Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Am J Sports Med. 2024 Nov;52(13):3223-3231. doi: 10.1177/03635465241283463. Epub 2024 Oct 14.
Platelet-rich plasma (PRP) is one of the most frequently used orthobiologic products for the injection treatment of patients affected by knee osteoarthritis (OA). Some preliminary evidence supports the influence of platelet concentration on patients' clinical outcomes.
To analyze if platelet concentration can influence the safety and clinical efficacy of PRP injections for the treatment of patients with knee OA.
Cohort study; Level of evidence, 3.
This study consisted of 253 patients with knee OA (142 men, 111 women; mean ± SD age, 54.8 ± 11.4 years; Kellgren-Lawrence grades 1-3) who were treated with 3 intra-articular injections of 5 mL of autologous leukocyte-rich or leukocyte-poor PRP. All patients were prospectively evaluated at baseline and at 2, 6, and 12 months. Patients were clinically assessed thorough the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and the International Knee Documentation Committee (IKDC) Subjective score. Platelet concentration was correlated with clinical outcome. Further analysis was performed by stratifying patients into 3 groups (homogeneous for OA severity) based on platelet concentration (high, medium, and low). All complications and adverse events were reported, as well as failures.
An overall statistically significant improvement in all clinical scores was documented from baseline to each follow-up evaluation. Platelet concentration positively correlated with clinical outcome. KOOS Pain improved more with higher platelet concentration at 2 months ( = .036; rho = 0.132), 6 months ( = .009; rho = 0.165), and 12 months ( = .014; rho = 0.155). The same trend was shown by the other KOOS subscales and by the IKDC Subjective score, as well as by the comparison of the groups of high-, medium-, and low-platelet PRP. The highest failure rate (15.0%) was found in the low-platelet group as compared with the medium-platelet group (3.3%) and the high-platelet group (3.3%). No differences were observed among the 3 groups in terms of adverse events.
This study demonstrated that platelet concentration influences the clinical outcome of PRP injections in knee OA treatment. PRP with a higher platelet concentration provides a lower failure rate and higher clinical improvement as compared with PRP with a lower platelet concentration, with overall better results up to 12 months of follow-up in patients with knee OA.
富含血小板的血浆（PRP）是用于治疗膝骨关节炎（OA）患者关节内注射治疗的最常用的生物制剂之一。一些初步证据支持血小板浓度对患者临床结果的影响。
分析血小板浓度是否会影响 PRP 注射治疗膝 OA 患者的安全性和临床疗效。
队列研究；证据水平，3 级。
本研究纳入了 253 例膝 OA 患者（142 名男性，111 名女性；平均年龄±标准差，54.8±11.4 岁；Kellgren-Lawrence 分级 1-3 级），他们接受了 3 次 5 mL 自体白细胞丰富或白细胞贫化 PRP 的关节内注射。所有患者均在基线和 2、6、12 个月时进行前瞻性评估。患者通过膝关节损伤和骨关节炎结果评分（KOOS）亚量表和国际膝关节文献委员会（IKDC）主观评分进行临床评估。血小板浓度与临床结果相关。进一步的分析是根据血小板浓度（高、中、低）将患者分为 3 组（OA 严重程度均匀）进行的。报告了所有并发症和不良事件，以及治疗失败的情况。
从基线到每次随访评估，所有临床评分均有统计学意义上的显著改善。血小板浓度与临床结果呈正相关。KOOS 疼痛在 2 个月时（=0.036；rho=0.132）、6 个月时（=0.009；rho=0.165）和 12 个月时（=0.014；rho=0.155）改善程度与血小板浓度较高有关。其他 KOOS 亚量表和 IKDC 主观评分以及高、中、低血小板 PRP 组之间的比较也显示出相同的趋势。低血小板组的失败率最高（15.0%），与中血小板组（3.3%）和高血小板组（3.3%）相比。在不良事件方面，3 组之间无差异。
本研究表明，血小板浓度影响 PRP 治疗膝骨关节炎的临床疗效。与血小板浓度较低的 PRP 相比，血小板浓度较高的 PRP 治疗膝骨关节炎患者的失败率较低，临床改善程度较高，在 12 个月的随访中总体效果更好。
