Comparison of clinical outcome, cartilage turnover, and inflammatory activity following either intra-articular or a combination of intra-articular with intra-osseous platelet-rich plasma injections in osteoarthritis knee: A randomized, clinical trial

Apurba Barman; Debapriya Bandyopadhyay; Sudipta Mohakud; Jagannatha Sahoo; Rituparna Maiti; Somnath Mukherjee; Satya Prakash; Sankha Subhra Roy; Amrutha Viswanath

doi:10.1016/j.injury.2022.11.036

Comparison of clinical outcome, cartilage turnover, and inflammatory activity following either intra-articular or a combination of intra-articular with intra-osseous platelet-rich plasma injections in osteoarthritis knee: A randomized, clinical trial

Injury. 2023 Feb;54(2):728-737. doi: 10.1016/j.injury.2022.11.036. Epub 2022 Nov 15.

Authors

Apurba Barman¹, Debapriya Bandyopadhyay², Sudipta Mohakud³, Jagannatha Sahoo⁴, Rituparna Maiti⁵, Somnath Mukherjee⁶, Satya Prakash⁶, Sankha Subhra Roy⁴, Amrutha Viswanath⁴

Affiliations

¹ Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India. Electronic address: pmr_apurba@aiimsbhubaneswar.edu.in.
² Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, India.
³ Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India.
⁴ Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India.
⁵ Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, India.
⁶ Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, India.

PMID: 36414504
DOI: 10.1016/j.injury.2022.11.036

Abstract

Background: The objective of the study was to determine the changes in clinical outcome (pain and knee activity) and assess bone/ cartilage biomarkers and inflammatory activity in persons with osteoarthritis (OA) knee following a single injection of intra-articular platelet-rich plasma (IA-PRP) and combination of intra-articular, intraosseous PRP (IA+IO-PRP).

Methods: This prospective, randomized, single-blind clinical trial was conducted at a tertiary care teaching hospital in India. Ninety-six persons with OA knee with a Kellgren-Lawrence score of 3 were randomized into three groups- Group-I (IA-PRP), Group-II (IA+IO-PRP)], Group-III, [intra-articular normal saline (IA-NS)]. The primary outcome was a visual analog scale (VAS) for pain. The secondary outcomes were the Knee Injury and Osteoarthritis Outcome Score (KOOS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), bone/ cartilage turnover biomarkers [C-telopeptide (CTX-II), N-telopeptide (NTX-I), cartilage oligomeric matrix protein (COMP), N-terminal propeptide of collagen type-IIA (PIIANP), and hyaluronic acid (HA)], ultrasonography (USG) findings of the knee joint. The outcome measures were assessed at baseline, 6, and 12 weeks of follow-up.

Results: Compared to IA-NS injection, IA-PRP and IA+IO-PRP injections significantly improved VAS-pain and KOOS scores at 6 and 12 weeks. Furthermore, both PRP groups showed a significant reduction in ESR, CRP, and CTX-II at 12 weeks following PRP injections. In addition, at 12 weeks, the IA+IO-PRP group showed a significant reduction (p=0.009) in NTX-I level. Persons in the IA+IO-PRP group reported significant reductions in the synovial-effusion and infra-patellar bursitis.

Conclusions: Significant clinical improvements were noticed following IA-PRP and IA-IO-PRP injections compared to IA-NS injections. Both PRP groups reported a significant reduction in ESR, CRP, and CTX-II levels at 12 weeks. Persons in the IA+IO-PRP group reported significant changes in u-NTX-I level and knee-USG findings.

Keywords: Biomarker; Knee; Osteoarthritis; Platelet-rich plasma.

Publication types

Randomized Controlled Trial

MeSH terms

Cartilage
Humans
Injections, Intra-Articular
Knee Joint / diagnostic imaging
Osteoarthritis, Knee* / diagnostic imaging
Osteoarthritis, Knee* / therapy
Pain
Platelet-Rich Plasma*
Prospective Studies
Single-Blind Method
Treatment Outcome