Effect of Autologous Conditioned Plasma Injections in Patients With Knee Osteoarthritis

Jasmijn V Korpershoek; Lucienne A Vonk; Giuseppe Filardo; Esmee C Kester; Nienke van Egmond; Daniël B F Saris; Roel J H Custers

doi:10.1177/23259671231184848

Effect of Autologous Conditioned Plasma Injections in Patients With Knee Osteoarthritis

Orthop J Sports Med. 2023 Jul 28;11(7):23259671231184848. doi: 10.1177/23259671231184848. eCollection 2023 Jul.

Authors

Jasmijn V Korpershoek¹, Lucienne A Vonk¹, Giuseppe Filardo^{2

3}, Esmee C Kester¹, Nienke van Egmond¹, Daniël B F Saris^{1

4

5}, Roel J H Custers¹

Affiliations

¹ Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands.
² Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland.
³ Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
⁴ Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁵ Department of Reconstructive Medicine, University of Twente, Enschede, the Netherlands.

Abstract

Background: Autologous conditioned plasma (ACP) is a commercially available platelet concentrate with promising results from clinical trials.

Purpose: To evaluate the clinical outcome after 3 consecutive injections of ACP in patients with knee osteoarthritis (OA) and study the influence of ACP composition and different patient factors as predictors of treatment effect.

Study design: Case series; Level of evidence, 4.

Methods: This prospective case series included 260 patients (307 knees) who received ACP treatment for knee OA. The mean patient age was 51 ± 10 years. Improvement up to 12 months' follow-up was measured using the Knee injury and Osteoarthritis Outcome Score (KOOS). ACP composition was analyzed in 100 patients. The predictive value of age, sex, history of knee trauma, Kellgren-Lawrence OA grade, body mass index, and ACP composition was evaluated using generalized estimating equations.

Results: The mean overall KOOS improved from 38 ± 14 at baseline to 45 ± 18 at 3 months, 45 ± 18 at 6 months, and 43 ± 18 at 12 months (all P < .05); 40% of patients achieved an improvement above the minimal clinically important difference (MCID) of 8 after 6 months and 33% after 12 months. The variation in ACP composition did not correlate with KOOS (P > .05). Older age led to a greater clinical benefit (β = 0.27; P = .05), whereas bilateral treatment predicted worse outcomes (β = -5.6; P < .05).

Conclusion: The improvement in KOOS after treatment with ACP did not reach the MCID in most study patients. Older age was a predictor for better outcomes. The composition of ACP varied between patients but did not predict outcomes within the evaluated range. The study findings show the limited benefit of ACP treatment for knee OA and call for caution with routine use in clinical practice.

Keywords: ACP; PRP; injections; knee osteoarthritis; platelets.