Sports Health. 2012 Mar;4(2):162-72.

Platelet-rich plasma treatment in symptomatic patients with knee osteoarthritis: preliminary results in a group of active patients.

Gobbi A, Karnatzikos G, Mahajan V, Malchira S.
Source
OASI Bioresearch Foundation, Gobbi NPO, Milan, Italy.
Abstract
BACKGROUND:
With increasing frequency, platelet-rich plasma (PRP) preparations have been used to treat cartilage lesions to regenerate tissue homeostasis and retard the progression of knee osteoarthritis (OA).
PURPOSE:
To determine the effectiveness of intra-articular PRP injections in active patients with knee OA and to evaluate clinical outcomes in patients with and without previous surgical treatment for cartilage lesions.
STUDY DESIGN:
Case series.
MATERIALS AND METHODS:
Fifty patients with knee OA were followed for a minimum of 12 months. All were treated with 2 intra-articular injections of autologous PRP. Twenty-five patients had undergone a previous operative intervention for cartilage lesions, whereas 25 had not. Operated patients had undergone either cartilage shaving or microfracture. Multiple evaluative scores were collected at pretreatment and at 6 and 12 months posttreatment. The required sample of patients was determined beforehand by using statistical power analysis; International Knee Documentation Committee (subjective) score was defined as the primary parameter. A P value of less than 0.05 was considered statistically significant. General linear model-repeated measure test evaluated within-time improvement for each variable for all patients. Post hoc test with Bonferroni adjustment for multiple comparisons was performed to investigate the significance in improvement within time evaluations for each variable for the total sample. The differences in improvement between operated and nonoperated patients were also investigated, as were those between sexes.
RESULTS:
All patients showed significant improvement in all scores at 6 and 12 months (P < 0.01) and returned to previous activities. No significant difference in improvement was found between the evaluated subgroups (P < 0.01).
CONCLUSIONS:
The PRP treatment showed positive effects in patients with knee OA. Operated and nonoperated patients showed significant improvement by means of diminishing pain and improved symptoms and quality of life.
PMID:
23016084
[PubMed]
PMCID:
PMC3435904
[Available on 2013/3/1]

Phys Ther Sport. 2012 Sep 22. pii: S1466-853X(12)00053-3. doi: 10.1016/j.ptsp.2012.05.002. [Epub ahead of print]

An exercise-based physical therapy program for patients with patellar tendinopathy after platelet-rich plasma injection.

van Ark M, van den Akker-Scheek I, Meijer LT, Zwerver J.
Source
Center for Sports Medicine, University Center for Sport, Exercise and Health, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: m.van.ark@umcg.nl.
Abstract
OBJECTIVES:
To describe a post platelet-rich plasma (PRP) injection, exercise-based physical therapy program, investigate feasibility and report the first results of patellar tendinopathy patients treated with PRP injection combined with the physical therapy program.
STUDY DESIGN:
Case-series.
SETTING:
A PRP injection followed by a physical therapy program seems promising for the treatment of patellar tendinopathy. However, descriptions of physical therapy programs are often limited and incomplete.
PARTICIPANTS:
Five patellar tendinopathy patients (six tendons) in the degenerative phase.
MAIN OUTCOME MEASURE:
VISA-P score.
RESULTS:
Muscle strength, endurance, power and retraining sport-specific function form the basis for the physical therapy program aiming to improve the load capacity of the knee. The program is characterised by gradually increasing intensity and difficulty of exercises. Five of the six tendons showed an improvement of at least 30 points on the VISA-P after 26 weeks.
CONCLUSIONS:
This study extensively describes, based on current knowledge, a physical therapy program after PRP injection for patellar tendinopathy patients. The combination treatment reported in this study is feasible and seems to be promising for patients in the late/degenerative phase of patellar tendinopathy.
Copyright © 2012 Elsevier Ltd. All rights reserved.
PMID:
23010772
[PubMed - as supplied by publisher]

Knee Surg Sports Traumatol Arthrosc. 2011 Apr;19(4):528-35. doi: 10.1007/s00167-010-1238-6. Epub 2010 Aug 26.

Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis.

