Skip to main content
  • Original article
  • Open access
  • Published:

Intra-articular injection of platelet - rich plasma and therapeutic exercise in knee osteoarthritis

Abstract

Context

There is no definite treatment strategy capable of decreasing destruction of cartilage and enhancing its healing. Intra-articular injection of platelet-rich plasma (PRP) provides a lot of growth factors that are capable of stimulating regeneration of cartilage and is supposed to be a future solution to patients with osteoarthritis (OA).

Aim

To detect the efficacy of intra-articular injection of PRP or therapeutic exercise (Ex) alone as well as a combination of both in the treatment of idiopathic knee OA.

Settings and design

A prospective randomized controlled clinical study was conducted.

Patients and methods

A total of 60 patients, 44 to 65 years of age, having idiopathic unilateral knee OA were included in the study and were divided into three groups: PRP group included 20 patients and were treated with intra-articular PRP injection, Ex group included 20 patients and were treated with only therapeutic Ex, and PRP and Ex group included 20 patients who were treated with both PRP intra-articular injection and therapeutic Ex. Evaluation of all patients was done by visual analogue scale, tenderness, range of motion, thigh circumference, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores at baseline and 1 and 6 months later. Objective evaluation was done through MRI of osteoarthritic knee at baseline and 6 months later.

Statistical analysis

Statistical analyses were performed using SPSS for windows, version 20.0.

Results

Baseline WOMAC score differences among the three groups were not statistically significant but were significant 6 months after treatment. In PRP and Ex groups, there was a significant improvement after treatment, whereas a highly significant improvement in PRP+Ex group. MRI grading differences among the three groups were not significant before or after treatment, with no improvement in all three groups after treatment.

Conclusion

A combination of intra-articular injection of PRP and therapeutic Ex resulted in significantly lesser visual analogue scale, WOMAC score, and joint tenderness compared with PRP or Ex alone.

References

  1. Bosomworth N. Exercise and knee osteoarthritis: benefit or hazard? Can Fam Physician 2009; 55:871-878

    PubMed  PubMed Central  Google Scholar 

  2. Wang C, Schmid C, Hibberd PL, Kalish R, Roubenoff R, Rones R, McAlindon T. Tai Chi for treating knee osteoarthritis: designing a long-term follow up randomized controlled trial. BMC Musculoskelet Disord 2008;9:100–108

    Google Scholar 

  3. Dreher M, Walterspacher S, Sonntag F, Prettin S, Kabitz H, Windisch W. Exercise in severe COPD: Is walking different from stair-climbing? Respir Med 2008; 102:912–918

    CAS  PubMed  Google Scholar 

  4. Hayami T. Osteoarthritis of the knee joint as a cause of musculoskeletal ambulation disability symptom complex (MADS). Clin Calcium 2008; 18:1574–1580s

    PubMed  Google Scholar 

  5. Henrotin F, Hauzeur J, Bruel P, Appelboom T. Intra-articular use of a medical device composed of hyaluronic acid and chondroitin sulfate: effects on clinical, ultrasonographic and biological parameters. BMC Res Notes 2012; 5:407

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Hochberg M, Altman R, April K, Benkhalti M. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2012; 64:465–474

    CAS  Google Scholar 

  7. Jevsevar D, Brown G, Jones D, Matzkin E, Manner P, Mooar P, et al. The American Academy of Orthopaedic Surgeons evidence-based guideline on: treatment of osteoarthritis of the knee, 2nd edition. J Bone Joint Surg Am 2013; 95:1885–1886

    PubMed  Google Scholar 

  8. Alberto M, Mauro G. Intra articular use of Hyaluronic acid in the treatment of osteoarthritis. Clin Interv Aging 2008; 3:365–369

    Google Scholar 

  9. Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop 2014; 5:351–361

    PubMed  PubMed Central  Google Scholar 

  10. Osteoarthritis Research Society International. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage 2014; 22:363–388

    Google Scholar 

  11. Lange A, Vanwanseele B, Singh M. Strength training for treatment of osteoarthritis of knee. Arthritis Rheum 2008; 59:1488–1494

    PubMed  Google Scholar 

  12. Rodeo S, Delos D, Weber A, Ju X, Cunningham E, Fortier L. What’s new in orthopaedic research? J Bone Joint Surg Am 2010; 92:2491–2501

    PubMed  Google Scholar 

  13. Mc Arthur B, Dy C, Fabricant P, Gonzalez D. Long term safety, efficacy, and patient acceptability of hyaluronic acid injection in patients with painful osteoarthritis of the knee. Patient Prefer Adherence 2012; 6:905–910

