Platelet-Rich Plasma Therapy: An Effective Approach for Managing Knee Osteoarthritis

Platelet-rich plasma (PRP) is a promising non-invasive therapeutic intervention for knee osteoarthritis (KOA) that has generated significant interest due to anecdotal accounts of its efficacy, resulting in reduced recovery time in various orthopedic interventions. This systematic review examines the effectiveness of PRP in managing KOA. Specifically, it seeks to determine the extent to which PRP can treat KOA patients effectively, alleviate KOA symptoms, and improve patient outcomes. Additionally, the review aims to identify the optimal concentration and composition of PRP required to achieve therapeutic results in KOA. Furthermore, the review investigates whether PRP can modify the synovial environment structurally and immunologically to improve outcomes in KOA patients. We conducted a comprehensive literature search on PubMed, Orthogate, Clinicaltrials.gov, and Embase of clinical trials investigating PRP treatment in KOA patients in the last five years. The results indicated that PRP is effective in treating KOA patients. Evidence shows that PRP therapy can alleviate pain, enhance joint function, increase range of motion, and improve mobility in KOA patients. PRP was effective in treating KOA when the mean platelet concentration of PRP treatment was 4.83 to 5.91 times higher than the baseline whole blood platelet concentration. However, studies investigating PRP with a mean platelet concentration of 3.48 to 4.04 times higher than baseline failed to demonstrate statistically significant improvements. PRP therapy slowed down KOA progression, which validates its effectiveness in impeding further structural damage and arresting the degenerative impact of the disease. Nonetheless, further investigation is necessary to examine how PRP therapy can modify the progression of the disease. Furthermore, future research should identify the most effective platelet concentration levels that provide optimal symptom relief. There is a need for further research to identify the specific PRP configuration that is most pertinent in a clinical setting, as there is a lack of standardization in PRP manufacturing protocols, including the variety of experimental setups and dosing schedules utilized in different studies.

Effect of intra-articular hyalase, Ketorolac, marcaine and triamcinolone, versus Ketorolac, marcaine and triamcinolone for reducing knee joint pain other than joint replacement

Introduction

Knee pain is one of the causes of physiological complications in patients with osteoarthritis of the knee. It is necessary to provide a solution to reduce pain in these patients. Our study aimed to compare the effect of intra-articular hyalase, ketorolac, marcaine, and triamcinolone versus ketorolac, marcaine, and triamcinolone for reducing knee joint pain after knee surgery.

Methods

This clinical study was performed on 30 candidates for knee surgery other than knee replacement from 2019 to 2020. The patients were randomly divided into two groups: hyalase, ketorolac, marcaine, and triamcinolone (group 1) and ketorolac, marcaine, and triamcinolone (group 2). The patient's pain score was recorded by the Numeric Rating Scale (NRS) and range of motion (ROM) at the end of the first week, the end of the first month, and the end of the third month as well as the sixth month and the twelfth month after surgery.

Results

The mean age of the patients was 42.3 years. On average, the group receiving hyalase (first group) received about 30% better scores and had less pain (P < 0.05). In the first week, first month, and third month, no significant difference was observed between the two groups. But the pain scores for the first and second groups were 3.1 and 4.5 during the sixth to twelfth months, respectively (P < 0.05). Moreover, the increase in ROM during the sixth to twelfth months was significantly higher in the group receiving hyalase (P < 0.05).

Conclusion

Adding hyalase to ketorolac, marcaine, and triamcinolone could improve pain control in the short and long term and this could be capable of reducing the need for additional drugs.

Clinical efficacy of repeated intra-articular pulsed radiofrequency for the treatment of knee joint pain and its effects on inflammatory cytokines in synovial fluid of patients

The application value of repeated intra-articular pulsed radiofrequency for the treatment of knee joint pain has remained to be determined. To investigate this, a total of 64 patients with chronic knee joint pain admitted to Caoxian People's Hospital (Caoxian, Chine) between October 2016 and May 2018 were enrolled in the present study and analyzed prospectively. The patients were randomly divided into a control group, receiving treatment with a single intra-articular pulsed radiofrequency through the knee joint (n=32), and an experimental group, receiving multiple intra-articular pulsed radiofrequency treatments through the knee joint (n=32). The visual analog scale score (VAS), clinical efficacy and adverse reactions prior to and after treatment were compared between the two treatments. Synovial fluid cytokines were measured using ELISA prior to and after treatment. After the treatment, the control group and the experimental group both had a lower VAS (P<0.001) and the control group had a higher VAS and lower pain relief than the experimental group (P<0.001). The control group had a total effectiveness rate of 78.13%, with 13 patients experiencing complete relief (40.63%), 12 patients exhibiting a marked improvement (37.5%) and 7 patients reporting no effects (21.87%). The experimental group had a total effectiveness rate of 90.63%, with 18 patients (56.25%) being cured, 11 patients having a marked effect (34.37%) and 3 patients reporting no effects (9.38%). The experimental group had a higher incidence of adverse reactions than the control group (P<0.05). After treatment, the two groups had decreased IL-6, IL-10 and TNF-α levels in the knee joint synovial fluid (P<0.05), with the experimental group having lower cytokine levels than the control group (P<0.05). These results indicated that repeated intra-articular pulsed radiofrequency is an effective method for the treatment of knee joint pain and may be used in clinical practice.