Filardo G, Kon E, Buda R, Timoncini A, Di Martino A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M.
Source
Biomechanics Laboratory-III Clinic, Rizzoli Orthopaedic Institute, Via Di Barbiano 1/10, 40136, Bologna, Italy. g.filardo@biomec.ior.it
Abstract
PURPOSE:
Platelet-rich plasma (PRP) therapy is a simple, low-cost and minimally invasive method that provides a natural concentrate of autologous blood growth factors (GFs) that can be used to enhance tissue regeneration. In a previous analysis of a 12-month follow-up study, promising results were obtained when treating patients affected by knee degeneration with PRP intra-articular injections. The main purpose of this study was to investigate the persistence of the beneficial effects observed.
METHODS:
Of the 91 patients evaluated in the previous 12-month follow-up study, 90 were available for the 2-year follow-up (24 patients presented a bilateral lesion, in a total of 114 knees treated). All of the patients presented a chronic knee degenerative condition and were treated with three intra-articular PRP injections. IKDC and EQ-VAS scores were used for clinical evaluation. Complications, adverse events and patient satisfaction were also recorded.
RESULTS:
All of the evaluated parameters worsened at the 24-month follow-up: these parameters were at significantly lower levels with respect to the 12-month evaluation (the IKDC objective evaluation fell from 67 to 59% of normal and nearly normal knees; the IKDC subjective score fell from 60 to 51), even if they remained higher than the basal level. Further analysis showed better results in younger patients (P = 0.0001) and lower degrees of cartilage degeneration (P < 0.0005). The median duration of the clinical improvement was 9 months.
CONCLUSIONS:
These findings indicate that treatment with PRP injections can reduce pain and improve knee function and quality of life with short-term efficacy. Further studies are needed to confirm these results and understand the mechanism of action, and to find other application modalities, with different platelet and GF concentrations and injection timing, which provide better and more durable results.
Comment in
Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. [Knee Surg Sports Traumatol Arthrosc. 2011]
PMID:
20740273

Am J Phys Med Rehabil. 2010 Dec;89(12):961-9. doi: 10.1097/PHM.0b013e3181fc7edf.

Injection of platelet-rich plasma in patients with primary and secondary knee osteoarthritis: a pilot study.

Sampson S, Reed M, Silvers H, Meng M, Mandelbaum B.
Source
The Orthobiologic Institute, Los Angeles, California 90025, USA.
Abstract
OBJECTIVE:
To evaluate the clinical effects of intraarticular platelet-rich plasma (PRP) injections in a small group of patients with primary and secondary osteoarthritis. Most of the current treatments for osteoarthritis are palliative and attack the symptoms rather than influencing the biochemical environment of the joint. Autologous platelet-rich plasma has emerged as a treatment option for tendinopathies and chronic wounds. In addition to release of growth factors, platelet-rich plasma also promotes concentrated anti-inflammatory signals including interleukin-1ra, which has been a focus of emerging treatments for osteoarthritis.
DESIGN:
In this single-center, uncontrolled, prospective preliminary study, 14 patients with primary and secondary knee osteoarthritis who met the study criteria received three platelet-rich plasma injections in the affected knee at ∼4-wk intervals. Outcome measures included the Brittberg-Peterson Visual Pain (Visual Analog Scale [VAS]), Activities, and Expectations score and the Knee Injury and Osteoarthritis Outcome Scores at preinjection visit at 2-, 5-, 11-, 18-, and 52-wk follow-up visits. Musculoskeletal ultrasound was used to measure cartilage thickness.
RESULTS:
There were no adverse events reported. The study demonstrated significant and almost linear improvements in Knee Injury and Osteoarthritis Outcome Scores, including pain and symptom relief. Brittberg-Peterson VAS showed many improvements including reduced pain after knee movement and at rest. Cartilage assessment was limited because of the small sample size. The majority of the patients expressed a favorable outcome at 12 mos after treatment.
CONCLUSIONS:
The positive trends and safety profile demonstrated could potentially be used to inspire a larger, blinded, and randomized clinical trial to determine whether platelet-rich plasma is safe and effective for the treatment of knee osteoarthritis.
PMID:
21403592
[PubMed - indexed for MEDLINE]

The Influence of Locally Applied Platelet-Derived Growth Factor–BB on Free Tendon Graft Remodeling After Anterior Cruciate Ligament Reconstruction

