Top

International Orthopaedics

Published in:

01-02-2021 | Osteoarthrosis | Original Paper

Intraosseous injections of platelet rich plasma for knee bone marrow lesions treatment: one year follow-up

Authors: A. Lychagin, M. Lipina, A. Garkavi, O. Islaieh, P. Timashev, K. Ashmore, E. Kon

Published in: International Orthopaedics | Issue 2/2021

Abstract

Purpose

Cartilage lesions are usually accompanied by subchondral bone alterations or bone marrow lesions (BMLs). BML associated with joint degeneration and cartilage lesions are considered to be predictors of rapidly progressing OA. Currently no existing treatment can fully halt OA progression. One of the approaches is an autologous, biological treatment based on the use of platelet rich plasma (PRP) injections. The purpose of this study is to assess the short-term effectiveness of intraosseous PRP injections, within the BML of individuals affected by OA, in ameliorating pain and improving knee functionality.

Materials and methods

The study involved 17 patients with an average age of 41.7 ± 14.3 years old. OA stage was determined using the Kellgren-Lawrence grading system by performing radiographic scanning of the knee joint before surgical intervention. Patients with K–L grade 3 knee joint OA prevailed. Patient OA history varied between one and nine years (average 5.2 ± 4.5 years). Clinical and functional state of the knee were assessed by pain visual analogue scale (VAS) score, the Western Ontario and McMaster Universities Score (WOMAC), and the Knee Injury and Osteoarthritis Outcome Score (KOOS) which were filled out by patients previous to the surgical procedure at one, three, six and 12 months post-operatively. Before surgery, in addition to standard blood tests, serum cartilage oligomeric matrix protein (COMP) levels were tested for all patients.

Results

Evaluation of preliminary results revealed a statistically significant reduction of pain based on the VAS score. A significant improvement was also observed in the patients’ WOMAC score and in the overall KOOS score. Serum marker levels were initially elevated in our experimental patient group compared to the same marker in healthy control respondents, and continued to rise one month and three months following surgery, at six and 12 month the level was similar as at three months.

Conclusions

In our opinion, first COMP increasing can be caused by injection of platelet rich plasma. It is not adequate to interpret this growth in COMP levels as increased osteochondral degeneration. One year follow-up period showed good quality of life improvement, significant pain reduction, and essential MRI changes. The long-term observation of these cohort of patients combined with an analysis of MRI images is still ongoing.

Delgado D, Garate A, Hunter V, Bilbao A, Patel R, Fiz AS, Sampson S, Sanchez M (2019) Current concepts in intraosseous platelet-rich plasma injections for knee osteoarthritis. J Clin Orthopaedics Trauma 10:36–41CrossRef

Madry H, van Dijk CN, Mueller-Gerbl M (2010) The basic science of the subchondral bone. Knee Surg Sports Traumatol Arthrosc 18:419–433CrossRef

Li et al (2013) Subchondral bone in osteoarthritis: insight into risk factors and microstructural changes. Arthritis Res Ther 15:223. https://doi.org/10.1186/ar4405CrossRefPubMedPubMedCentral

Kon E, Ronga M, Filardo G, Farr G, Madry H, Milano G, Andriolo L, Shabshin N (2016) Bone marrow lesions and subchondral bone pathology of the knee. Knee Surg Sports Traumatol Arthrosc 24(6):1797–1814. https://doi.org/10.1007/s00167-016-4113-2CrossRefPubMed

Appel H, Kuhne M, Spiekermann S, Kohler D, Zacher J, Stein H et al (2006) Immunohistochemical analysis of hip arthritis in ankylosing spondylitis: evaluation of the bone-cartilage interface and subchondral bone marrow. Arthritis Rheum 54:1805–1813CrossRef

Pelletier JP (2007) Risk factors associated with the loss of cartilage volume on weight-bearing areas in knee osteoarthritis patients assessed by quantitative magnetic resonance imaging: a longitudinal study. Arthritis Res Ther 9(4):R74CrossRef

Zhao J, Li X, Bolbos RI, Link TM, Majumdar S (2010) Longitudinal assessment of bone marrow edema-like lesions and cartilage degeneration in osteoarthritis using 3 T MR T1rho quantification. Skelet Radiol 39:523–531CrossRef

Wilson AJ, Murphy WA, Hardy DC, Totty WG (1988) Transient osteoporosis: transient bone marrow edema? Radiology 167:757–760CrossRef

Felson DT, McLaughlin S, Goggins J, LaValley MP, Gale ME, Totterman S, Li W, Hill C, Gale D (2003) Bone marrow edema and its relation to progression of knee osteoarthritis. Ann Intern Med 139:330–336CrossRef

10.

