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01-02-2021 | Arthroscopy | Original Paper

Leucocyte-poor-platelet-rich plasma intra-operative injection in chondral knee injuries improve patients outcomes. A prospective randomized trial

Authors: Marcus Vinicius Danieli, João Paulo Fernandes Guerreiro, Alexandre Oliveira Queiroz, Hamilton da Rosa Pereira, Daniele Cristina Cataneo

Published in: International Orthopaedics | Issue 2/2021

Abstract

Purpose

Evaluate the effects of intra-operative leucocyte-poor-platelet-rich plasma (PRP) (type P3-Bβ with endogenous activation) injection in International Cartilage Repair Society (ICRS) grade III knee chondral injuries treated by chondroplasties, to increase and ameliorate the repair tissue.

Methods

Patients were divided into two groups. Group A (control) consisted of 31 patients and Group B (PRP) 33 patients, totaling 64 patients analyzed. Patients also could had associated injuries (meniscal and/or ACL) being equally divided between both groups to avoid bias. PRP was injected at the end of surgery in group B. The patient outcomes were assessed using subjective International Knee Documentation Committee (IKDC) form, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Tegner activity forms, prior to the surgery and three, six, 12, and 24 months after surgery (medium-term follow up).

Results

IKDC and KOOS scores showed increase at each evaluation time points after surgery in both groups, but the treated Group (B) showed a higher increase with statistically significant difference. The Tegner activity scores were higher for the treated group only at six and 12 months.

Conclusion

Based on the subjective IKDC, KOOS, and Tegner scores, those patients affected by ICRS grade III chondral injuries undergoing arthroscopic chondroplasty who were also treated with PRP showed better and faster outcomes than the control group. Independently from the associated injury (meniscal or ACL). This difference could be measured for up to two years.

Alford JW, Cole BJ (2005) Cartilage restoration. Part 1. Basic science historical perspective patient evaluation and treatment options. Am J Sports Med 33(2):295–306. https://doi.org/10.1177/0363546504273510CrossRefPubMed

Bhosale AM, Richardson JB (2008) Articular cartilage: structure, injuries and review of management. Br Med Bull 87(1):77–95. https://doi.org/10.1093/bmb/ldn025CrossRefPubMed

Filardo G, Andriolo L, Balboni F et al (2015) Cartilage failures. Systematic literature review critical survey analysis and definition. Knee Surg Sports Traumatol Arthrosc 23(12):3660–3669. https://doi.org/10.1007/s00167-014-3272-2CrossRefPubMed

Mascarenhas R, Saltzman BM, Fortier LA, Cole BJ (2015) Role of platelet-rich plasma in articular cartilage injury and disease. J Knee Surg 28(1):3–10. https://doi.org/10.1055/s-0034-1384672CrossRefPubMed

Mehta S, Watson JT (2008) Platelet rich concentrate: basic science and current clinical applications. J Orthop Trauma 22(6):433–438. https://doi.org/10.1097/BOT.0b013e31817e793fCrossRef

Foster TE, Puskas BL, Mandelbaum BR et al (2009) Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med 37(11):2259–2272. https://doi.org/10.1177/0363546509349921CrossRefPubMed

Del Torto M, Enea D, Panfoli N et al (2015) Hamstrings anterior cruciate ligament reconstruction with and without platelet rich fibrin matrix. Knee Surg Sports Traumatol Arthrosc 23(12):3614–3622. https://doi.org/10.1007/s00167-014-3260-6CrossRefPubMed

Lopez-Vidriero E, Goulding KA, Simon DA et al (2010) The use of platelet-rich plasma in arthroscopy and sports medicine: optimizing the healing environment. Arthroscopy 26(2):269–278. https://doi.org/10.1016/j.arthro.2009.11.015CrossRefPubMed

Sheth U, Simunovic N, Klein G et al (2012) Efficacy of autologous platelet-rich plasma use for Orthopaedic indications: a meta-analysis. J Bone Joint Surg Am 94(4):298–307. https://doi.org/10.2106/JBJS.K.00154CrossRef

10.

