Editor-in-Chief: Kenneth D. Candido, MD
Osteoarthritis (OA) is a progressive joint disease associated with both mechanical and biologic abnormalities of the articular cartilage and subchondral bone. In normal cartilage, a delicate balance exists between matrix synthesis and degradation; in OA, however, cartilage degradation exceeds synthesis. Treatment modalities include nonpharmacological, pharmacological, and surgical approaches. Intrarticular platelet rich plasma (PRP) has emerged as promising treatment for early stages of knee OA.
PRP is an autologous blood product defined as a volume of plasma that has a supraphysiologic platelet count. PRP can accelerate the physiological recovery process, relieve pain, and contains anti-inflammatory and anti-bacterial activity. Although the mechanisms for these complex interactions are not completely understood, they are attributed to the more than 30 bioactive proteins contained in the alpha granules of platelets including growth factors and proteins, such as fibrin, fibronectin, vitronectin and thrombospondin. Several studies now have demonstrated that intraarticular PRP injections are safe and effective treatment to reduce pain and improve quality of life through increased function in knee OA.
The available literature suggests that PRP is a better option than hyaluronic acid for many knee OA patients. We identified 12 comparative studies that demonstrated superiority of PRP as compared to hyaluronic acid for knee OA. Considering what is known about the deleterious effects of local anesthetic and corticosteroids on soft tissue health, it may be time for a shift in the knee OA treatment algorithm to favor early intervention for regenerative therapies including platelet rich plasma.
Key words: Platelet rich plasma, hyaluronic acid, knee pain, knee osteoarthritis, arthritis, chondrotoxicity