Perry T, O'Neill T, Parkes M, Felson DT, Hodgson R, Arden NK (2018) Bone marrow lesion type and pain in knee osteoarthritis. Ann Rheum Dis 77:1145

11.

Link TM, Steinbach LS, Ghosh S, Ries M, Lu Y, Lane N et al (2003) Osteoarthritis: MR imaging findings in different stages of disease and correlation with clinical findings. Radiology 226:373–381CrossRef

12.

Roemer FW, Frobell R, Hunter DJ, Crema MD, Fischer W, Bohndorf K et al (2009) MRI-detected subchondral bone marrow signal alterations of the knee joint: terminology, imaging appearance, relevance and radiological differential diagnosis. Osteoarthr Cartil 17:1115–1131CrossRef

13.

Roemer FW et al (2010) Subchondral bone marrow lesions are highly associated with, and predict subchondral bone attrition longitudinally: the MOST study. Osteoarthr Cartil 18(1):47–53CrossRef

14.

Peterfy CG et al (2004) Whole-organ magnetic resonance imaging score (WORMS) of the knee in osteoarthritis. Osteoarthr Cartil 12(3):177–190CrossRef

15.

Abhishek A, Doherty M (2013) Diagnosis and clinical presentation of osteoarthritis. Rheum Dis Clin N Am 39(1):45–66. https://doi.org/10.1016/j.rdc.2012.10.007CrossRef

16.

Mayerhoefer ME, Breitenseher MJ, Kramer J, Aigner N, Norden C, Hofmann S (2005) STIR vs. T1- weighted fat-suppressed gadolinium-enhanced MRI of bone marrow edema of the knee: computer-assisted quantitative comparison and influence of injected contrast media volume and acquisition parameters. J Magn Reson Imaging 22:788–793CrossRef

17.

McAlindon TE, Watt I, McCrae F, Goddard P, Dieppe PA (1991) Magnetic resonance imaging in osteoarthritis of the knee: correlation with radiographic and scintigraphic findings. Ann Rheum Dis 50:14–19CrossRef

18.

Ahlback S, Bauer GC, Bohne WH (1968) Spontaneous osteonecrosis of the knee. Arthritis Rheum 11(6):705–733CrossRef

19.

Wluka AE, Hanna F, Davies-Tuck M, Wang Y, Bell RJ, Davis SR, Adams J, Cicuttini FM (2009) Bone marrow lesions predict increase in knee cartilage defects and loss of cartilage volume in middle-aged women without knee pain over 2 years. Ann Rheum Dis 68:850–855CrossRef

20.

Odding E et al (1998) Associations of radiological osteoarthritis of the hip and knee with locomotor disability in the Rotterdam study. Ann Rheum Dis 57(4):203–208CrossRef

21.

Sowers MF et al (2003) Magnetic resonance-detected subchondral bone marrow and cartilage defect characteristics associated with pain and X-ray-defined knee osteoarthritis. Osteoarthr Cartil 11(6):387–393CrossRef

22.

Hunter DJ, Gerstenfeld L, Bishop G, Davis AD, Mason ZD, Einhorn TA, Maciewicz RA, Newham P, Foster M, Jackson S, Morgan EF (2009) Bone marrow lesions from osteoarthritis knees are characterized by sclerotic bone that is less well mineralized. Arthritis Res Ther 11:R11CrossRef

23.

Manicourt DH, Brasseur JP, Boutsen Y, Depreseux G, Devogelaer JP (2004) Role of alendronate in therapy for posttraumatic complex regional pain syndrome type I of the lower extremity. Arthritis Rheum 50:3690–3697CrossRef

24.

Lecouvet FE, van de Berg BC, Maldague BE, Lebon CJ, Jamart J, Saleh M, Noel H, Malghem J (1988) Early irreversible osteonecrosis versus transient lesions of the femoral condyles: prognostic value of subchondral bone and marrow changes on MR imaging. AJR Am J Roentgenol 170:71–77CrossRef

25.

Carrino JA, Blum J, Parellada JA, Schweitzer ME, Morrison WB (2006) MRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts. Osteoarthr Cartil 14:1081–1085CrossRef

26.

