Evidence for Knee Osteoarthritis

Knee Osteoarthritis:

A systematic review performed in 2017 by Xing et al looked at the published literature on the use of PRP in knee osteoarthritis (1). The methodology used in the paper, excluded all studies that demonstrated bias towards the use of PRP over alternative methods. Having employed this technique to reduce bias, they still concluded thet PRP was an effective intervention in treating knee OA, without the increased of adverse events.

Smith et al performed a level one feasibility study on behalf of the FDA in 2016 published in the American Journal of Sports Medicine (2). This paper looked at safety and the use of PRP as well as its clinical benefits. The PRP was judged to be safe with no reported adverse events. At the 1 year mark, the average improvement in pain and function scores improved by 78% in the group that was given PRP. In the placebo group, there was a 7% improvement in the scores.

A systematic review comparing the effects of PRP with Hyaluronic Acid (HA) and Saline was performed by Dai et al in 2016 (3). The group looked at all the level one studies published comparing these treatment modalities in the treatment of knee OA. The concluded that at one year, PRP was more effective than the HA and saline group in terms of managing pain symptoms and functional improvement in patients. Meheux et al used similar methodology and confirmed the significant improvement in outcomes (4).

These findings were further confirmed by a randomised clinical trial by Raeissadat (5). The patients were randomised to either receive HA or PRP. While both groups demonstrated a significant improvement in pain and functional scores, the PRP group demonstrated superior outcomes.

Gormeli et al investigated the frequency of PRP injections required to get a significantly better outcome (6). They found that PRP and HA are effective in improving patient symptoms at all stages of osteoarthritis. They also concluded that PRP had superior results to HA and 3 serial injections for early OA was more effective than a single injection in early osteoarthritis. In advanced osteoarthritis, the treatment effect was reached after a single injection.

Corticosteroids are commonly used in the management of knee OA. Forogh et al performed a double blind randomized study comparing corticosteroids with PRP (7). They concluded that PRP was better at reducing joint pain in the longer term compared to corticosteroid. They also found enhanced activity of daily living and improvement in the quality of life scores.

Radiological studies looking at the effects of PRP on articlaur cartilage have been performed. Halpern et al performed injected PRP in patient with mild to moderate osteoarthritis and performed functional and pain outcome scores at one year as well as a repeat MRI scan (8). They concluded that patients improved in pain and functional scores and did not demonstrate advancement of the osteoarthritis in the knee in 73% of cases.

  1. Xing D, Wang B, Zhang W, Yang Z, Hou Y, Chen Y, et al. Intra-articular platelet-rich plasma injections for knee osteoarthritis: An overview of systematic reviews and risk of bias considerations. Int J Rheum Dis. Wiley/Blackwell (10.1111); 2017 Nov;20(11):1612–30.
  2. Smith PA. Intra-articular Autologous Conditioned Plasma Injections Provide Safe and Efficacious Treatment for Knee Osteoarthritis: An FDA-Sanctioned, Randomized, Double-blind, Placebo-controlled Clinical Trial. Am J Sports Med. 2016 Apr;44(4):884–91.
  3. Dai W-L, Zhou A-G, Zhang H, Zhang J. Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Meta-analysis of Randomized Controlled Trials. Arthroscopy. 2017 Mar;33(3):659–670.e1.
  4. Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD. Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review. Arthroscopy. 2016 Mar;32(3):495–505.
  5. Raeissadat SA, Rayegani SM, Hassanabadi H, Fathi M, Ghorbani E, Babaee M, et al. Knee Osteoarthritis Injection Choices: Platelet- Rich Plasma (PRP) versus Hyaluronic Acid (A one-year randomized clinical trial). Clin Med�Insights�Arthritis�Musculoskelet Disord. SAGE PublicationsSage UK: London, England; 2015 Jan 7;8:CMAMD.S17894.
  6. Görmeli G, Görmeli CA, Ataoglu B, Çolak C, Aslantürk O, Ertem K. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc. Springer Berlin Heidelberg; 2017 Mar;25(3):958–65.
  7. Forogh B, Mianehsaz E, Shoaee S, Ahadi T, Raissi GR, Sajadi S. Effect of single injection of platelet-rich plasma in comparison with corticosteroid on knee osteoarthritis: a double-blind randomized clinical trial. J Sports Med Phys Fitness. 2016 Jul;56(7-8):901–8.
  8. Halpern B, Chaudhury S, Rodeo SA, Hayter C, Bogner E, Potter HG, et al. Clinical and MRI outcomes after platelet-rich plasma treatment for knee osteoarthritis. Clin J Sport Med. Clinical Journal of Sport Medicine; 2013 May;23(3):238–9.