Singh Ambika, Chakravarty Sarthak, Sehgal Dylan, Rust Brandon, Sharieff Khavir A
Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA.
Surgery, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Tampa, USA.
Cureus. 2024 Dec 10;16(12):e75497. doi: 10.7759/cureus.75497. eCollection 2024 Dec.
Knee osteoarthritis (KOA) is a healthcare burden affecting over 595 million people worldwide. Recently, intra-articular platelet-rich plasma (PRP) injections from the patient's blood have shown promise in slowing KOA progression due to platelets' regenerative properties. This study aimed to evaluate the optimal dosing and schedule for PRP therapy in managing mild to moderate KOA. A systematic search was conducted across Embase, Ovid Medline, Web of Science, Cochrane Central, and CINAHL using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify articles published from August 2015 to March 2024. Keywords included "platelet rich plasma," "knee osteoarthritis," and "administration schedule." Inclusion criteria were studies on human patients utilizing PRP as monotherapy in experimental trials, while review articles, editorials, case reports, and meta-analyses were excluded. Three reviewers independently extracted and described patient interventions and outcomes, focusing on Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS), and imaging changes. Thirty-nine publications with PRP monotherapy protocols were found, with fourteen meeting the inclusion criteria. Twelve studies were randomized clinical trials, and two were longitudinal cohort studies, totaling 1704 patients with a mean follow-up of 7.51 ± 4.82 months. The most common PRP protocol was 4.357 ± 1.419 mL infusions, with three doses every four weeks and a single dose being frequent. Platelet values varied, with seven including a mean platelet count, three reporting that the platelet concentration in each dose had to be at least 150,000/μL, and four did not include platelet concentration. There was notable variation in PRP acquisition protocols, blood volume, and centrifugation processes across studies. Therapeutic benefits were represented by WOMAC and VAS scores rather than imaging changes. PRP injections appear to be safe and effective for symptomatic relief of knee pain associated with mild to moderate osteoarthritis (OA). The average infusion volume was 4 mL, administered at three doses four weeks apart. Given that platelet-derived growth factors promote the proliferation of chondrocytes and mesenchymal stem cells, leading to the stimulation of articular cartilage remodeling, further studies are warranted to assess the optimal platelet count necessary for the long-term effects of PRP in knee cartilage healing and sustained symptomatic improvement.
膝关节骨关节炎（KOA）是一种影响全球超过5.95亿人的医疗负担。最近，从患者血液中提取的关节腔内注射富血小板血浆（PRP），因其血小板的再生特性，在减缓KOA进展方面显示出了前景。本研究旨在评估PRP治疗轻至中度KOA的最佳剂量和方案。按照系统评价和Meta分析的首选报告项目（PRISMA）指南，在Embase、Ovid Medline、Web of Science、Cochrane Central和CINAHL数据库中进行了系统检索，以识别2015年8月至2024年3月发表的文章。关键词包括“富血小板血浆”、“膝关节骨关节炎”和“给药方案”。纳入标准为在实验性试验中以PRP作为单一疗法的人类患者研究，排除综述文章、社论、病例报告和Meta分析。三名评审员独立提取并描述患者干预措施和结果，重点关注西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、视觉模拟量表（VAS）和影像学变化。发现39篇有PRP单一疗法方案的出版物，其中14篇符合纳入标准。12项研究为随机临床试验，2项为纵向队列研究，共1704例患者，平均随访7.51±4.82个月。最常见的PRP方案是输注4.357±1.419 mL，每四周注射三剂，单剂量较为常见。血小板值各不相同，7项研究包括平均血小板计数，3项报告每剂中的血小板浓度必须至少为150,000/μL，4项未提及血小板浓度。各项研究在PRP采集方案、血量和离心过程方面存在显著差异。治疗效果以WOMAC和VAS评分表示，而非影像学变化。PRP注射对于轻至中度骨关节炎（OA）相关的膝关节疼痛的症状缓解似乎是安全有效的。平均输注量为4 mL，每隔四周注射三剂。鉴于血小板衍生生长因子可促进软骨细胞和间充质干细胞的增殖，从而刺激关节软骨重塑，有必要进一步开展研究，以评估PRP在膝关节软骨愈合和持续症状改善方面的长期效果所需的最佳血小板计数。