Radke S, Rader C, Kenn W, Kirschner S, Walther M, Eulert J (2003) Transient marrow edema syndrome of the hip: results after core decompression. A prospective MRI-controlled study in 22 patients. Arch Orthop Trauma 123:223–227CrossRef

27.

Kohn MD, Sassoon AA, Fernando ND (2016) Classifications in brief: Kellgren-Lawrence classification of osteoarthritis. Clin Orthop Relat Res 474(8):1886–1893. https://doi.org/10.1007/S11999-016-4732-4CrossRefPubMedPubMedCentral

28.

Marot V, Murgier J, Carrozzo A, Reina N, Monaco E, Chiron P, Berard E, Cavaignac E (2019) Determination of normal KOOS and WOMAC values in a healthy population. Knee Surg Sports Traumatol Arthrosc 27(2):541–548. https://doi.org/10.1007/s00167-018-5153-6CrossRefPubMed

29.

Bellido M, Lugo L, Roman-Blas JA et al (2011) Improving subchondral bone integrity reduces progression of cartilage damage in experimental osteoarthritis preceded by osteoporosis. Osteoarthr Cartil 19(10):1228–1236CrossRef

30.

Vasina EM, Cauwenberghs S, Feijge MA, Heemskerk JW, Weber C, Koenen RR (2011) Microparticles from apoptotic platelets promote resident macrophage differentiation. Cell Death Dis 2:211CrossRef

31.

Liu-Bryan R, Terkeltaub R (2015) Emerging regulators of the inflammatory process in osteoarthritis. Nat Rev Rheumatol 11(1):35–44CrossRef

32.

Tohidnezhad M, Wruck CJ, Slowik A et al (2014) Role of platelet-released growth factors in detoxification of reactive oxygen species in osteoblasts. Bone 65:9–17CrossRef

33.

Cohen SB, Sharkey PF (2016) Subchondroplasty for treating bone marrow lesions. J Knee Surg 29(7):555–563PubMed

34.

Bonadio MB, Giglio PN, Helito CP, Pécora JR, Camanho GL, Demange MK (2017) Subchondroplasty for treating bone marrow lesions in the knee - initial experience. Rev Bras Ortop 52(3):325–330. https://doi.org/10.1016/j.rboe.2017.04.003CrossRefPubMedPubMedCentral

35.

Marcacci M, Filardo G, Kon E (2013) Treatment of cartilage lesions: what works and why? Injury 44(Suppl. 1):S11–S15CrossRef

36.

Bi X (2018) Correlation of serum cartilage oligomeric matrix protein with knee osteoarthritis diagnosis: a meta-analysis. J Orthop Surg Res 13(1):262. https://doi.org/10.1186/s13018-018-0959-yCrossRefPubMedPubMedCentral

37.

Hao HQ, Zhang JF, He QQ, Wang Z (2019) Cartilage oligomeric matrix protein, C-terminal cross-linking telopeptide of type II collagen, and matrix metalloproteinase-3 as biomarkers for knee and hip osteoarthritis (OA) diagnosis: a systematic review and meta-analysis. Osteoarthr Cartil 27(5):726–736. https://doi.org/10.1016/j.joca.2018.10.009CrossRef

Title: Intraosseous injections of platelet rich plasma for knee bone marrow lesions treatment: one year follow-up
Authors: A. Lychagin
M. Lipina
A. Garkavi
O. Islaieh
P. Timashev
K. Ashmore
E. Kon
Publication date: 01-02-2021
Publisher: Springer Berlin Heidelberg
Keywords: Osteoarthrosis
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Osteoarthrosis
Published in: International Orthopaedics / Issue 2/2021
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04546-5

At a glance: The STEP trials

Springer Medicine

Intraosseous injections of platelet rich plasma for knee bone marrow lesions treatment: one year follow-up

Abstract

Purpose

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2021

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

Ankle joint re-balancing in the management of ankle fracture malunion using fibular lengthening: prospective clinical-radiological results at mid-term follow-up

Osteoarthritis: an ancient disease, an unsolved conundrum

Hyaluronic acid and platelet-rich plasma for the management of knee osteoarthritis

Intra-articular gold induced cytokine (GOLDIC®) injection therapy in patients with osteoarthritis of knee joint: a clinical study

Osteochondral autograft transplantation versus autologous bone-cartilage paste grafting for the treatment of knee osteochondritis dissecans