Journal of Orthopedics and Joint Surgery

Register      Login

VOLUME 6 , ISSUE 1 ( January-June, 2024 ) > List of Articles


Is Intra-articular Platelet-rich Plasma Injection Safe and Effective in Osteoarthritis Knee? A Prospective Study: A Case Series

R Sahaya Jose, N Kattu Bava, M Syed Moosa

Keywords : Case report, Kellgren–Lawrence grading, Knee osteoarthritis, Platelet-rich plasma, Visual analog score, Western Ontario and McMaster Universities Arthritis Index score

Citation Information : Jose RS, Bava NK, Moosa MS. Is Intra-articular Platelet-rich Plasma Injection Safe and Effective in Osteoarthritis Knee? A Prospective Study: A Case Series. 2024; 6 (1):49-54.

DOI: 10.5005/jojs-10079-1131

License: CC BY-NC 4.0

Published Online: 12-01-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Background: Osteoarthritis (OA) of the knee is the most common slowly progressive chronic degenerative joint disease, characterized by varying degrees of loss of joint cartilage with local inflammation, usually affecting the elderly population. If oral drugs are ineffective, intra-articular injections (corticosteroids, viscous supplements, and blood-derived products) can be offered as another nonoperative modality. The release of platelet-derived factors directly at the site of cartilage disease, particularly with interest to knee OA, may stimulate the natural regenerative signaling cascade and enhance tissue healing with further mediation of the anti-inflammatory response. Suppression of mediators, such as interleukin-1 interaction with nociceptors, brings inflammatory and analgesic effects. Subjects and methods: This prospective study was conducted in our institution's outpatient orthopedics department from March 2022 to May 2023. In total, 30 patients of either sex, between 40 and 70 years of age, suffering from primary knee OA with Kellgren–Lawrence (KL) grades I, II, or III on standing anteroposterior and lateral knee radiographs, with symptoms for >3 months according to the American College of Rheumatology (ACR) clinical classification criteria and pain score of >4 cm on 10 cm visual analog scale (VAS) was included. We excluded patients below 40 and above 70 years of age with septic arthritis, grade IV OA according to KL grading, and systemic infections. Injected platelet-rich plasma (PRP) injection in the knee using an anterolateral approach. The patients were followed up for 6 weeks, 3 months, and 6 months using VAS, Western Ontario, and the McMaster University Osteoarthritis Index (WOMAC) scoring system. The data collected were subjected to data entry in Microsoft (MS) Excel. The data were analyzed using the Chi-squared test using the Statistical Package for the Social Sciences (SPSS) (SPSS Inc. IBM Chicago city, Illinois state, United States of America) version 20.0. Results: We have excellent improvement in VAS score from the mean value of 7.5 ± 2 initially at preinjection to 4.5 ± 1.5 after 6 months follow-up and WOMAC score from 74.5 ± 8.5 initially at preinjection to 55.5 ± 10.5 after 6 months follow-up. Conclusion: Based on our results, this minimally invasive PRP injection to the knee joint is a safe and effective treatment in mild to moderate OA. Since PRP injection is biologically considered to induce the growth of degenerated articular cartilage, it will be more effective in relatively young patients and lower degrees of cartilage degeneration. Since no complications were seen in this study, it is safe and effective to use PRP injection intra-articularly in grades I, II, and III OA of the knee joint. Clinical significance: Identifying the patients early with grades I, II, and grade III OA knee and treating them with intra-articular PRP injection shall delay the progression and the need for future total knee replacement surgery.

