Original Article
Platelet-Rich Plasma Intra-Articular Injection Versus Hyaluronic Acid Viscosupplementation as Treatments for Cartilage Pathology: From Early Degeneration to Osteoarthritis

https://doi.org/10.1016/j.arthro.2011.05.011Get rights and content

Purpose

The aim of our study is to compare the efficacy of platelet-rich plasma (PRP) and viscosupplementation (hyaluronic acid [HA]) intra-articular injections for the treatment of knee cartilage degenerative lesions and osteoarthritis (OA).

Methods

The study involved 150 patients affected by cartilage degenerative lesions and early and severe OA. Fifty symptomatic patients were treated with 3 autologous PRP intra-articular injections and were evaluated prospectively at enrollment and at 2- and 6-month follow-up. The results obtained were compared with 2 homogeneous groups of patients treated with HA injections. One group was treated with injections of high–molecular weight HA; the other group was treated with low–molecular weight (LW) HA. International Knee Documentation Committee and EQ VAS scores were used for clinical evaluation; adverse events and patient satisfaction were also recorded.

Results

At 2 months' follow-up, the PRP and LW HA groups showed a similar improvement, with higher results compared with the high–molecular weight HA group (P < .005). At 6 months' follow-up, better results were observed in the PRP group (P < .005). PRP and LW HA treatments offered similar results in patients aged over 50 years and in the treatment of advanced OA. PRP showed a better performance compared with HA in younger patients affected by cartilage lesions or early OA.

Conclusions

Autologous PRP injections showed more and longer efficacy than HA injections in reducing pain and symptoms and recovering articular function. Better results were achieved in younger and more active patients with a low degree of cartilage degeneration, whereas a worse outcome was obtained in more degenerated joints and in older patients, in whom results similar to those of viscosupplementation have been observed.

Level of Evidence

Level II, prospective comparative study.

Section snippets

Patient Selection

Clinical experimentation of this prospective comparative study was approved by our hospital's ethics committee and internal review board, and informed consent in all patients was obtained.

The following diagnostic criteria for patient selection were used: patients affected by a unilateral lesion with a history of chronic (≥4 months) pain or swelling of the knee and imaging findings (radiography or magnetic resonance imaging [MRI]) of degenerative changes of the joint. Exclusion criteria included

Results

No complications related to the infiltrations were observed during the treatment and follow-up period. A statistically significant improvement in all clinical scores from basal evaluation to the 2- and 6-month follow-up visits was observed in all treatment groups (Table 2, Figure 3, Figure 4). These results were confirmed, including age as a covariate in the analysis.

Further analysis showed the overall worst results in patients aged over 50 years: at 6 months of follow-up, IKDC evaluation

Discussion

The results of this study showed positive effects of PRP in patients affected by knee degeneration, with an improvement of symptoms and function.

Articular cartilage lesions and degeneration are difficult to treat and present a challenge for orthopaedic surgeons because of the distinctive structure and function of hyaline cartilage and its inherent low healing potential.3, 4, 5, 29 For therapeutic intervention, laboratory investigations are focusing on the possibility of preserving normal

Conclusions

The clinical results of this comparative study suggest that this procedure may be useful for the treatment of degenerative articular pathology of the knee. Autologous PRP injections showed more and longer efficacy than HA injections in reducing pain and symptoms and recovering articular function, in particular in more active patients with a low degree of cartilage degeneration. In patients aged 50 years or younger, LW HA and PRP were more effective than HW HA at 2 months and PRP was more

Acknowledgment

The authors thank A. Di Martino, G. Altadonna, F. Balboni, M. Lo Presti, A. Bondi, S. Bassini, A. Montaperto, B. Di Matteo, and L. D'Orazio at the Biomechanics Laboratory–III Clinic, Rizzoli Orthopaedic Institute; A. Gabriele, F. Pieretti, M. Vaccari, A.M. Del Vento, M. Zagarella, V. Roverini, I. Brognara, L. D'Amato, and S. Ardone at the Immunohematology and Transfusion Medicine Service, Rizzoli Orthopaedic Institute; and E. Pignotti from the Task Force, Rizzoli Orthopaedic Institute, Bologna,

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