Efficacy of platelet-rich plasma in the treatment of degenerative knee pathology

Study Type: ACE Review
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
Synopsis
Six ACE Reports (5 randomized controlled trials and 1 systematic review/meta-analysis) were identified from the OrthoEvidence database which evaluated the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis. All included studies were randomized controlled trials, and reported clinical and functional assessment at various time points between 1 and 6 months following treatment. Pooled analysis of Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Sponsor: Conflicts:
Not Reported None disclosed
Funding: Sponsor: Conflicts:
Non-Industry funded Ministero della Salute, Italy None disclosed
Funding: Sponsor: Conflicts:
Non-Industry funded Prof D.S. Grewal Memorial Orthopaedics Society, Indian Arthroplasty Association None disclosed
Funding: Sponsor: Conflicts:
Industry funded BTI Biotechnology Institute None disclosed
Funding: Sponsor: Conflicts:
Industry funded BTI Biotechnology Institute Royalties
Funding: Sponsor: Conflicts:
Not Reported Royalties
Background
Significant pain and disability is a common symptom of patients suffering from degenerative knee conditions, such as knee osteoarthritis and gonarthrosis. Although there are numerous management options available for this disease, the most efficacious modality has yet to be determined. Currently, intra-articular injections of hyaluronic acid (HA) are the most popular method of treatment. However, substantial interest has arisen in the efficacy of platelet rich plasma and its related derivatives in the management of degenerative knee pathology. Many studies have examined this subject; however conclusive findings regarding the application of PRP injections remain elusive. Hence, this review aimed to determine the efficacy of PRP and its related products, plasma rich in growth factors (PRGF) and autologous conditioned plasma (ACP), on the treatment of knee osteoarthritis and gonarthrosis.
What was the principal research question?
Were intra-articular PRP injections (plasma rich in growth factors and autologous conditioned plasma) more effective in treating degenerative knee pathology than hyaluronic acid or saline injections?
Report Characteristics: Six reports from the OrthoEvidence database were identified that evaluated the use of platelet-rich plasma injection(s) in the management of symptomatic knee osteoarthritis. Five of the included reports were of randomized controlled trials, and 1 was a systematic review/meta-analysis. The included studies ranged in publication date from August 2012 to February 2013. A total of 480 patients were included in the four trials.
Report Selection: The following terms were used to search the OrthoEvidence database for relevant articles: "platelet-rich plasma", "plasma rich in growth factors", "platelet-rich fibrin matrix", and "conditioned plasma". The search identified 35 articles for possible inclusion. Screening the identified articles on the basis of the inclusion criteria resulted in the exclusion of 29 reports, and left 6 reports for inclusion. Inclusion criteria were: studies that (1) assessed the use of platelet-rich plasma (or related product) for treatment of osteoarthritis of the knee which (2) had a minimum follow-up period of 6 months and (3) reported one of the outcomes of pain or disability/physical function.
Outcomes: The outcomes assessed throughout the studies included were: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; total and pain, stiffness, and physical function subscales), OMERACT-OARSI responders, the International Knee Documentation Committee (IKDC) questionnaire, the Knee Injury and Osteoarthritis Outcome Score (KOOS) instrument, and a visual analog scale (VAS) for pain.
Heterogeneity: Heterogeneity was assessed using the I-squared statistic for poolable outcomes. Heterogeneity was assumed to be high, and pooling was performed with a random effects model.
Report Details and Scores
CONTENT IS LOCKED
Pooling and Statistical Analysis
Main Findings
Forest Plot: WOMAC Total Score
Forest Plot: OMERACT-OARSI Responders
What should I remember most?
Implications for patient treatment and future research:
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.
May 12, 2013
Useful and well done study.
July 17, 2013
Great review identifying the need for further quality research in this area.
Dr. Frank Smith
January 25, 2016
Orthopaedic Surgeon - Canada
This is useful information and worth further exploration