteil, France;
| | - Augustin Latourte
- Rheumatology Department, Inserm U1132, DMU Locomotion, AP-HP Lariboisière Hospital, Université de Paris, 75010 Paris, France; (A.L.); (P.R.)
| | - Pascal Richette
- Rheumatology Department, Inserm U1132, DMU Locomotion, AP-HP Lariboisière Hospital, Université de Paris, 75010 Paris, France; (A.L.); (P.R.)
| | - Francis Berenbaum
- Rheumatology Department, Inserm UMRS_938, (AP-HP) Saint-Antoine Hospital, Sorbonne Université, 75012 Paris, France; (S.B.); (A.C.); (F.B.)
| | - Jérémie Sellam
- Rheumatology Department, Inserm UMRS_938, (AP-HP) Saint-Antoine Hospital, Sorbonne Université, 75012 Paris, France; (S.B.); (A.C.); (F.B.)
| | - Karine Louati
- Rheumatology Department, Inserm UMRS_938, (AP-HP) Saint-Antoine Hospital, Sorbonne Université, 75012 Paris, France; (S.B.); (A.C.); (F.B.)
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Cash C, Scott L, Walden RL, Kuhn A, Bowman E. Bibliometric analysis of the top 50 highly cited articles on platelet-rich plasma in osteoarthritis and tendinopathy. Regen Med 2022; 17:491-506. [PMID: 35578970 DOI: 10.2217/rme-2022-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The primary goal of this study was to compile the top 50 most cited articles on the use of platelet-rich plasma (PRP). A search of relevant studies was performed in accordance with the PRISMA guidelines in Web of Science. The top 25 most cited articles in osteoarthritis and tendinopathy were then compiled and evaluated. Level 1 evidence articles constituted the majority of the studies (64%) and were more likely to have a higher citation density. Altmetric data was highest for level 1 systematic reviews. Of the articles that report a positive outcome for PRP, 13% (2/16) had low risk of bias. This study defines the most cited and influential publications regarding PRP to further research in this area.
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Affiliation(s)
- Carsen Cash
- Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Leon Scott
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Rachel Lane Walden
- Eskind Biomedical Library, Vanderbilt University, Nashville, TN 37232, USA
| | - Andrew Kuhn
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Eric Bowman
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Coşkun HS, Yurtbay A, Say F. Platelet Rich Plasma Versus Autologous Conditioned Serum in Osteoarthritis of the Knee: Clinical Results of a Five-Year Retrospective Study. Cureus 2022; 14:e24500. [PMID: 35651374 PMCID: PMC9135591 DOI: 10.7759/cureus.24500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives: There is no consensus on the effectiveness of platelet-rich plasma (PRP) and autologous conditioned serum (ACS) in the treatment of knee osteoarthritis (OA). Also, the group of patients who will benefit most from this treatment is not clear. This study aims to understand the effects of two treatment modalities: ACS and PRP on pain and clinical scores in the treatment of OA. For this reason, we compared the long-term (five-year follow up) clinical results of the patients to whom these two treatment methods were applied. Materials and methods: Eighty-two knee osteoarthritis cases, selected from a database prospectively maintained in our tertiary university hospital after institutional ethics committee approval, examined between January 2013 and September 2020 and treated with ACS and PRP by the same orthobiological treatment team, were retrospectively analyzed. The clinical results of group A (n=40) treated with ACS and group B (n=42) treated with PRP were statistically analyzed. Clinical evaluations were made pre-injection and at one, six, 12, 24 and 60 months post-treatment, using the knee injury and osteoarthritis result score (KOOS) for the evaluation of function and a visual analog scale (VAS) for the evaluation of pain. Results: Side effects were noted in two patients (5%) in group A and 16 patients (38.1%) in group B. More side effects were seen in group B compared to group A (p<0.001). The better VAS scores in both groups were detected in the sixth and 12th months. When VAS scores were examined, better results were obtained in group A in the 12th and 24th months (p<0.05). When KOOS scores were examined, the superiority of ACS to PRP at 12 and 24 months was shown in KOOS.S, KOOS.P and KOOS.ADL scores (p<0.05). There was no statistically significant difference between the two groups in terms of all scores and baseline scores at 60 months. Conclusion: The effectiveness of ACS and PRP treatments can last up to two years. After two years, the effectiveness of both treatments decreases. Comparing the two treatments, ACS treatment showed better results on VAS and KOOS scores compared to PRP treatment.
