Comparative Analysis of the Effectiveness of Intra- Articular Injection of Platelet-Rich Plasma versus Hyaluronic Acid for Knee Osteoarthritis: Results of an Open-Label Trial

Document Type : RESEARCH PAPER

Authors

1 Center of Excellence for Stem Cell Research and Regenerative Medicine, Mashhad University of Medical Sciences, Mashhad, Iran- Rheumatology Division, Department of Internal Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran

2 Center of Excellence for Stem Cell Research and Regenerative Medicine, Mashhad University of Medical Sciences, Mashhad, Iran-Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran

3 Center of Excellence for Stem Cell Research and Regenerative Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Center of Excellence for Stem Cell Research and Regenerative Medicine, Mashhad University of Medical Sciences, Mashhad, Iran- Department of Clinical Biochemistry, Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

5 Center of Excellence for Stem Cell Research and Regenerative Medicine, Mashhad University of Medical Sciences, Mashhad, Iran- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

6 Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

7 Center of Excellence for Stem Cell Research and Regenerative Medicine, Mashhad University of Medical Sciences, Mashhad, Iran-Department of Internal Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran - Golestan Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran

8 Center of Excellence for Stem Cell Research and Regenerative Medicine, Mashhad University of Medical Sciences, Mashhad, Iran-Department of Internal Medicine, School of Medicine,

Abstract

Background: Platelet-rich plasma (PRP), an autologous source of growth factors, and hyaluronic acid (HA) are among
the minimally invasive treatments for knee osteoarthritis (OA). This trial was designed to compare the effectiveness of
intra-articular injection of PRP with HA (as one of the standard treatments) on mild to moderate knee OA.
Methods: In this phase I open-label clinical trial, 10 patients underwent intra-articular PRP injection and 10 others
received HA injection. At baseline (pre-injection) visit and 1, 3, 6, and 12 months post-injection, clinical assessments
were performed using visual analogue scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS)
questionnaire. Physical examinations of the knee, including crepitation and range of motion (ROM) were performed at
each visit. The follow-up responses were compared with the baseline visit.
Results: The PRP treatment was ascertained to be safe and caused no adverse effects. Significant improvements
in the majority of KOOS subscales and VAS were found throughout the entire 12-month follow-up, following the PRp
injections. HA injection, however, caused only one month significant improvement in the majority of patient-reported
outcomes. In the majority of visits, the extent of improvements in the scores of KOOS subscales, as well as the extent
of reduction in VAS were significantly greater in PRP recipients, compared to HA recipients. The ROM in both groups
slightly increased after interventions. The frequency of coarse crepitation, which was detected in 100% of the patients
in both groups at the baseline visit, decreased significantly to fine crepitation at the first follow-up visit in 80% and 40%
of the PRP and HA recipients, respectively.
Conclusion: Intra-articular injection of PRP or HA alleviates symptoms and pain and improves functionality and physical
examinations in patients with knee OA. However, PRP therapy produces greater and longer-lasting improvements in
most of the outcome parameters compared to HA.
Level of evidence: II

Keywords

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The Archives of Bone and Joint Surgery
Volume 9, Issue 5
September and October 2021
Pages 487-495

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History

  • Receive Date: 17 September 2020
  • Revise Date: 07 January 2021
  • Accept Date: 13 February 2021

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