Kreuz PC, Krüger JP, Metzlaff S et al (2015) Platelet-rich plasma preparation types show impact on chondrogenic differentiation. Migration and proliferation of human subchondral mesenchymal progenitor cells. Arthroscopy 31(10):1951–1961. https://doi.org/10.1016/j.arthro.2015.03.033CrossRefPubMed

11.

Cugat R, Cuscó X, Seijas R et al (2015) Biologic enhancement of cartilage repair: the role of platelet-rich plasma and other commercially available growth factors. Arthroscopy 31(4):777–783. https://doi.org/10.1016/j.arthro.2014.11.031CrossRefPubMed

12.

Filardo G, Kon E, Roffi A et al (2015) Platelet-rich plasma: why intra-articular? A systematic review of preclinical studies and clinical evidence on PRP for joint degeneration. Knee Surg Sports Traumatol Arthrosc 23(9):2459–2474. https://doi.org/10.1007/s00167-013-2743-1CrossRefPubMed

13.

Mishra A, Harmon K, Woodall J, Vieira A (2012) Sports medicine applications of platelet rich plasma. Curr Pharm Biotechnol 13(7):1185–1195. https://doi.org/10.2174/138920112800624283CrossRefPubMed

14.

Sundman EA, Cole BJ, Karas V et al (2014) The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med 42(1):35–41. https://doi.org/10.1177/0363546513507766CrossRefPubMed

15.

Sakata R, McNary SM, Miyatake K et al (2015) Stimulation of the superficial zone protein and lubrication in the articular cartilage by human platelet-rich plasma. Am J Sports Med 43(6):1467–1473. https://doi.org/10.1177/0363546515575023CrossRefPubMedPubMedCentral

16.

Filardo G, Di Matteo B, Di Martino A et al (2015) Platelet-rich plasma intra-articular knee injections show no superiority versus viscosupplementation: a randomized controlled trial. Am J Sports Med 43(7):1575–1582. https://doi.org/10.1177/0363546515582027CrossRefPubMed

17.

Kanchanatawan W, Arirachakaran A, Chaijenkij K et al (2016) Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 24(5):1665–1677. https://doi.org/10.1007/s00167-015-3784-4CrossRefPubMed

18.

Filardo G, Previtali D, Napoli F et al (2020) PRP injections for the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials. Cartilage 1947603520931170. Advance online publication. https://doi.org/10.1177/1947603520931170

19.

Tavassoli M, Janmohammadi N, Hosseini A et al (2019) Single- and double-dose of platelet-rich plasma versus hyaluronic acid for treatment of knee osteoarthritis: a randomized controlled trial. World J Orthop 10(9):310–326. https://doi.org/10.5312/wjo.v10.i9.310CrossRefPubMedPubMedCentral

20.

Kon E, Mandelbaum B, Buda R et al (2011) Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Arthroscopy 27(11):1490–1501. https://doi.org/10.1016/j.arthro.2011.05.011CrossRefPubMed

21.

Delong JM, Russel RP, Mazzoca AD (2012) Platelet-rich plasma: the PAW classification system. Arthroscopy 28(7):998–1009. https://doi.org/10.1016/j.arthro.2012.04.148CrossRefPubMed

22.

Magalon J, Bausset O, Serratrice N et al (2014) Characterization and comparison of 5 platelet-rich plasma preparations in a single-donor model. Arthroscopy 30(5):629–638. https://doi.org/10.1016/j.arthro.2014.02.020CrossRefPubMed

23.

Oh JH, Kim W, Park KU, Roh YH (2015) Comparison of the cellular composition and cytokine-release kinetics of various platelet-rich plasma preparations. Am J Sports Med 43(12):3062–3070. https://doi.org/10.1177/0363546515608481CrossRefPubMed

24.