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Szwedowski D, Mobasheri A, Moniuszko A, Zabrzyński J, Jeka S. Intra-Articular Injection of Platelet-Rich Plasma Is More Effective than Hyaluronic Acid or Steroid Injection in the Treatment of Mild to Moderate Knee Osteoarthritis: A Prospective, Randomized, Triple-Parallel Clinical Trial. Biomedicines 2022; 10:biomedicines10050991. [PMID: 35625728 PMCID: PMC9138252 DOI: 10.3390/biomedicines10050991] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 02/01/2023] Open
Abstract
Purpose: To prospectively compare the efficacy and safety of intra-articular injections of platelet-rich plasma (PRP) with hyaluronic acid (HA) and glucocorticosteroid (CS) control groups for knee osteoarthritis (KOA) in a randomized, triple-parallel, single-center clinical trial. Methods: A total of 75 patients were randomly assigned to one of three groups receiving a single injection of either leukocyte-poor platelet-rich plasma (25 knees), hyaluronic acid (25 knees), or glucocorticosteroid (25 knees). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was collected at baseline and 6, 12, and 26 weeks after treatment. Results: After 6 weeks of PRP administration, a decrease in the mean WOMAC value was observed in all three study groups. Three months after administration, the greatest decrease in the mean WOMAC value was obtained in the PRP group. The results in the HA and CS groups were similar (p = 0.681). In the one-way analysis of variance and post hoc analysis using the HSD Tukey test, a significantly greater improvement was shown by comparing the PRP and CS groups (p = 0.001), and the PRP and HA groups (p = 0.010). After intra-articular injection of CS, the reduction in pain was greatest 6 weeks after administration, and the mean value was the lowest among all groups. During subsequent visits, the value of the pain subscale increased, and after 6 months, it was the highest among the studied groups. Using the Wilcoxon paired test, no PRP effect was found to reduce stiffness at the 6-month follow-up (p = 0.908). Functional improvement was achieved in all groups, i.e., a decrease in the value of this subscale 6 months after administration. The largest decrease was seen in the group that received PRP (p < 0.001) and then in the HA group. The smallest decrease among the investigated methods was shown in the CS group. Conclusions: Intra-articular injections of PRP can provide clinically significant functional improvement for at least 6 months in patients with mild to moderate KOA which is superior to HA or CS injections.
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Affiliation(s)
- Dawid Szwedowski
- Orthopedic Arthroscopic Surgery International (O.A.S.I.) Bioresearch Foundation, Gobbi N.P.O., 20133 Milan, Italy
- Department of Orthopaedics and Trauma Surgery, Provincial Polyclinical Hospital, 87-100 Torun, Poland
- Correspondence:
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, FI-90014 Oulu, Finland;
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Santariskiu 5, LT-08406 Vilnius, Lithuania
- Departments of Orthopedics, Rheumatology and Clinical Immunology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
- Department of Joint Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Andrzej Moniuszko
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Diseases Unit, Central Clinical Hospital of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland;
| | - Jan Zabrzyński
- Department of General Orthopedics, Musculoskeletal Oncology and Trauma Surgery, University of Medical Sciences, 61-701 Poznan, Poland;
| | - Sławomir Jeka
- Department and Clinic of Rheumatology and Connective Tissue Diseases, University Hospital No. 2, Collegium Medicum UMK, 85-168 Bydgoszcz, Poland;
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Gardner JE, Williams CW, Bowers RL. Subchondral versus intra-articular orthobiologic injections for the treatment of knee osteoarthritis: a review. Regen Med 2022; 17:389-400. [PMID: 35410486 DOI: 10.2217/rme-2021-0174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Recent perspectives suggest that osteoarthritis (OA) is a disease involving not only the articular cartilage but also the osteochondral unit, including the synovium, supportive cartilage and subchondral bone. Current conservative treatments for OA are symptomatic and do not prevent progression or reverse the disease process. Compelling data show that intra-articular orthobiologic injections, such as platelet-rich plasma and mesenchymal stromal cells, are effective in providing relief of OA symptoms. However, recent data suggest that injections of orthobiologics into the subchondral bone may be superior to intra-articular injections for the management of OA. This review highlights the rationale and current evidence for intra-articular and subchondral bone injections of orthobiologics for the treatment of OA.