The Effectiveness of Endovenous Thermal Ablation for the Knee Symptoms of the Osteoarthritis with Varicose Veins

Patients with varicose veins of the lower extremities with osteoarthritis of the knee often experience improvement in knee joint symptoms after endovascular treatment. We considered that it was important to decide the operation indication of lower extremity varices, to know the correlation between the two diseases in the treatment of varicose veins. To investigate the postoperative improvement of knee symptoms related to varicose veins with knee osteoarthritis, we conducted a questionnaire survey for a total of 12 months, from December 2014 to May 2015 and from October 2018 to March 2019. The participants were 35 patients (7 men and 28 women) with varicose veins complicated with knee osteoarthritis. We classified knee osteoarthritis according to a grading scale and compared the improvement of knee symptoms after endovenous thermal ablation. The higher the knee grade, the lower the degree of improvement. However, the improvement was observed in all knee osteoarthritis grades, and as a whole, 25 patients (71.4%) have experienced improvement of subjective symptoms. For patients with knee osteoarthritis, we strongly recommend surgical treatment of the varicose veins regardless of the progression of knee grade. (This is a translation of Jpn J Phlebol 2019; 30(3): 279–283.)

Acute Effects of Turmeric Extracts on Knee Joint Pain: A Pilot, Randomized Controlled Trial

Turmeric extracts (TEs) have been shown to be suitable as a pain treatment for human joint arthritis. In a pilot, randomized clinical trial, 68 individuals with mild/moderate knee joint pain (KJP) consumed a new formulation of water-soluble TEs and insoluble curcuminoids (B-Turmactive®) or brewer's yeast as a placebo for 1 week. Our hypothesis was that B-Turmactive would have a short-term analgesic effect on KJP measured by the self-reported Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). After 3 days and 1 week, both treatments reduced pain when walking on a flat surface (P < .01), going up or down stairs (P < .001), and sitting or lying (P < .05), but only B-Turmactive reduced pain at night while in bed and in an upright standing position (P < .01). Concerning global KJP, it was reduced by both treatments after 3 days and 1 week of the intervention (P < .001), being less with B-Turmactive after 1 week (P = .012 vs. 3 weeks). Although no intertreatment differences were observed, only B-Turmactive decreased high-sensitivity C-reactive protein levels (P = .045) at 1 week, which indicates a prompt analgesic effect mediated by a decrease in inflammatory status.

The minimal effective dose of cis-9-cetylmyristoleate (CMO) in persons presenting with knee joint pain: A double-blind, randomized, placebo-controlled trial

BACKGROUND

Nutraceuticals containing cis-9-cetylmyristoleate (CMO) are used to improve knee pain despite the lack of placebo-controlled studies in humans. The aim of the study was to explore the minimal effective dose of CMO for relieving knee joint pain.

METHODS

Twenty-eight subjects with mild degree arthritic knee joint pain were randomized into 4 groups; groups A, B, and C that contained 100%, 80%, and 62.4% of fatty acid component with 12.5% of CMO, and control group D (starch 100%). The pain intensity, functional disability, and the Patient Global Impression of Change (PGIC) were assessed for a 12-week ingestion period.

RESULTS

Compared to group D (n = 6), there were significant differences in pain score in group A (n = 7, P = 0.005) and group C (n = 7, P = 0.012), but not significant in group B (n = 6, P = 0.180). Western Ontario and McMaster Universities Arthritis (WOMAC) score decreased significantly in groups A and C. The PGIC was positive in the majority (>50%) in groups A, B, and C, whereas negative in 83.3% in group D (control).

CONCLUSION

CMO is effective in alleviating knee pain in persons with mild degree arthritis of the knee joint, at an effective dose of 62.4%.

Maslinic acid in olive fruit alleviates mild knee joint pain and improves quality of life by promoting weight loss in the elderly

Consumption of olives (Olea europaea L.) is associated with a low incidence of inflammation-related diseases. Olive fruit is rich in bioactive pentacyclic triterpenoids, mainly maslinic acid. This study, a randomized, double-blind, and placebo-controlled trial, examined the effects of an orally administered maslinic acid supplement, olive fruit extract, on 20 middle-aged and elderly volunteers with mild knee joint pain. Each subject (58 ± 7 years) received either olive fruit extract, containing 50 mg maslinic acid (n = 12), or placebo (n = 8) daily for 12 weeks and evaluated for pain and physical functions as primary outcome measures. Secondary outcome measures included body composition and inflammatory biomarkers in serum. Although both groups exhibited improved pain visual analogue scale score and quality of life after supplementation, symptoms were better in the maslinic acid group than in the placebo group. After 12 weeks, maslinic acid group exhibited significant decrease in body weight and body mass index suggesting that maslinic acid affected the weight of volunteers with mild knee joint pain. Therefore, olive products containing maslinic acid may be useful as a new preventive and therapeutic food ingredient for arthritic diseases. Since this clinical study is a preliminary study, it was not registered in a publicly accessible database.