SICOT e-Newsletter

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 the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Total scores suggested a possible beneficial effect with PRP injection in comparison to saline and a lower effect versus hyaluronic acid. Beneficial effects were also noted for individual subscales of the WOMAC assessment (pain, stiffness, and physical function). However, pooling of OMERACT-OARSI responders and a review of the literature indicated that there was no significant difference between PRP and comparison groups in other functional outcome measures, such as the International Knee Documentation Committee (IKDC) assessment and Knee Injury and Osteoarthritis Outcome Score (KOOS). Furthermore, contrasting results were obtained between two studies reporting function on the Lequesne Index. The discrepancy in the efficacy of PRP in treatment for osteoarthritis of the knee indicates the need for future high-quality randomized trials, with uniform reporting, in order to provide further evidence in this emerging treatment method.

What was the principle research question of the Review?

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.

What should I remember most?

The results of this review suggest that intra-articular platelet-rich plasma injections are beneficial in reducing pain caused by degenerative knee diseases, in comparison to hyaluronic acid and placebo injections. Additionally, total WOMAC scores supported the application of platelet-rich plasma injections when analyzed against both hyaluronic acid and placebo injection groups, and benefits were seen in individual WOMAC subscales. No significant differences between the groups existed for IKDC and KOOS outcomes, and outcome on the Lequesne Index was conflicting. Overall, as pooling of the majority of outcomes was not possible for the four included studies, the efficacy in the utilization of platelet-rich plasma and other related products in the treatment of knee osteoarthritis and gonarthrosis remain inconclusive.

Implications for patient treatment and future research:

Pain reduction in osteoarthritis and gonarthrosis patients may be achieved with the use of platelet-rich plasma injections. However, due to the inability to pool the spectrum of functional outcomes, advocacy of widespread application of platelet-rich plasma as a treatment method should be withheld until future studies have provided more insight on the efficacy of this treatment with uniform methodology.