Leukocyte-Poor Platelet-Rich Plasma Injections Improve Cartilage T1ρ and T2 and Patient-Reported Outcomes in Mild-to-Moderate Knee Osteoarthritis

Favian Su; Michelle W Tong; Drew A Lansdown; Anthony Luke; C Benjamin Ma; Brian T Feeley; Sharmila Majumdar; Alan L Zhang

doi:10.1016/j.asmr.2023.04.009

Leukocyte-Poor Platelet-Rich Plasma Injections Improve Cartilage T1ρ and T2 and Patient-Reported Outcomes in Mild-to-Moderate Knee Osteoarthritis

Arthrosc Sports Med Rehabil. 2023 May 20;5(3):e817-e825. doi: 10.1016/j.asmr.2023.04.009. eCollection 2023 Jun.

Authors

Favian Su¹, Michelle W Tong², Drew A Lansdown¹, Anthony Luke¹, C Benjamin Ma¹, Brian T Feeley¹, Sharmila Majumdar², Alan L Zhang¹

Affiliations

¹ Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A.
² Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, U.S.A.

Abstract

Purpose: To use T1ρ and T2 magnetic resonance imaging to evaluate the effect of leukocyte-poor platelet-rich plasma (LP-PRP) injections on knee cartilage health and to correlate structural changes with patient-reported outcome measurements.

Methods: Ten patients with symptomatic unilateral mild-to-moderate knee osteoarthritis (Kellgren-Lawrence Grade 1-2) underwent T1ρ and T2 magnetic resonance imaging of both the symptomatic and contralateral knee before injection and 6 months after injection with LP-PRP. Patient-reported outcome questionnaires (Knee Osteoarthritis Outcome Score and International Knee Documentation Committee) that evaluate the domains of pain, symptoms, activities of daily living, sports function, and quality of life were completed at baseline, 3 months, 6 months, and 12 months after injection. T1ρ and T2 relaxation times, which are correlated with the proteoglycan and collagen concentration of cartilage, were measured in compartments with and without chondral lesions.

Results: Ten patients were prospectively enrolled (9 female, 1 male) with a mean age of 52.9 years (range, 42-68) years and mean body mass index of 23.2 ± 1.9. Significant increases in Knee Osteoarthritis Outcome Score for all subscales and International Knee Documentation Committee scores were observed 3 months after injection and the improvements were sustained at 12 months. T1ρ and T2 values of compartments with chondral lesions were observed to significantly decrease by 6.0% (P = .036) and 7.1% (P = .017) 6 months after LP-PRP injection, respectively. No significant associations between T1ρ and T2 relaxation times and improvement in patient-reported outcomes were observed.

Conclusions: Patients undergoing LP-PRP injections for the treatment of mild-to-moderate knee osteoarthritis had increased proteoglycan and collagen deposition in the cartilage of affected compartments by 6 months after injection. Patient-reported outcomes scores improved 3 months after injection and were sustained through 1 year after injection, but these improvements were not associated with the changes in proteoglycan and collagen deposition in knee cartilage.

Level of evidence: Level II, prospective cohort study.

Grants and funding

R38 AG070171/AG/NIA NIH HHS/United States