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Knee – Osteoarthritis
Knee biologic/regenerative medicine injections can be performed to treat knee osteoarthritis. Knee osteoarthritis and regenerative injections is the most researched subject. However, more research is continually being conducted to study the benefit of these treatments. Knee injections are performed under ultrasound guidance to ensure proper injection of the biologic material into your joint.
Improved clinical outcomes from PRP injections for knee OA may be related to a higher platelet dose.
https://www.sciencedirect.com/science/article/pii/S0749806324002068
The administration of three or five injections of platelet-rich plasma is safe, substantially more effective than single injections, and leads to remarkable clinical improvement by significantly reducing knee pain, improving joint stiffness, and enhancing physical function in patients with grade I-III knee osteoarthritis. Furthermore, no significant difference was observed in the efficacy of three or five injections. Therefore, we recommend using three injections of PRP in the treatment of patients with knee osteoarthritis of grade I-III.
https://josr-online.biomedcentral.com/articles/10.1186/s13018-024-04736-6
The use of PRP for the treatment of knee osteoarthritis has shown statistically significant improvements in some patient-reported outcomes compared with placebo.
https://journals.lww.com/jaaos/abstract/2024/04010/american_academy_of_orthopaedic_surgeons.2.aspx
Both PRP (~15 billion platelets) and MFAT injections for knee OA resulted in improved patient-reported outcomes at 12 months posttreatment, with no differences found between treatments.
https://journals.sagepub.com/doi/full/10.1177/23259671241233916
PRP + HA therapy resulted in more pronounced pain and functional improvement in symptomatic KOA patients than HA treatments, and combination therapy may have higher clinical safety than PRP or HA monotherapy.
https://pubmed.ncbi.nlm.nih.gov/38972025/
This ESSKA-ICRS consensus established recommendations on the appropriateness or inappropriateness of PRP injections for the treatment of knee OA, providing a useful reference for clinical practice. PRP injections are considered appropriate in patients aged ≤80 years with knee KL 0-III OA grade after failed conservative non-injective or injective treatments, while they are not considered appropriate as first treatment nor in KL IV OA grade.
https://pubmed.ncbi.nlm.nih.gov/38961773/
MSCs transplantation effectively treats KOA patients, with autologous BM-MSC potentially offering more excellent benefits.
https://josr-online.biomedcentral.com/articles/10.1186/s13018-024-04846-1
Intra-articular injection of MSCs for chronic knee pain associated with OA probably provides little to no improvement in pain or physical function.
https://pubmed.ncbi.nlm.nih.gov/38777213/
54.9% of the reviewed articles provided information about post-injection NSAID restriction, with the most common time frame being longer than 4 weeks. 33.8% provided information about weight bearing restrictions. Two studies reported detailed rehabilitation protocols.
https://www.cartilagejournal.org/article/S2667-2545(24)00037-4/fulltext
The ultrasound guided I + PG of 5% glucose seem to be more effective to alleviate pain and improve knee joint function than single therapy in short term. Clinical rehabilitators could clinically try this combination of I + PG to improve clinical symptoms in patients with KOA.
https://josr-online.biomedcentral.com/articles/10.1186/s13018-024-04762-4
Compared to IA-PRP injection, IO+IA-PRP injection provided significant pain relief in VAS- and KOOS- pain scores at 12 weeks. However, during knee activities, a single episode of IO+IA-PRP injection did not provide additional benefits in other KOOS parameter scores. Compared to IA-PRP injection, IO+IA-PRP injection was more painful.
https://www.archives-pmr.org/article/S0003-9993(24)00717-2/abstract?rss=yes
The consensus group reached a high level of agreement on all the questions/statements despite the lack of clear evidence for some questions. According to the results from this consensus group, given the large body of existing literature and expert opinions, PRP was regarded as a valid treatment option for knee OA and as a possible first-line injectable treatment option for nonoperative management of knee OA, mainly for KL grades 1-3.
https://pubmed.ncbi.nlm.nih.gov/38436492/
Conclusions drawn from individual RCTs evaluating PRP for knee OA demonstrated slight robustness. On meta-analysis, PRP demonstrated a significant advantage over hyaluronic acid as well as improved symptom relief, lower rates of reintervention, and more frequent achievement of the MCID for pain improvement when compared with alternative nonoperative treatment options. Statistically significant pooled treatment effects evaluating PRP for knee OA are more robust than approximately half of all comparable meta-analyses in medicine and health care. Future RCTs and meta-analyses should consider reporting FIs and fragility quotients to facilitate interpretation of results in their proper context.
https://journals.sagepub.com/doi/abs/10.1177/03635465231224463
PRP is more effective than CSI, ESWT, and placebo in reducing VAS and more effective than CSI and placebo in improving AOFAS. PRP did not demonstrate a consistent advantage across all outcome measures, such as PFT and FFI. These findings underscore the complexity of PF treatment and call for a more standardized approach to PRP preparation and outcome measurement.
https://pubmed.ncbi.nlm.nih.gov/38395675/
Patients with early knee OA had significantly better improvement in pain and function when treated with an 8-mL injection of PRP compared with a 4-mL injection of PRP. The larger dose of PRP had approximately twice the number of platelets.
https://journals.sagepub.com/doi/full/10.1177/23259671241227863
PRP is an effective treatment for KOA. It provides symptomatic relief, has the potential to reduce disease progression, and has sustained effects up to 12 months. PRP offers superior pain relief and functional enhancement compared to CS and HA injections.