  1. Zhang Y, Morgan BJ, Smith R, et al. Platelet-rich plasma induces post-natal maturation of immature articular cartilage and correlates with LOXL1 activation. Sci Rep 2017,7(1):3699. DOI: 10.1038/s41598-017-02297-9
  2. Helmick CG, Felson DT, Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum 2008;58(1):26–35. DOI: 10.1002/art.23177
  3. Mascarenhas R, Saltzman BM, Fortier LA, et al. Role of platelet-rich plasma in articular cartilage injury and disease. J Knee Surg 2015;28(1):3–10. DOI: 10.1055/s-0034-1384672
  4. Sánchez-González DJ, Méndez-Bolaina E, Trejo-Bahena NI. Platelet-rich plasma peptides: key for regeneration. Int J Pept 2012;2012:532519. DOI: 10.1155/2012/532519
  5. Xu Z, Yin W, Zhang Y, et al. Comparative evaluation of leukocyte- and platelet-rich plasma and pure platelet-rich plasma for cartilage regeneration. Sci Rep 2017;7(1):43301. DOI: 10.1038/srep43301
  6. Fahy N, Farrell E, Ritter T, et al. Immune modulation to improve tissue engineering outcomes for cartilage repair in the osteoarthritic joint. Tissue Eng Part B Rev 2015;21(1):55–66. DOI: 10.1089/ten.TEB.2014.0098
  7. Gaissmaier C, Fritz J, Krackhardt T, et al. Effect of human platelet supernatant on proliferation and matrix synthesis of human articular chondrocytes in monolayer and three-dimensional alginate cultures. Biomaterials 2005;26(14):1953–1960. DOI: 10.1016/j.biomaterials.2004.06.031
  8. Loeser RF, Goldring SR, Scanzello CR, et al. Osteoarthritis: a disease of the joint as an organ. Arthritis Rheum 2012;64(6):1697–1707. DOI: 10.1002/art.34453
  9. Kon E, Buda R, Filardo G, et al. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc 2010;18(4):472–479. DOI: 10.1007/s00167-009-0940-8
  10. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med 2001;8(12):1153–1157. DOI: 10.1111/j.1553-2712.2001.tb01132.x
  11. Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988;15(12):1833–1840. PMID: 3068365.
  12. Bansal H, Leon J, Pont JL, et al. Platelet-rich plasma (PRP) in osteoarthritis (OA) knee: correct dose critical for long term clinical efficacy. Sci Rep 2021;11(1):1–0. DOI: 10.1038/s41598-021-83025-2
  13. Hassan AS, El-Shafey AM, Ahmed HS, et al. Effectiveness of the intra-articular injection of platelet rich plasma in the treatment of patients with primary knee osteoarthritis. Egypt Rheumatol 2015;37(3):119–124. DOI: 10.1016/j.ejr.2014.11.004
  14. Lacko M, Harvanová D, Slovinská L, et al. Effect of intra-articular injection of platelet-rich plasma on the serum levels of osteoarthritic biomarkers in patients with unilateral knee osteoarthritis. J Clin Med 2021;10(24):5801. DOI: 10.3390/jcm10245801
  15. Rai D, Singh J, Somashekharappa T, et al. Platelet-rich plasma as an effective biological therapy in early-stage knee osteoarthritis: one year follow up. SICOT J 2021;7:6. DOI: 10.1051/sicotj/2021003
  16. Kavadar G, Demircioglu DT, Celik MY, et al. 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. DOI: 10.1589/jpts.27.3863
  17. Kumar M, Kumar S, Chandra T, et al. Clinical outcome of intra-articular injection of platelet-rich plasma in early-stage knee osteoarthritis in North Indian patients. J Postgrad Med Educ Res 2018;52(2):56–61. DOI: 10.5005/jp-journals-10028-1276
  18. Ghai B, Gupta V, Jain A, et al. Effectiveness of platelet rich plasma in pain management of osteoarthritis knee: double blind, randomized comparative study. Braz J Anesthesiol 2019;69(5):439-447. DOI: 10.1016/j.bjan.2019.06.003
  19. Joshi Jubert N, Rodríguez L, Reverté-Vinaixa MM, et al. Platelet-rich plasma injections for advanced knee osteoarthritis: a prospective, randomized, double-blinded clinical trial. Orthop J Sports Med 2017;5(2):2325967116689386. DOI: 10.1177/2325967116689386
  20. Arjun MN, Vasdev V, Kishore K, et al. Comparison of intra articular autologous platelet-rich plasma with steroids in osteoarthritis knee: experience from a North Indian tertiary care center. Indian J Rheumatol 2020;15(3):165–170. DOI: 10.4103/injr.injr_159_19
  21. Rahimzadeh P, Imani F, Faiz SH, et al. The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis. Clin Interv Aging 2018;13:73–79. DOI: 10.2147/CIA.S147757
  22. Kumar A, Kumar N, Kumar A. A comparative study between role of platelet rich plasma (PRP) and corticosteroid injection in the treatment of osteoarthritis knee. International J Orthop 2021;7(1):263–267. DOI: 10.22271/ortho.2021.v7.i1e.2494
  23. Vilchez-Cavazos F, Millán-Alanís JM, Blazquez-Saldana J, et al. Comparison of the clinical effectiveness of single versus multiple injections of platelet-rich plasma in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Orthop J Sports Med 2019;7(12):2325967119887116.
  24. Anzillotti G, Conte P, Di Matteo B, et al. Injection of biologic agents for treating severe knee osteoarthritis: is there a chance for a good outcome? A systematic review of clinical evidence. Eur Rev Med Pharmacol Sci 2022;26(15):5447–5459. DOI: 10.26355/eurrev_202208_29413
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.