AAOS2017: Intraarticular PRP vs HA injections for degenerative knee pathology

Study Type: Randomized Trial
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
This ACE Report is a summary of a conference presentation or abstract. The information provided has limited the ability to provide an accurate assessment of the risk of bias or the overall quality. Please interpret the results with caution as trials may be in progress and select results may have been presented.
192 patients with symptomatic, unilateral degenerative knee pathology were randomized to intraarticular injections of either leukocyte-rich platelet-rich plasma or high-molecular-weight hyaluronic acid. Injections were administered once weekly for 3 weeks. Outcomes reported included Please login to view the rest of this report. Please login to view the rest of this report.
Why was this study needed now?
Despite the prevalence of symptomatic degenerative knee pathology, a gold standard conservative treatment option which demonstrates consistent, long-term efficacy has yet to be identified. More recently, injection therapies, including biologic products of platelet-rich plasma and viscosupplementation techniques with hyaluronic acid, have been at the forefront of clinical research. Nevertheless, there is still no consensus on the comparative efficacy of these injection therapies.
What was the principal research question?
In the treatment of degenerative knee pathology, how do clinical outcome scores and treatment failure rates compare between intraarticular injections of leukocyte-rich platelet-rich plasma and intraarticular injections of high molecular weight hyaluronic acid when assessed over a 24-month follow-up?
Population: 192 patients with symptomatic unilateral degenerative knee pathology confirmed on imaging (Kellgren-Lawrence 0-III or chondropathy on MRI)
Intervention: PRP group: Patients were administered an intraarticular injection of leukocyte-rich platelet-rich plasma once per week for 3 weeks.
Comparison: HA group: Patients were administered an intraarticular injection of high-molecular-weight hyaluronic acid once per week for 3 weeks.
Outcomes: The primary outcome was the International Knee Documentation Committee (IKDC) subjective score. Other clinical scores included the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Euro-QoL 5-dimension Visual Analog Scale (EQ-VAS), and the Tegner Score. Clinical examination was used to measure knee range of motion (ROM), transpatellar circumference, patient satisfaction, and the incidence of adverse events. Treatment failure was defined as the requirement of re-intervention at the index knee.
Methods: RCT
Time: Follow-up was scheduled for 2, 6, 12 and 24 months.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.
Richard Boden
April 5, 2017
Physiotherapist - Canada
What was the control?
Dr. Ortho Evidence
April 5, 2017
Other - Canada
Thank you for your comment. This trial compared outcomes between Leukocyte-rich platelet-rich plasma injections and high molecular weight hyaluronic acid injections. A placebo control group, using saline injections, was not used in this study.
Michael B. MacMillan
April 9, 2017
Sports Medicine Specialist - Canada
question? how does the level of the osteoarthritis impact on the results
Dr. Ortho Evidence
April 10, 2017
Other - Canada
Dear Dr. MacMillan, Thank you for your comment. As stated in this study characteristics section of this ACE Report, the trial included patients with Kellgren-Lawrence (KL) grade 0-III. Unfortunately, the conference abstract did not report the distribution of patients between KL grades or provide a subgroup analysis by grade. Additional trials are needed to determine if the effects of these treatments differ based on the severity of osteoarthritis.
Joseph Sklar
April 12, 2017
Orthopaedic Surgeon - United States
First, Why would K-L grade zero and one ( and even two ) be included at all? Second, I wonder who was paying for the PRP. If it was self-pay, then I would suspect that patients would wait longer to seek re-treatment than if it was a covered expense.