    Google Scholar 

  14. Angoorani H, Mazaherinezhad A, Marjomaki O, Younespour Sh. Treatment of knee osteoarthritis with platelet-rich plasma in comparison with transcutaneous electrical nerve stimulation plus exercise. Med J Islam Repub Iran 2015; 29:223

    PubMed  PubMed Central  Google Scholar 

  15. Raeissadat S, Rayegani S, Hassanabadi H. Knee osteoarthritis injection choices: platelet-rich plasma versus hyaluronic acid. Clin Med Insights Arthritis Musculoskel Disord 2014; 8:1–8

    Google Scholar 

  16. Laudy A, Bakker E, Rekers M, Moen M. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and metaanalysis. Am J Phys Med Rehabil 2014; 93:108–121

    Google Scholar 

  17. Richmond J, Hunter D, Irrgang J. Treatment of osteoarthritis of the knee. J Am Acad Orthop Surg 2009; 17:591–600

    PubMed  PubMed Central  Google Scholar 

  18. Kellgren J, Lawrence J. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16:494–502

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Mc Cormack H, Home D, Sheather S. Clinical application of visual analogue scales: a critical review. Psychol Med 1988; 18:1007–1019

    Google Scholar 

  20. Gunn A. The diagnosis of abdominal pain with computer analysis. J R Coll Surg Edinb 1976; 21:170–172

    CAS  PubMed  Google Scholar 

  21. Jones A, Hopkinson N, Pattrick M, Berman P, Doherty M. Evaluation of a method for clinically assessing osteoarthritis of the knee. Ann Rheum Dis 1992; 51:243–245

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Steultjens M, Dekker J, van Baar M, Oostendorp R, BijIsma J. Range of joint motion and disability in patients with osteoarthritis of the knee or hip. Rheumatology 2000; 39:955–961

    CAS  PubMed  Google Scholar 

  23. Strobel M, Stedtfeld H. Diagnostic evaluation of the knee. New York, NY: Springer-Verlag 1990. 166–182

    Google Scholar 

  24. Mc Connell S, Kolopack P, Davis A. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Rheum 2001; 45:453–461

    Google Scholar 

  25. Park H, Kim S, Lee S, Park N, Park J, Choi Y, Jeon H. A practical MRI grading system for osteoarthritis of the knee: association with Kellgren-Lawrence radiographic scores. Eur J Radiol 2013; 82:112–117

    PubMed  Google Scholar 

  26. Hill C, Gale D, Chaisson C, Skinner K, Kazis L, Gale M. Knee effusions, popliteal cysts, and synovial thickening: association with knee pain in osteoarthritis. J Rheumatol 2001; 28:1330–1337

    CAS  PubMed  Google Scholar 

  27. Santo F, Martinez M. Practical guidelines for using PRP in the orthopaedic office. American Academy of Orthopaedic Surgeons. 2010. Available at: http://www.aaos.org. [Accessed 15 November 2012]

  28. Halpern B, Chaudhury S, Rodeo S, Hayter C, Bogner E, Potter H, Nguyen J. Clinical and MRI outcomes after platelet-rich plasma treatment for knee osteoarthritis. Clin J Sport Med 2013; 23:238–239

    PubMed  Google Scholar 

  29. Oiestad B, Osterås N, Frobell R. Efficacy of strength and aerobic exercise on patient-reported outcomes and structural changes in patients with knee osteoarthritis: study protocol for a randomized controlled trial. BMC Musculoskelet Disord 2013; 14: 266

    PubMed  PubMed Central  Google Scholar 

  30. Baker K, Nelson M, Felson D, Layne J, Sarno R, Roubenoff R. The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial. J Rheumatol 2001; 28:1655–1665

    CAS  PubMed  Google Scholar 

  31. Carlos J, Meheux M, Patrick C, McCulloch M, David M. Efficacy of intraarticular platelet-rich plasma injections in knee osteoarthritis: a systematic review. Orthop Sports Med 2015; 10:316–322

    Google Scholar 

  32. Brown G. Treatment of osteoarthritis of the knee: AAOS clinical practice guidelines, evidence-based guideline, 2d ed. J Am Acad Orthop Surg 2013; 21:577–579

    PubMed  Google Scholar 

  33. Raeissadat S, Rayegani S, Hassanabadi H, Rahimi R, Sedighipour L, Rostami K. Is platelet-rich plasma superior to whole blood in the management of chronic tennis elbow: one year randomized clinical trial. BMC Sports Sci Med Rehabil 2015; 18:10–12

