1st Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40127, Bologna, Italy.
Musculoskelet Surg. 2024 Sep;108(3):275-288. doi: 10.1007/s12306-024-00827-z. Epub 2024 Jun 3.
Intra-articular injection-based therapy is often used aside conservative treatment and lifestyle modifications to manage knee osteoarthritis (KO) patients. Conventional injections contain steroids and hyaluronic acid, while more recently multipotential adult stem cell, platelet-rich plasma (PRP), and platelet lysate (PL) injections have been used to promote cartilage regeneration or repair. The aim of the current study is to analyse current evidence on PL injections for the treatment of KO and to determine if these are effective and how these perform compared to other injection regimens. The databases of Scopus, Embase, PubMed, Web of Science, and Cochrane Library were searched on 30 June 2023. Risk of bias was assessed using the SYRCLE tool for animal studies and Cochrane RoB 2 as well as ROBINS-I tool for human studies. Studies were included if these were in English, any year, and regarded animals with osteoarthritis (OA) or human adult patients with OA. In vitro trials and non-adult human studies were excluded. Results on OA symptom stage and severity, and pain were recorded. The research retrieved three human studies (n = 48, n = 25, n = 58) and four animal studies: one rabbit, two studies, and one rat study. PL was found to decrease KO symptoms at follow-up ≤ 1 year with respect to baseline levels and when compared to hyaluronic acid or platelet-rich plasma. Symptoms returned 6 months-1 year after the final administration, with studies showing peak efficacy at approximately 6 months. Animal studies showed clinical improvements, reduction of lameness, and partial effect on the cartilage regeneration of the seven studies, two had a high risk of bias, four were associated to some concerns, and one had low risk. A major source of bias in these studies was the use of questionnaires and scoring that could be subject to interpretation. Overall, PL was well-tolerated and showed efficacy comparable to PRP; when pain control was assessed, it showed similar efficacy compared to hyaluronic acid. These findings may support its use in clinical trials to confirm these initial findings; future research should also focus on the comparison with other non-surgical treatments, on a more detail of the potential regenerative properties, and to optimise the treatment schedule.
关节内注射治疗通常与保守治疗和生活方式改变一起用于管理膝骨关节炎 (KO) 患者。传统的注射剂包含类固醇和透明质酸，而最近多潜能成体干细胞、富含血小板的血浆 (PRP) 和血小板裂解液 (PL) 注射已被用于促进软骨再生或修复。本研究的目的是分析目前关于 PL 注射治疗 KO 的证据，并确定这些治疗方法是否有效，以及与其他注射方案相比效果如何。本研究于 2023 年 6 月 30 日检索了 Scopus、Embase、PubMed、Web of Science 和 Cochrane Library 数据库。使用 SYRCLE 工具评估动物研究的偏倚风险，使用 Cochrane RoB 2 和 ROBINS-I 工具评估人类研究的偏倚风险。如果这些研究是英文的、任何年份的、涉及骨关节炎 (OA) 动物或 OA 成人患者，则将其纳入研究。排除了体外试验和非成人人类研究。记录了 OA 症状阶段和严重程度以及疼痛的结果。本研究共检索到 3 项人类研究（n=48、n=25、n=58）和 4 项动物研究：1 项兔研究、2 项研究和 1 项大鼠研究。与基线水平相比，PL 在随访≤1 年时可降低 KO 症状，与透明质酸或 PRP 相比也可降低 KO 症状。末次给药后 6 个月-1 年内症状复发，研究显示大约 6 个月时达到疗效峰值。7 项动物研究显示临床改善、跛行减轻，部分研究显示软骨再生有一定效果，其中 2 项研究有高偏倚风险，4 项研究有一定偏倚风险，1 项研究低偏倚风险。这些研究中的一个主要偏倚来源是使用可能存在解释偏差的问卷和评分。总体而言，PL 耐受性良好，疗效与 PRP 相当；当评估疼痛控制时，其疗效与透明质酸相当。这些发现可能支持其在临床试验中的使用，以确认这些初步发现；未来的研究还应侧重于与其他非手术治疗的比较，更详细地研究潜在的再生特性，并优化治疗方案。