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Affiliation(s)
- James E Gardner
- Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Christopher W Williams
- Department of Physical Medicine & Rehabilitation, Emory University, Atlanta, GA 30322, USA.,Interventional Orthopedics of Atlanta, Atlanta, GA 30305, USA
| | - Robert L Bowers
- Department of Orthopaedics, Emory University, Atlanta, GA 30322, USA.,Department of Physical Medicine & Rehabilitation, Emory University, Atlanta, GA 30322, USA
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Zitsch BP, James CR, Crist BD, Stoker AM, Della Rocca GJ, Cook JL. A prospective randomized double-blind clinical trial to assess the effects of leukocyte-reduced platelet-rich plasma on pro-inflammatory, degradative, and anabolic biomarkers after closed pilon fractures. J Orthop Res 2022; 40:925-932. [PMID: 34185333 DOI: 10.1002/jor.25123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 01/19/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
Posttraumatic osteoarthritis (PTOA) significantly affects patients with pilon fractures even after adequate anatomical reduction, and treatment strategies targeting the biologic mediators of PTOA are needed. This study was designed to determine the effects of intra-articular injection of platelet-rich plasma (PRP) on synovial fluid (SF) biomarkers for patients undergoing open reduction and internal fixation (ORIF) of pilon fractures. Patients undergoing staged management of pilon fractures were enrolled in a prospective, double-blinded, randomized, and placebo-controlled clinical trial to determine the effects of a single intra-articular injection of leukocyte-reduced PRP on SF biomarkers. Arthrocentesis of the injured and uninjured ankles was performed at the time of external skeletal fixation (ESF) and ORIF. Patients were randomized to receive either autogenous leukocyte-reduced PRP or saline (control) via intra-articular injection into the injured ankle at the time of ESF. SF biomarker concentrations were compared-uninjured, injured pretreatment, and saline-injected or PRP-injected. Eleven patients (PRP, n = 5; saline, n = 6) completed the study. Twenty-one uninjured, and 11 injured pretreatment, five PRP-treated, and six saline-treated SF samples were analyzed. PRP-treated SF contained significantly higher levels of PDGF-AA (p = 0.046) and significantly lower levels of MMP-3 (p = 0.042), MMP-9 (p = 0.009), IL-1β (p = 0.049), IL-6 (p < 0.01), IL-8 (p = 0.048), and PGE2 (p < 0.04). This study provided mechanistic data to suggest that a single intraarticular injection of leukocyte-reduced PRP is associated with anti-inflammatory, anti-degradative, and anabolic responses compared with saline control. These findings provide the impetus for investigating long-term clinical outcomes after PRP injection as an orthobiologic adjunct to ORIF for mitigating the incidence and severity of PTOA after pilon fractures.
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Affiliation(s)
| | - Christopher R James
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA
| | - Brett D Crist
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA
| | - Aaron M Stoker
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | | | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
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45
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Role of Platelets in Osteoarthritis-Updated Systematic Review and Meta-Analysis on the Role of Platelet-Rich Plasma in Osteoarthritis. Cells 2022; 11:cells11071080. [PMID: 35406644 PMCID: PMC8997794 DOI: 10.3390/cells11071080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 01/15/2023] Open
Abstract
Platelets are an essential component of hemostasis, with an increasing role in host inflammatory processes in injured tissues. The reaction between receptors and vascular endothelial cells results in the recruitment of platelets in the immune response pathway. The aim of the present review is to describe the role of platelets in osteoarthritis. Platelets induce secretion of biological substances, many of which are key players in the inflammatory response in osteoarthritis. Molecules involved in cartilage degeneration, or being markers of inflammation in osteoarthritis, are cytokines, such as tumor necrosis factor α (TNFα), interleukins (IL), type II collagen, aggrecan, and metalloproteinases. Surprisingly, platelets may also be used as a treatment modality for osteoarthritis. Multiple randomized controlled trials included in our systematic review and meta-analyses prove the effectiveness of platelet-rich plasma (PRP) as a minimally invasive method of pain alleviation in osteoarthritis treatment.