The meta-analysis comparing Adipose Tissue-Derived Minimally Manipulated Products (MM-AT) products with PRP injections did not demonstrate the overall superiority of one product over the other.
https://www.mdpi.com/2077-0383/13/1/67
In summary, this study shows that at 1 year post injection, there was no superior MSC orthobiologic as compared to CSI for knee osteoarthritis.
https://www.nature.com/articles/s41591-023-02632-w
According to the sub-group analysis, patients with less osteoarthritis damage (i.e., Kellgren–Lawrence grades 1–2) and older study subjects (i.e., >40 years old) with focal chondropathy had benefited most from their PRP injection. Thus, platelet-rich plasma seems to be a well-tolerated and efficient therapy for cartilage lesions of the knee.
https://www.mdpi.com/2306-5354/10/11/1276
The current study found that PRP and PRP + HA were the most successful in improving function and alleviating pain after 3, 6, and 12 months of follow-up. CSC, HA, PRP, and combination therapy did not result in an increase in the incidence of treatment-related side events as compared to placebo.
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-023-06925-6
Arthroscopic debridement associated with PRP is more successful in relieving knee pain and enhancing knee joint function than arthroscopic debridement in treating KOA. The treatment scheme deserves to be popularized in clinical practice, but further research and longer interventions will be needed to validate it, using high-quality methods.
https://pubmed.ncbi.nlm.nih.gov/37715357/
Although no significant difference was observed among the dextrose prolotherapy groups, higher dextrose concentrations demonstrated a greater improvement compared to the control group. Therefore, the use of 20% dextrose is recommended due to its significant superiority. Long-term follow-up and placebo-controlled studies are needed.
https://link.springer.com/article/10.1007/s10067-023-06723-4
The improvement in KOOS after treatment with ACP did not reach the MCID in most study patients. Older age was a predictor for better outcomes. The composition of ACP varied between patients but did not predict outcomes within the evaluated range. The study findings show the limited benefit of ACP treatment for knee OA and call for caution with routine use in clinical practice.
https://journals.sagepub.com/doi/full/10.1177/23259671231184848
PRP demonstrated significantly improved pain and function for patients with knee osteoarthritis compared with placebo. Additionally, PRP exhibited the highest SUCRA values for these outcomes when compared with BMAC, HA, and CS.
https://www.sciencedirect.com/science/article/abs/pii/S0749806324000938
This study suggests that the triple low-dose injection of HMW HA is more effective in improving WOMAC, VAS scores and Lequesne Index values than a single high-dose injection.
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-024-07200-y
Although the symptomatology generated by KOA was worse in women when compared to men, treatment with repeated injections of PRP was effective, ultimately achieving a higher improvement in women providing comparable final follow-up outcomes between men and women.
https://pubmed.ncbi.nlm.nih.gov/38363024/
PRP did not improve pain at 24 weeks of follow-up in patients with mild-to-moderate knee osteoarthritis compared with exercise alone. Moreover, exercise alone was clinically superior to PRP alone, considering function and the physical component of health-related quality of life. ***4 billion platelets injected per PRP injection
https://pubmed.ncbi.nlm.nih.gov/38323999/
This systematic review and meta-analysis demonstrated that intra-articular corticosteroid injections offer clinically perceivable pain relief and functional improvement higher than the placebo effect only at short-term follow-up in patients affected by knee OA, with benefits losing clinical relevance already after 6 weeks. These results, together with the low number and the limited quality of the RCTs comparing this treatment with placebo, question the indication for the use of corticosteroid injections in clinical practice for the treatment of knee OA.
https://pubmed.ncbi.nlm.nih.gov/38294103/
Conclusions drawn from individual RCTs evaluating PRP for knee OA demonstrated slight robustness. On meta-analysis, PRP demonstrated a significant advantage over hyaluronic acid as well as improved symptom relief, lower rates of reintervention, and more frequent achievement of the MCID for pain improvement when compared with alternative nonoperative treatment options. Statistically significant pooled treatment effects evaluating PRP for knee OA are more robust than approximately half of all comparable meta-analyses in medicine and health care. Future RCTs and meta-analyses should consider reporting FIs and fragility quotients to facilitate interpretation of results in their proper context.
https://pubmed.ncbi.nlm.nih.gov/38420745/
Intra-articular injection of autologous culture-expanded Autologous Adipose-Derived Mesenchymal Stem Cells (ADMSCs) provided significant pain relief and functional improvements in patients with K-L grade 3 osteoarthritis. Long-term results are needed to determine the disease-modifying effects of ADMSCs, such as structural changes, and the duration of effect of intra-articular injection of ADMSCs in knee osteoarthritis.
https://journals.sagepub.com/doi/abs/10.1177/03635465231179223
Retrospective study. Every 3 month injection of MFAT vs PRP (40cc blood draw). Both ASCs and PRP were safe and resulted in clinical improvement in patients with knee OA at 6 months; however, at 12 and 24 months, ASCs outperformed leukocyte-poor PRP in clinical and MRI radiological outcomes.
https://pubmed.ncbi.nlm.nih.gov/37350015/
The efficacy of platelet-rich plasma in treating osteoarthritis with an inflammatory phenotype: A 5-year follow up retrospective study. The WOMAC, KSS, and KSS function scores were significantly better in the I-KOA group than in the KOA group at each time point after treatment (P < 0.05).
https://pubmed.ncbi.nlm.nih.gov/37931364/
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