Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Chondral Injuries In Young Patients^[*]

Abstract

Objective The present study aimed to compare the clinical and functional outcomes of hyaluronic acid (HA) or platelet-rich plasma (PRP) applications to treat young patients with knee chondral lesions with no arthrosis.

Methods Prospective clinical and functional evaluation of 30 young adult patients with knee chondral lesions submitted to conservative treatment with HA or PRP for a minimum follow-up time of 12 months. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) and visual analog scale (VAS) were used for the evaluation.

Results According to the WOMAC score, the PRP group showed significant improvement in all evaluated points, whereas the HA group presented no score improvement. In the VAS, the PRP group showed improvement in all evaluated points, and the HA group presented improvement at 6 and 12 months. Compared to the HA group, the PRP group presented better WOMAC scores at all evaluated points and better VAS scores up to 6 months after treatment.

Conclusion Platelet-rich plasma application resulted in better clinical and functional outcomes at both the WOMAC and VAS scores when applied to knees from young patients with chondral lesions, but no arthrosis. These outcomes were sustained for up to 12 months.

Level of evidence Randomized clinical trial (Type 2B)

Keywords

hyaluronic acid - cartilage, articular - knee - platelet-rich plasma - viscosupplementation

^* Study developed at the Knee Surgery Group, Uniorte Hospital de Ortopedia, Londrina, PR, Brazil.

