Biomechanics Laboratory-III Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy.
Arthroscopy. 2011 Nov;27(11):1490-501. doi: 10.1016/j.arthro.2011.05.011. Epub 2011 Aug 10.
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).
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.
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.
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 II, prospective comparative study.
本研究旨在比较富血小板血浆（PRP）和关节内注射黏弹性补充剂（透明质酸[HA]）治疗膝关节软骨退行性病变和骨关节炎（OA）的疗效。
本研究纳入了 150 例患有软骨退行性病变和早期、严重 OA 的患者。50 例有症状的患者接受了 3 次自体 PRP 关节内注射，并在入组时和 2 个月、6 个月随访时进行前瞻性评估。将获得的结果与接受 HA 注射的 2 个同质患者组进行比较。一组接受高分子量 HA 注射治疗；另一组接受低分子量（LW）HA 治疗。采用国际膝关节文献委员会和 EQ VAS 评分进行临床评估；还记录了不良反应和患者满意度。
在 2 个月的随访时，PRP 组和 LW HA 组的改善情况相似，与高分子量 HA 组相比，结果更高（P <.005）。在 6 个月的随访时，PRP 组的结果更好（P <.005）。在 50 岁以上的患者和晚期 OA 的治疗中，PRP 和 LW HA 治疗的结果相似。在受软骨病变或早期 OA 影响的年轻患者中，PRP 与 HA 相比表现出更好的疗效。
与 HA 注射相比，自体 PRP 注射在减轻疼痛和症状以及恢复关节功能方面具有更持久的疗效。在软骨退变程度较低、年龄较小且更活跃的患者中，效果更好，而在退变程度较高的关节和年龄较大的患者中，效果较差，观察到与黏弹性补充剂相似的结果。
Ⅱ级，前瞻性比较研究。
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