Harrison S, Vavken P, Kevy S et al (2011) Platelet activation by collagen provides sustained release of anabolic cytokines. Am J Sports Med 39(4):729–734. https://doi.org/10.1177/0363546511401576CrossRefPubMedPubMedCentral

25.

Hart R, Safi A, Komzák M et al (2013) Platelet-rich plasma in patients with tibiofemoral cartilage degeneration. Arch Orthop Trauma Surg 133(9):1295–1301. https://doi.org/10.1007/s00402-013-1782-xCrossRefPubMed

26.

Di Martino A, Di Matteo B, Papio T et al (2019) Platelet-rich plasma versus hyaluronic acid injections for the treatment of knee osteoarthritis. Results at 5 years of a double-blind, Randomized Controlled Trial. Am J Sports Med 47(2):347–354. https://doi.org/10.1177/0363546518814532CrossRefPubMed

27.

Marmotti A, Rossi R, Castoldi F et al (2015) PRP and articular cartilage: a clinical update. Biomed Res Int 2015:542502. https://doi.org/10.1155/2015/542502CrossRefPubMedPubMedCentral

28.

Siclari A, Mascaro G, Gentili C et al (2012) A cell-free scaffold-based cartilage repair provides improved function hyaline-like repair at one year. Clin Orthop Relat Res 470(3):910–919. https://doi.org/10.1007/s11999-011-2107-4CrossRefPubMed

29.

Yoshida R, Murray MM (2013) Peripheral blood mononuclear cells enhance the anabolic effects of platelet-rich plasma on anterior cruciate ligament fibroblasts. J Orthop Res 31(1):29–34. https://doi.org/10.1002/jor.22183CrossRefPubMed

30.

Belk JW, Kraeutler MJ, Houck DA et al (2020) Platelet-rich plasma versus hyaluronic acid for knee osteoarthritis. Am J Sports Med 363546520909397. Advance online publication. https://doi.org/10.1177/0363546520909397

31.

Figueroa D, Figueroa F, Calvo R et al (2015) Platelet-rich plasma use in anterior cruciate ligament surgery: systematic review of the literature. Arthroscopy 31(5):981–988. https://doi.org/10.1016/j.arthro.2014.11.022CrossRefPubMed

32.

Danieli MV, Guerreiro JPF, Queiroz AO et al (2016) Diagnosis and classification of chondral knee injuries: comparison between magnetic resonance imaging and arthroscopy. Knee Surg Sports Traumatol Arthrosc 24(5):1627–1633. https://doi.org/10.1007/s00167-015-3622-8CrossRefPubMed

33.

Link TM, Neumann J, Li X (2017) Prestructural cartilage assessment using MRI. J Magn Reson Imaging 45(4):949–965. https://doi.org/10.1002/jmri.25554CrossRefPubMed

34.

Dye SF, Vaupel GL, Dye CC (1998) Conscious neurosensory mapping of the internal structures of the human knee without Intraarticular anesthesia. Am J Sports Med 26(6):773–777. https://doi.org/10.1177/03635465980260060601CrossRefPubMed

Title: Leucocyte-poor-platelet-rich plasma intra-operative injection in chondral knee injuries improve patients outcomes. A prospective randomized trial
Authors: Marcus Vinicius Danieli
João Paulo Fernandes Guerreiro
Alexandre Oliveira Queiroz
Hamilton da Rosa Pereira
Daniele Cristina Cataneo
Publication date: 01-02-2021
Publisher: Springer Berlin Heidelberg
Keywords: Arthroscopy
Arthroscopy
Published in: International Orthopaedics / Issue 2/2021
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04830-4

At a glance: The STEP trials

Springer Medicine

Leucocyte-poor-platelet-rich plasma intra-operative injection in chondral knee injuries improve patients outcomes. A prospective randomized trial

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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