Kamada Kohei, Matsushita Takehiko, Yamashita Takahiro, Matsumoto Tomoyuki, Iwaguro Hideki, Kuroda Ryosuke, Sobajima Satoshi
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Orthopaedic Surgery, Sobajima Clinic, Osaka, Japan.
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2024 Sep 30;38:43-48. doi: 10.1016/j.asmart.2024.09.006. eCollection 2024 Oct.
Platelet-rich-plasma (PRP) is rapidly spreading as a conservative treatment option for knee osteoarthritis (KOA), however, its therapeutic efficacy is controversial. This study aimed to investigate the factors affecting the therapeutic effect of intra-articular PRP therapy for KOA in patients who received multiple PRP injections (PRP-I).
This is a historical cohort study included 1057 knees of 701 patients who received PRP-I during KOA treatment from 2018 to 2020. The difference in visual analog scale (VAS) scores before and after PRP-I was defined as the amount of change in VAS (ΔVAS). A linear mixed-effects model was employed with ΔVAS as a random effect and age, sex, BMI, KL classification, pre-treatment VAS, treatment duration, and the number of PRP injections as fixed effects. Evaluations using the Kellgren-Lawrence (KL) classification were added.
Age, KL grade, and VAS score before treatment and after three, four, and five PRP-I were significantly associated with ΔVAS score. According to KL grade, age was significantly associated with ΔVAS score in the KL grade 4 group. VAS score before treatment was significantly associated with ΔVAS score, regardless of KL grade. Three-time PRP-I were significantly associated with ΔVAS in the KL-grade 1 and 2 groups. For KL grade 4, two or more PRP-I were significantly associated with the high efficacy.
Age, pain before treatment, KL grade and number of injections were associated with pain reduction after intra-articular PRP-I for KOA treatment. Pain reduction can be expected after PRP-I when patients are younger or experience severe pain before treatment. Three-time PRP-I are recommended to reduce pain in early-stage KOA and more than three times in advanced-stage KOA.
Retrospectively registration.
富血小板血浆（PRP）作为膝关节骨关节炎（KOA）的一种保守治疗选择正在迅速普及，然而，其治疗效果存在争议。本研究旨在探讨影响接受多次PRP注射（PRP-I）的KOA患者关节内PRP治疗效果的因素。
这是一项历史性队列研究，纳入了2018年至2020年期间在KOA治疗中接受PRP-I的701例患者的1057个膝关节。PRP-I前后视觉模拟量表（VAS）评分的差异定义为VAS变化量（ΔVAS）。采用线性混合效应模型，将ΔVAS作为随机效应，年龄、性别、BMI、KL分级、治疗前VAS、治疗持续时间和PRP注射次数作为固定效应。增加了使用Kellgren-Lawrence（KL）分级的评估。
年龄、KL分级以及治疗前和三次、四次、五次PRP-I后的VAS评分与ΔVAS评分显著相关。根据KL分级，在KL 4级组中年龄与ΔVAS评分显著相关。无论KL分级如何，治疗前VAS评分与ΔVAS评分显著相关。在KL 1级和2级组中，三次PRP-I与ΔVAS显著相关。对于KL 4级，两次或更多次PRP-I与高疗效显著相关。
年龄、治疗前疼痛、KL分级和注射次数与KOA治疗关节内PRP-I后疼痛减轻有关。当患者较年轻或治疗前经历严重疼痛时，PRP-I后有望减轻疼痛。建议在早期KOA中进行三次PRP-I以减轻疼痛，在晚期KOA中进行三次以上。
回顾性注册。