Publikationsverlauf

Eingereicht: 13. April 2020

Angenommen: 17. September 2020

Artikel online veröffentlicht:
19. April 2021

• Referências

• 1 Lories RJ, Luyten FP. The bone-cartilage unit in osteoarthritis. Nat Rev Rheumatol 2011; 7 (01) 43-49
• 2 Widuchowski W, Widuchowski J, Trzaska T. Articular cartilage defects: study of 25,124 knee arthroscopies. Knee 2007; 14 (03) 177-182
• 3 Prakash D, Learmonth D. Natural progression of osteo-chondral defect in the femoral condyle. Knee 2002; 9 (01) 7-10
• 4 Sánchez M, Anitua E, Orive G, Mujika I, Andia I. Platelet-rich therapies in the treatment of orthopaedic sport injuries. Sports Med 2009; 39 (05) 345-354
• 5 van Buul GM, Koevoet WLM, Kops N. et al. Platelet-rich plasma releasate inhibits inflammatory processes in osteoarthritic chondrocytes. Am J Sports Med 2011; 39 (11) 2362-2370
• 6 Sundman EA, Cole BJ, Karas V. et al. The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med 2014; 42 (01) 35-41
• 7 Sánchez M, Anitua E, Azofra J, Aguirre JJ, Andia I. Intra-articular injection of an autologous preparation rich in growth factors for the treatment of knee OA: a retrospective cohort study. Clin Exp Rheumatol 2008; 26 (05) 910-913
• 8 Lubkowska A, Dolegowska B, Banfi G. Growth factor content in PRP and their applicability in medicine. J Biol Regul Homeost Agents 2012; 26 (02 Suppl 1): 3S-22S
• 9 Pavlovic V, Ciric M, Jovanovic V, Stojanovic P. Platelet Rich Plasma: a short overview of certain bioactive components. Open Med (Wars) 2016; 11 (01) 242-247
• 10 Parrish WR, Roides B. Platelet rich plasma in osteoarthritis: more than a growth factor therapy. Musculoskelet Regen 2017; 3: e1518
• 11 Kawasaki K, Ochi M, Uchio Y, Adachi N, Matsusaki M. Hyaluronic acid enhances proliferation and chondroitin sulfate synthesis in cultured chondrocytes embedded in collagen gels. J Cell Physiol 1999; 179 (02) 142-148
• 12 Wang CT, Lin YT, Chiang BL, Lin YH, Hou SM. High molecular weight hyaluronic acid down-regulates the gene expression of osteoarthritis-associated cytokines and enzymes in fibroblast-like synoviocytes from patients with early osteoarthritis. Osteoarthritis Cartilage 2006; 14 (12) 1237-1247
• 13 Ghosh P. Osteoarthritis and hyaluronan--palliative or disease-modifying treatment?. Semin Arthritis Rheum 1993; 22 (06 Suppl 1): 1-3
• 14 Laurent TC, Laurent UBG, Fraser JRE. The structure and function of hyaluronan: An overview. Immunol Cell Biol 1996; 74 (02) A1-A7
• 15 Kavadar G, Demircioglu DT, Celik MY, Emre TY. Effectiveness of platelet-rich plasma in the treatment of moderate knee osteoarthritis: a randomized prospective study. J Phys Ther Sci 2015; 27 (12) 3863-3867
• 16 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; 32 (03) 495-505
• 17 Kanchanatawan W, Arirachakaran A, Chaijenkij K. et al. Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 2016; 24 (05) 1665-1677
• 18 Dai WL, Zhou AG, Zhang H, Zhang J. Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Meta-analysis of Randomized Controlled Trials. Arthroscopy 2017; 33 (03) 659-670.e1
• 19 Milano G, Sánchez M, Jo CH, Saccomanno MF, Thampatty B, Wang JH. Platelet-rich plasma in orthopaedic sports medicine: state of the art. J ISAKOS 2019; 4: 188-195
• 20 Louis ML, Magalon J, Jouve E. et al. Growth Factors Levels Determine Efficacy of Platelets Rich Plasma Injection in Knee Osteoarthritis: A Randomized Double Blind Noninferiority Trial Compared With Viscosupplementation. Arthroscopy 2018; 34 (05) 1530-1540.e2
• 21 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 2017; 25 (03) 958-965
• 22 Mascarenhas R, Saltzman BM, Fortier LA, Cole BJ. Role of platelet-rich plasma in articular cartilage injury and disease. J Knee Surg 2015; 28 (01) 3-10
• 23 Levy DM, Petersen KA, Scalley Vaught M, Christian DR, Cole BJ. Injections for Knee Osteoarthritis: Corticosteroids, Viscosupplementation, Platelet-Rich Plasma, and Autologous Stem Cells. Arthroscopy 2018; 34 (05) 1730-1743
• 24 Chen P, Huang L, Ma Y. et al. Intra-articular platelet-rich plasma injection for knee osteoarthritis: a summary of meta-analyses. J Orthop Surg Res 2019; 14 (01) 385
• 25 Oh JH, Kim W, Park KU, Roh YH. Comparison of the Cellular Composition and Cytokine-Release Kinetics of Various Platelet-Rich Plasma Preparations. Am J Sports Med 2015; 43 (12) 3062-3070
• 26 Ha CW, Park YB, Jang JW, Kim M, Kim JA, Park YG. Variability of the Composition of Growth Factors and Cytokines in Platelet-Rich Plasma From the Knee With Osteoarthritis. Arthroscopy 2019; 35 (10) 2878-2884.e1
• 27 Riboh JC, Saltzman BM, Yanke AB, Fortier L, Cole BJ. Effect of Leukocyte Concentration on the Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis. Am J Sports Med 2016; 44 (03) 792-800
• 28 Han Y, Huang H, Pan J. et al. Meta-analysis Comparing Platelet-Rich Plasma vs Hyaluronic Acid Injection in Patients with Knee Osteoarthritis. Pain Med 2019; 20 (07) 1418-1429
• 29 Di Y, Han C, Zhao L, Ren Y. Is local platelet-rich plasma injection clinically superior to hyaluronic acid for treatment of knee osteoarthritis? A systematic review of randomized controlled trials. Arthritis Res Ther 2018; 20 (01) 128
• 30 Tavassoli M, Janmohammadi N, Hosseini A, Khafri S, Esmaeilnejad-Ganji SM. Single- and double-dose of platelet-rich plasma versus hyaluronic acid for treatment of knee osteoarthritis: A randomized controlled trial. World J Orthop 2019; 10 (09) 310-326