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Abbas A, Du JT, Dhotar HS. The Effect of Leukocyte Concentration on Platelet-Rich Plasma Injections for Knee Osteoarthritis: A Network Meta-Analysis. J Bone Joint Surg Am 2022; 104:559-570. [PMID: 34826301 DOI: 10.2106/jbjs.20.02258] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- Aazad Abbas
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jin Tong Du
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Herman S Dhotar
- Department of Orthopaedic Surgery, North York General Hospital, University of Toronto, North York, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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47
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Swärd E, Wilcke M. Effects of intra-articular Platelet-Rich Plasma (PRP) injections on osteoarthritis in the thumb basal joint and scaphoidtrapeziotrapezoidal joint. PLoS One 2022; 17:e0264203. [PMID: 35259167 PMCID: PMC8903265 DOI: 10.1371/journal.pone.0264203] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/05/2022] [Indexed: 11/19/2022] Open
Abstract
Intra-articular injection of platelet rich plasma (PRP) has been reported to decrease pain and improve function in knee osteoarthritis. There are few reports on the effect of PRP in the treatment of osteoarthritis in the hand. Our aim was to evaluate the effect of PRP-injections on pain and functional outcome in the short-term for osteoarthritis in the thumb basal joint and scaphoidtrapeziotrapezoidal (STT) joint. A retrospective analysis was performed of 29 patients treated with intra-articular PRP injection for painful osteoarthritis in the thumb basal joint (21 patients) or STT joint (eight patients). The patients received two consecutive, radiologically guided PRP injections at an interval of 3–4 weeks. Pain at rest and on load (numerical rating scale (NRS) 0–10), Patient-rated Wrist and Hand Evaluation (PRWHE) score (0–100), grip strength (Jamar) and key pinch were recorded pre-injection and 3 months after the second injection. Mean age was 63 (range 34–86) years and 17 patients were women. We used generalized estimating equations (GEE) to analyze the effect on the outcome variables. Possible predictors were included in the model (high pain level pre-injection, gender, age, manually demanding work, affected joint (thumb base or STT) and use of analgesic). The GEE analysis showed that PRP injections had no effect on reported pain, PRWHE score, grip strength or key pinch. 16/28 patients experience a positive effect according to a yes/no question. The short-term effect of PRP for osteoarthritis in the thumb base and STT-joint is doubtful and needs to be properly investigated in placebo-controlled studies.
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Affiliation(s)
- Elin Swärd
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department for Hand Surgery, Södersjukhuset, Stockholm, Sweden
| | - Maria Wilcke
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department for Hand Surgery, Södersjukhuset, Stockholm, Sweden
- * E-mail:
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48
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Sibillin O, Mitchell D, Harris G, Harvey J, Spencer P, Spencer L. The use of intra-articular platelet rich plasma for the symptomatic management of osteoarthritis of the knee: a pilot study. ANZ J Surg 2022; 92:1178-1183. [PMID: 35254716 DOI: 10.1111/ans.17565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/23/2021] [Accepted: 01/29/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Osteoarthritis of the knee is a chronic inflammatory condition resulting in significant patient disability, with intra-articular platelet rich plasma (PRP) injections having shown potential to improve symptomatic outcomes. This retrospective cohort pilot study aimed to observe whether PRP injections were beneficial in the symptomatic management of knee osteoarthritis in an Australian population, based on patient reported outcomes. An additional aim was to observe for an association between the number of injections and patient characteristics, such as body mass index, age, sex and radiologically determined severity of the disease. METHODS The cohort was drawn from those who attended Ballarat Orthopaedic and Sports Medicine for PRP injections and who had completed the appropriate pre- and post-injection Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. WOMAC scores were analysed to observe for any difference following a course of PRP injections. RESULTS The data suggest that the use of PRP improved patient reported WOMAC scores. Additionally, it was shown that two injections had a greater effect than one injection, with a third injection providing no further benefit. Finally, there was an association with lower WOMAC scores post PRP therapy amongst male participants compared to female participants. CONCLUSION These results suggest two PRP injections are optimal for the symptomatic management of knee osteoarthritis, identifying a need for further prospective research in this Australian population.
