BACKGROUND:
Platelet
Rich Plasma (PRP), a blood-derived product rich in growth factors, is a
promising treatment for cartilage defects but there is still a lack of clinical
evidence. The aim of this study is to show, through a randomized double blind
prospective trial, the efficacy of this procedure, by comparing PRP to
Hyaluronic Acid (HA) injections for the treatment of knee chondropathy or
osteoarthritis (OA).
METHODS:
109
patients (55 treated with HA and 54 with PRP) were treated and evaluated at 12
months of follow-up. The patients were enrolled according to the following
inclusion criteria: age> 18 years, history of chronic (at least 4 months)
pain or swelling of the knee and imaging findings of degenerative changes of
the joint (Kellgren-Lawrence Score up to 3). A cycle of 3 weekly injections was
administered blindly. All patients were prospectively evaluated before and at
2, 6, and 12 months after the treatment by: IKDC, EQ-VAS, TEGNER, and KOOS
scores. Range of motion and knee circumference changes were measured over time.
Adverse events and patient satisfaction were also recorded.
RESULTS:
Only minor
adverse events were detected in some patients, such as mild pain and effusion
after the injections, in particular in the PRP group, where a significantly
higher post-injective pain reaction was observed (p=0.039). At the follow-up
evaluations, both groups presented a clinical improvement but the comparison
between the two groups showed a not statistically significant difference in all
scores evaluated. A trend favorable for the PRP group was only found in
patients with low grade articular degeneration (Kellgren-Lawrence score up to
2).
CONCLUSIONS:
Results
suggest that PRP injections offer a significant clinical improvement up to one
year of follow-up. However, conversely to what was shown by the current
literature, for middle-aged patients with moderate signs of OA, PRP results
were not better than those obtained with HA injections, and thus it should not
be considered as first line treatment. More promising results are shown for its
use in low grade degeneration, but they still have to be confirmed.
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