The Orthobiologic Institute, Los Angeles, California 90025, USA.
Am J Phys Med Rehabil. 2010 Dec;89(12):961-9. doi: 10.1097/PHM.0b013e3181fc7edf.
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.
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.
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.
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.
评估小样本原发性和继发性骨关节炎患者关节内富血小板血浆（PRP）注射的临床效果。目前大多数骨关节炎的治疗方法都是对症治疗，针对的是症状，而不是影响关节的生化环境。自体富血小板血浆已成为治疗肌腱病和慢性伤口的一种选择。除了释放生长因子外，富血小板血浆还可促进包括白细胞介素-1受体拮抗剂在内的集中抗炎信号，这是新兴骨关节炎治疗的重点。
在这项单中心、非对照、前瞻性初步研究中，符合研究标准的 14 例原发性和继发性膝骨关节炎患者在约 4 周的间隔内接受了 3 次富血小板血浆注射到受影响的膝关节。主要终点是 Brittberg-Peterson 视觉疼痛（视觉模拟评分 [VAS]）、活动和期望评分和膝关节损伤和骨关节炎结果评分（KOOS），在注射前、2 周、5 周、11 周、18 周和 52 周的随访中进行评估。肌肉骨骼超声用于测量软骨厚度。
未报告不良事件。研究表明，膝关节损伤和骨关节炎结果评分（包括疼痛和症状缓解）有显著且几乎线性的改善。Brittberg-Peterson VAS 显示出许多改善，包括膝关节运动后和休息时疼痛减轻。由于样本量小，软骨评估受到限制。大多数患者在治疗后 12 个月表达了良好的结果。
所显示的积极趋势和安全性特征可用于激发更大规模、盲法、随机临床试验，以确定富血小板血浆是否安全有效治疗膝骨关节炎。
