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Platelet-Rich Plasma Injections for Knee Osteoarthritis - Hype or Help?

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The efficacy of platelet-rich plasma injections for knee osteoarthritis is being reevaluated by many researchers. Read the article to know more.

Medically reviewed by

Dr. Anuj Nigam

Published At May 24, 2023
Reviewed AtNovember 20, 2023

What Is Platelet-Rich Plasma?

Platelet-rich plasma is made up of two components: plasma (the liquid part of the blood), and platelets (blood cells that play a crucial role in the healing of tissues). Platelets are responsible for their blood clotting abilities. They also contain growth factors that stimulate reproduction and tissue regeneration in the affected area.

Platelet-Rich Plasma Therapy for Knee Osteoarthritis

Platelet-rich plasma therapy is a treatment modality where the platelet-rich plasma concentrate that is rich in blood growth factors is injected into the affected joint to provide symptomatic relief to the patients.

How Does Platelet-Rich Plasma Therapy Work?

The platelets in the blood contain various growth factors that when injected into the injured tissues can initiate tissue regeneration. Therefore, platelet-rich plasma therapy can reverse the tissue damage that is existing in the tissues.

Does Platelet-Rich Plasma Therapy for Knee Osteoarthritis Work for Everyone?

  • Not enough evidence is available to support the theory that platelet-rich plasma therapy relieves osteoarthritis symptoms.

  • Various clinical trials of platelet-rich plasma injections for knee osteoarthritis have shown not at all or very little symptomatic benefit from the treatment.

  • In many trials, platelet-rich plasma therapy has not been found better than a placebo treatment.

  • In patients where the therapy has been found to be effective, it is evident that not all patients benefit from it.

Is Platelet-Rich Plasma Therapy for Knee Osteoarthritis Effective?

  • Platelet-rich plasma therapy is an experimental treatment modality.

  • The evidence related to the efficacy of using this therapy has not been proved completely. Scientists no longer consider it to be an efficient treatment modality since various limitations are associated with the usage of this therapy.

  • Various clinical trials have suggested conflicting results.

  • Many studies have advocated its usage, and many other scientists have opposed its usage for the treatment of knee osteoarthritis suggesting no effect on the trial cases.

  • More research studies are required to determine whether this therapy can serve as a suitable option to alleviate pain in osteoarthritic patients.

Factors That Determine the Efficacy of Platelet-Rich Plasma Therapy for Knee Osteoarthritis

  • Condition of the Specific Disease- The platelet-rich plasma therapy is not found to be effective in advanced cases and therefore the condition is difficult to treat in such advanced cases.
  • Overall Health of the Patient- The overall health of the patient is very important since a patient having poor health will not respond well to the treatment therapy.

  • Immune Status- Every individual is unique and will respond differently to the treatment therapy being given to him or her. It completely depends on his immune status and how he will respond to a particular treatment modality.

Who Can Benefit From Platelet-Rich Plasma Therapy?

  • Health experts do not currently advocate the use of platelet-rich plasma therapy.

  • The doctor’s advice is a must before opting for this treatment therapy.

  • This is an experimental treatment modality therefore it is not yet proven to be a safe and effective method.

  • The insurance policy will not cover this treatment.

  • A team of well-qualified doctors is required for the treatment since it is a sensitive procedure.

What Happens During the Procedure?

  • The blood is withdrawn from the arm by the doctor.

  • The blood sample is then centrifuged to separate the components and obtain a concentrate of the platelet-rich plasma.

  • The doctor will then numb the patient’s knee.

  • The platelet-rich plasma is then injected into the injured joint space in the patient’s knee. Ultrasound may be used to direct the injection.

  • After resting for a while, the patient can go back home.

What Are the Risks Associated With the Platelet-Rich Plasma Therapy for Knee Osteoarthritis?

  • Bleeding at the site of injection.

  • Pain and tenderness at the site of injection.

  • Infection at the injection site.

  • Nerve damage at the injection site.

  • Pain and stiffness in the joint space.

  • Increased heartbeat.

  • Nausea and vomiting.

  • Lightheadedness.

  • Fainting.

  • Headache.

  • Fatigue.

  • Sweating.

What Are the Uncertainties Associated With Platelet-Rich Plasma Therapy?

Medical experts still have many questions unanswered related to platelet-rich plasma treatment modality.

  • Indications- For example, when this treatment should be provided? Another question that is frequently asked is whether it is an effective treatment modality for knee osteoarthritis. Should the treatment be provided in the early stages of knee osteoarthritis or when all other treatment options have been used?

  • Dosage of the Platelet-Rich Plasma Therapy- What is the optimal dosage of the plasma to be injected?

  • The Concentration of the Platelets- What is the concentration of the platelets to be used for the treatment purpose?

  • Addition of Thrombin- Does the addition of thrombin make the platelet-rich plasma more effective as a treatment therapy?

  • Timings of Injection- When the injection should be administered?

  • Frequency of Injection- What is the frequency with which injections should be given? Is it sufficient enough to give one injection?

  • Rehabilitation Protocol- What is the best protocol for rehabilitation to be used after the injection?

Limitations of Platelet-Rich Plasma Therapy

  • Lack of Standardized Dosage for Platelet-Rich Plasma Therapy- The dosage of the platelet-rich plasma injection is patient-dependent and varies from one patient to another.

  • Lack of a Standardized Device - There is no proper device to date to formulate the ideal composition.

  • Use Is Limited to a Few Elite Athletes- It is mainly used to treat a few rich and high-class athletes only.

  • Inhibits Bone Formation- Platelet-rich plasma injection accelerates soft-tissue regeneration and repair, however, it inhibits bone formation. Hence it is mainly used for the treatment of tendons

  • Fibrous Scar Formation- Platelet-rich fibrin can cause fibrous connective tissue and scar formation.

  • Lacks Osteoinduction- Platelet-rich plasma lacks the property of osteoinduction (the process by which the process of bone healing is stimulated).

  • Works in Conjunction With Other Therapies- It is believed that this therapy works best in combination with other treatments.

  • Lack of Substantial Data Regarding Platelet-Rich Plasma Therapy- Several clinical studies and trials are going on to add value to its users.

Conclusion

It is a common question that is frequently asked whether platelet-rich plasma therapy is a future or a trend. The role of platelet-rich plasma is being widely studied through extensive clinical trials in the field of tissue or stem cell regeneration and repair. The therapy shows promising results but just for short-term or temporary use, which may assist the physical therapy but it is yet to be confirmed whether it can be used as the mainstay treatment therapy for musculoskeletal injuries. The possible role of platelet-rich plasma therapy in initiating the healing process of musculoskeletal injuries in elite, high-class athletes, is the only benefit that may eventually pave the way for the development of more advanced treatments. But the therapy should be exercised with caution until successful clinical data is collected to support the hypothesis. The doctors should continue to do extensive research to standardize its dosage, method of preparation, and use. Therefore, it can be concluded that platelet-rich plasma is an optional therapy with its limitations and that is yet to be proved.

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Dr. Anuj Nigam
Dr. Anuj Nigam

Orthopedician and Traumatology

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