American Society of Regional Anesthesia and Pain Medicine May 2017 - 39
baseline levels before PRP treatment. Authors of one of the recent
RCTs stated that the outcomes were further improved at 18 months
by annual repetition of the PRP treatment.11 Variables possibly
affecting the duration of clinical effects are related to the variety of
study designs and variability of autologous agent preparations (eg,
methods of PRP preparation, white blood cell count in the injectate,
volume of blood used for PRP preparations, type of anticoagulant
used). Substantial variability in treatment strategies was also noted
(number of PRP injections; timing of injections; patients' use of
opioids, NSAIDs, or other pharmacologic agents; and concomitant
use of physical rehabilitation or other treatment modalities). The
duration of clinical benefit depended on variabilities in patient
selection, including age, sex, and comorbidities (eg, obesity,
depression, disability, worker compensation status) that were not
routinely presented in the reports.
SUMMARY
Dissatisfaction with the results of available injectable agents for
management of pain and dysfunction associated with knee OA has
led to explorations of newer options, including PRP, platelet lysates,
conditioned serum, alpha-2-macroglobulin, isolated growth factors,
and mesenchymal stem cells. Regenerative medicine agents are
used with the intention of shifting the balance toward reparative
processes in the knee joint affected by the degenerative process
or injury. Results of robust experimental studies, widespread
use in sports medicine, and simplicity of preparation of PRP
have contributed to its popularity for the treatment of symptoms
associated with knee OA. Analysis of existing clinical studies
suggests that the duration of therapeutic benefits of PRP or
recounted autologous products injection-including decreased
pain and improved functional status-for patients with knee OA
and chondropathy lasted up to 6 months from the time of injection.
Pain and functional scores decreased after 12 months of follow-
up but were still superior to pre-injection scores in most of the
publications. The analysis is limited by the significant variability of
the studies.
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Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total knee arthroplasty volume,
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Losina E, Burbine SA, Suter LG, et al. Pharmacologic regimens for knee
osteoarthritis prevention: can they be cost-effective? Osteoarthritis Cartilage.
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Cheng OT, Souzdalnitski D, Vrooman B, Cheng J. Evidence-based knee injections
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Strand V, McIntyre LF, Beach WR, Miller LE, Block JE. Safety and efficacy of
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Rutjes AW, Juni P, da Costa BR, Trelle S, Nuesch E, Reichenbach S.
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Thorlund JB, Juhl CB, Roos EM, Lohmander LS. Arthroscopic surgery for
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Souzdalnitski D. Regenerative medicine: invigorating pain management practice.
Tech Reg Anesth Pain Manag. 2015;19(1-2):1-2.
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LaPrade CM, James EW, LaPrade RF, Engebretsen L. How should we evaluate
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10. Souzdalnitski D, Narouze SN, Lerman IR, Calodney A. Platelet-rich plasma
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11. Gobbi A, Lad D, Karnatzikos G. The effects of repeated intra-articular PRP
injections on clinical outcomes of early osteoarthritis of the knee. Knee Surg
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2017
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