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Affiliation(s)
- Olivia Sibillin
- Department of Orthopaedics, Ballarat Orthopaedics and Sports Medicine Clinic, Lake Wendouree, Victoria, Australia
| | - David Mitchell
- Department of Orthopaedics, Ballarat Orthopaedics and Sports Medicine Clinic, Lake Wendouree, Victoria, Australia.,Department of Orthopaedics, NOVAR MUSCULOSKELETAL RESEARCH INSTITUTE, Ballarat, Victoria, Australia
| | - Greg Harris
- Department of Orthopaedics, Ballarat Orthopaedics and Sports Medicine Clinic, Lake Wendouree, Victoria, Australia
| | - Jack Harvey
- School of Science, Psychology and Sport, Federation University, Australia, Institute for Health and Sport, Victoria University, Ballarat, Victoria, Australia
| | - Polly Spencer
- Department of Anaesthetics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Luke Spencer
- Department of Orthopaedics, Ballarat Orthopaedics and Sports Medicine Clinic, Lake Wendouree, Victoria, Australia.,Department of Orthopaedics, NOVAR MUSCULOSKELETAL RESEARCH INSTITUTE, Ballarat, Victoria, Australia
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Elsayem K, Darwish AS, AbouZeid AA, Kamel N, Dahab MM, El-Naggar O. Autologous platelet gel improves outcomes in tubularized incised plate repair of hypospadias. J Pediatr Surg 2022; 57:488-491. [PMID: 33933265 DOI: 10.1016/j.jpedsurg.2021.03.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND hypospadias is one of the most widespread male congenital anomalies, occurring in 1:250 to 1:300 live births. Several repair techniques have been developing to improve the outcomes. PURPOSE a randomized prospective controlled study was adopted to evaluate effectiveness of autologous platelet gel in healing promotion and improving the outcomes of hypospadias repair. METHODS thirty children who aged between 6 months and 12 years were recruited and subdivided into two groups; group A had tubularized incised plate (TIP) repair with autologous platelet gel application and group B had TIP repair without autologous platelet gel. RESULTS there was no significant difference in duration of operation between both groups. All patients in groups A and B had slit-like meatus shape in the distal glans. While all those of group A had one urine stream, yet only 11 of group B had one. There were complications that happened exclusively in group B such as spray stream (27%) and fistula (20%). Whereas other complications occurred insignificantly more in group B than in A including meatal stenosis (53 versus 27%), glans dehiscence, (20 versus 7%), bleeding (33 versus 13%), infection (33 versus 27%), edema (27% versus13), respectively. The incidence of skin necrosis was equal in both groups. CONCLUSION autologous platelet gel usage in TIP hypospadias repair can be a reliable technique to promote wound healing, and to limit of postoperative surgical complications.
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Affiliation(s)
- Karam Elsayem
- Pediatric Surgery Unit, Surgery Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
| | - Ahmed S Darwish
- Pediatric Surgery Unit, Surgery Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
| | | | - Noha Kamel
- Clinical Pathology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
| | - Mohamed M Dahab
- Pediatric Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Osama El-Naggar
- Pediatric Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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50
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Intra-Articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Review of Their Current Molecular Mechanisms of Action and Their Degree of Efficacy. Int J Mol Sci 2022; 23:ijms23031301. [PMID: 35163225 PMCID: PMC8836227 DOI: 10.3390/ijms23031301] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 12/24/2022] Open
Abstract
Knee osteoarthritis (OA) is estimated to affect more than 10% of the population, with a lifetime risk of 45%. Contemporary guidelines advise control of body weight, therapeutic physical exercise, drug treatment (oral non-steroidal anti-inflammatory drugs, paracetamol, opioids), and mechanical aids (walking aids, braces, orthoses). Nevertheless, these treatments typically have only short-term benefits. Intra-articular corticosteroids are typically advised, but only for short-term pain alleviation, given that their benefits last only a few weeks. The efficacy of hyaluronic acid is controversial. When the aforesaid options fail, total knee arthroplasty is generally recommended as an efficacious treatment. However, it is costly and can involve medical and postoperative complications. Therefore, determining alternate safe and effective treatments for knee OA is paramount. Platelet-rich plasma (PRP) has lately been investigated for the treatment of knee OA. This article reviews recent knowledge concerning PRP’s molecular mechanisms of action. The effectiveness of intra-articular PRP injections in the knee joint remains controversial, although most recent publications show pain alleviation in the short term. Orthopedic surgeons treating people with knee OA are becoming increasingly interested in PRP, despite indecisive clinical data and basic science information. Further studies comparing PRP with placebo are required.
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