    Google Scholar 

  34. Patel S, Dhillon M, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis. Am J Sports Med 2013; 41:356–364

    PubMed  Google Scholar 

  35. Carlos E. Intraarticular injections of platelet-rich plasma (PRP) in the management of knee osteoarthritis. Arch Bone Joint Surg 2013; 1:5–8

    Google Scholar 

  36. Gibbs N, Diamond R, Sekyere O, Wayne D. Management of knee osteoarthritis by combined stromal vascular fraction cell therapy, platelet-rich plasma, and musculoskeletal exercises: a case series. J Pain Res 2015; 8:799–806

    PubMed  PubMed Central  Google Scholar 

  37. Nejati P, Farzinmehr A, Moradi-Lakeh M. The effect of exercise therapy on knee osteoarthritis: a randomized clinical trial. Med J Islam Repub Iran 2015; 29:186

    PubMed  PubMed Central  Google Scholar 

  38. Spakova T, Rosocha J, Lacko M, Harvanova D, Gharaibeh A. Treatment of knee joint osteoarthritis with autologous platelet rich plasma in comparison with hyaluronic acid. Am J Phys Med Rehabil 2012; 91:411–417

    PubMed  Google Scholar 

  39. Paterson L, Nicholls M, Bennell K, Bates D. Intra-articular injection of photo-activated platelet-rich plasma in patients with knee osteoarthritis: a double-blind, randomized controlled pilot study. BMC Musculoskelet Dis 2016; 17:67

    Google Scholar 

  40. Soliman A, Mohamed A, Hanan S, Soliman M. Effectivenes s of the intra-articular injection of platelet rich plasma in the treatment of patients with primary knee osteoarthritis. Egypt Rheumatol 2015; 37:119–124

    Google Scholar 

  41. Maheshwari P, Harshwardhan H. Platelet rich plasma for the treatment of osteoarthrosis knee. Int J Res 2017; 3:242–246

    Google Scholar 

  42. Daly M. Managing hip and knee osteoarthritis with exercise: what is the best prescription? Ther Adv Musculoskel Dis 2010; 2:279–290

    Google Scholar 

  43. Esser S, Bailey A. Effects of exercise and physical activity on knee osteoarthritis. Curr Pain Headache Rep 2011; 15:423–430

    PubMed  Google Scholar 

  44. Lee H, Salter D. Osteoarthritis - progress in basic research and treatment: biomechanics of cartilage and osteoarthritis. Licensee InTech 2015; 41–65

    Google Scholar 

  45. Farrokhi S, Fitzgerald G. The role of physical activity and therapeutic exercise in development and management of knee osteoarthritis. JCOM 2012; 19:30–44

    Google Scholar 

  46. Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Cenacchi A. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc 2010; 18:472–479

    PubMed  Google Scholar 

  47. Wang-Saegusa A, Cugat R, Ares O, Seijas R, Cusco X, Garcia-Balletbo M. nfiltration of plasma rich in growth factors for osteoarthritis of the knee short-term effectson function and quality of life. Arch Orthop Trauma Surg 2011; 131:311–317

    PubMed  Google Scholar 

  48. Anitua E, Sanchez M, Nurden A, Zalduendo M, de la Fuente M, Azofra J. Platelet released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients. Rheumatology 2007; 46:1769–1772

    CAS  PubMed  Google Scholar 

  49. van Buul G, Koevoet W, Kops N. Platelet-rich plasma releasate inhibits inflammatory processes in osteoarthritic chondrocytes. Am JSports Med 2011; 39:2362–2370

    Google Scholar 

  50. Drengk A, Zapf A, Sturmer E, Sturmer K, Frosch K. Influence of platelet-rich plasma on chondrogenic differentiation and proliferation of chondrocytes and mesenchymal stem cells. Cells Tissues Organs 2009; 189:326–331

    Google Scholar 

  51. Woollard J, Gil A, Sparto P. Change in knee cartilage volume in individuals completing a therapeutic exercise program for knee osteoarthritis. J Orthop Sports Phys Ther 2011; 41:708–722

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eman A. R. Hafez.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Badr, M.E.M., Hafez, E.A.R., El-Ghaweet, A.I. et al. Intra-articular injection of platelet - rich plasma and therapeutic exercise in knee osteoarthritis. Egypt Rheumatol Rehabil 46, 1–10 (2019). https://doi.org/10.4103/err.err_22_18

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/err.err_22_18

Keywords