Evaluation of the efficacy and safety of intra-articular injection of platelet-rich plasma in patients with osteoarthritis of the knee joint

Currently, there is insufficient data in the literature on the efficacy and safety of platelet-rich plasma (PRP) therapy in patients with osteoarthritis (OA) of the knee. The aim of this study was to evaluate the efficacy and safety of local therapy with PRP and hyaluronic acid (HA) by intra-articular injection in patients with stage II-III knee OA.

Material and methods. Patients (n = 32, age 60.9 ± 7.7 years) were divided into 2 groups: the first (18 patients) received a combination of PRP and HA intra-articularly. PRP was injected according to the schedule (1, 7, and 14 days) and HA (1 day). In the second group (14 patients), HA was injected intra-articularly in isolation. Manipulations were performed on one knee joint. Prior to treatment, all patients underwent radiography of the knee joint and ultrasound in three zones (upper pole of the patella, lateral and medial condyles of the tibia) to evaluate changes in cartilage thickness in the dynamic range. Diagnostic arthroscopy of the affected joint was performed to objectify the severity of cartilage lesions one day prior to the first intra-articular drug injection. Control ultrasound was performed at 12 and 24 weeks of followup. The clinical efficacy of the therapy was assessed using WOMAC, Lequesne, and visual analog pain scale.

Results. Analysis of the dynamics of pain syndrome showed an analgesic effect of therapy and improvement of the functional status of patients in the first and second groups after 3 months. In both groups, after 3 months of observation, according to ultrasound data, a statistically significant increase in cartilaginous tissue in the area of the upper pole of the patella was revealed, as well as in the area of the lateral condyle of the tibia in the second group after 3 months with a further increase in cartilage thickness by the 6th month of observation. In the third localization, the medial condyle of the tibia, both groups showed no statistically significant increase in cartilage thickness.

Conclusions. PRP and HA are effective and safe in the treatment of stage II–III knee OA with chronic pain syndrome. Regression of clinical effects occurred 6 months after initiation of therapy, while the combination of therapy methods did not contribute to prolongation of positive results. Thus, the combination of the indicated treatment methods (PRP + HA) does not seem appropriate.

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