Andreas Weiler,*† Cornelius Förster,‡ Patrick Hunt,† Roman Falk,† Tobias Jung,† Frank N. Unterhauser,† Volker Bergmann,§ Gerhard Schmidmaier,† and Norbert P. Haas†
From †Sports Traumatology & Arthroscopy Service, Trauma & Reconstructive Surgery, Charité, Humboldt-University of Berlin, Germany, the ‡Department of Trauma & Reconstructive Surgery, University of Rostock, Germany, and the §Institute of Veterinary Pathology, Free University of Berlin, Germany
Background: Ligaments and tendons do not gain mechanical properties of the native tissue after injury or grafting. Purpose: To determine the influence of platelet-derived growth factor on tendon graft remodeling.
Study Design: Laboratory animal study.
Methods: Forty-eight sheep underwent anterior cruciate ligament reconstruction and were sacrificed after 3, 6, 12, and 24 weeks. In 6 animals at each time point, platelet-derived growth factor was locally delivered via coated sutures. After mechanical testing, tissue samples were taken for histologic, immunohistochemical, and electron microscopy evaluations.
Results: With platelet-derived growth factor treatment, cross-sectional area was significantly lower at 3 and 12 weeks. Load to failure was significantly higher at 6 weeks. Tensile stress was significantly higher at 3 and 12 weeks. Crimp length was signifi- cantly higher at 3 and 6 weeks. Vascular density was significantly higher at 6 weeks. Electron microscopy showed a significantly higher collagen fibril amount at 12 weeks. Differences in these parameters at other time points were not significant.
Conclusions: There were alterations in several but not all time points. The local application of platelet-derived growth factor alters the tissue’s mechanical properties during free tendon graft remodeling after anterior cruciate ligament reconstruction. Growth factors present a promising tool toward the complete mechanical restitution of a healing ligament substitute.
Keywords: anterior cruciate ligament (ACL); tendon graft; remodeling; growth factors; animal model

Plasma Rich in Growth Factors to Treat an Articular Cartilage Avulsion: A Case Report

MIKEL SANCHEZ1, JUAN AZOFRA1, EDUARDO ANITUA2, ISABEL ANDIA3, SABINO PADILLA4, JUANMA SANTISTEBAN4, and INIGO MUJIKA4
1Arthroscopic Surgery Unit, USP-La Esperanza Clinic, Vitoria-Gasteiz, Basque Country, SPAIN; 2B.T.I. Biotechnology Institute, Vitoria-Gasteiz, Basque Country, SPAIN; 3Department of Neurochemistry Research, Osakidetza–Basque Health Service, Zamudio, Basque Country, SPAIN; and 4Department of Research and Development, Medical Services, Athletic Club of Bilbao, Basque Country, SPAIN
ABSTRACT
SANCHEZ, M., J. AZOFRA, E. ANITUA, I. ANDIA, S. PADILLA, J. SANTISTEBAN, and I. MUJIKA.
Plasma Rich in Growth Factors to Treat an Articular Cartilage Avulsion: A Case Report. Med. Sci. Sports Exerc., Vol. 35, No. 10, pp. 1648–1652, 2003.
Introduction: The application of an autologous plasma rich in growth factors is beneficial in restoring connective tissues, as shown by clinical evidence in oral surgery and more recently in arthroscopic anterior cruciate ligament reconstruction and two cases of ruptured Achilles tendon in professional athletes. This is attributed to the slow delivery of growth factors from harvested platelets that have been activated by endogenous thrombin promoted by the addition of calcium chloride.
Purpose: This case report describes a new application of this therapy in the arthroscopic treatment of a large, nontraumatic avulsion of articular cartilage in the knee of an adolescent soccer player.
Methods: After arthroscopic reattachment of the large (>2 cm) loose chondral body in its crater in the medial femoral condyle, autologous plasma rich in growth factors was injected into the area between the crater and the fixed fragment.
Results and Conclusion: Despite the extremely poor prognosis of the case, complete articular cartilage healing was considerably accelerated, and the functional outcome was excellent, allowing a rapid resumption of symptom-free athletic activity. This technique opens new perspectives for human tissue regeneration.
Key Words: PRGF, KNEE ARTHROSCOPY, TISSUE REGENERATION, FUNCTIONAL RECOVERY