A retrospective study of the effect of ultrasound-guided intra-articular injection of platelet-rich plasma in the treatment of knee osteoarthritis_West China Medical Journal

Authors：

LUAN Shuo , LI Xiao , LIN Caina , LIU Cuicui , MA Chao ,  WU Shaoling

Department of Rehabilitation Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, P. R. China;

Corresponding?author：

WU Shaoling, Email: wushaolinggz@126.com

Keywords：

Knee osteoarthritis; Ultrasound-guided injection; Platelet-rich plasma; Retrospective study

DOI：

10.7507/1002-0179.202002248

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Objective To explore the clinical efficacy of the ultrasound-guided intra-articular injection of platelet-rich plasma (PRP) in the treatment of patients with different stages of knee osteoarthritis.Methods We retrospectively analyzed the clinical characteristics and X-ray data of patients with knee osteoarthritis who received ultrasound-guided intra-articular injection of PRP in the Department of Rehabilitation Medicine at Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University between May 2018 and June 2019. The patients were grouped according to the Kellgren & Lawrence Classification (K&L 0, Ⅰ, Ⅱ, Ⅲ, and Ⅳ). All the patients received four injections with a one-week interval. The Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to evaluate the clinical efficacy before the injection, and 3 and 6 months after the injection. Adverse reactions were recorded.Results A total of 102 patients were included without any grade 0 cases. There were 20 patients in K&L Ⅰ group, 37 in Ⅱ group, 31 in Ⅲ group, and 14 in Ⅳ group. No adverse event was reported. Significant differences of VAS scores and WOMAC index were observed in Ⅰ, Ⅱ and Ⅲ groups at the 3rd and 6th month follow-up (P<0.05). VAS and WOMAC scores of the three groups at the 3rd and 6th month after the treatment were significantly improved compared with those before the treatment (P<0.05). There was no significant difference in VAS score at the 3rd or 6th month after the treatment three groups (P>0.05). For K&L Ⅰ group, there was no statistically significant difference in WOMAC score at the 3rd or 6th month after the treatment (P>0.05). However, the WOMAC scores at the 3rd month after the treatment were better than those at the 6th month in K&L Ⅱ and Ⅲ groups (P<0.05). There was no significant time-depended changes in VAS score or WOMAC score in K&L Ⅳ group (P>0.05).Conclusion The ultrasound-guided intra-articular PRP injection is safe and effective for pain relief and function improvement in patients with knee osteoarthritis at the early and middle stage.

Citation： LUAN Shuo, LI Xiao, LIN Caina, LIU Cuicui, MA Chao, WU Shaoling. A retrospective study of the effect of ultrasound-guided intra-articular injection of platelet-rich plasma in the treatment of knee osteoarthritis. West China Medical Journal, 2020, 35(5): 568-573. doi: 10.7507/1002-0179.202002248 Copy

1.	Tang X, Wang S, Zhan S, et al. The prevalence of symptomatic knee osteoarthritis in China: results from the China health and retirement longitudinal study. Arthritis Rheumatol, 2016, 68(3): 648-653.
2.	中華醫學會骨科學分會關節外科學組. 骨關節炎診療指南(2018年版). 中華骨科雜志, 2018, 38(12): 705-715.
3.	中國醫師協會急救復蘇專業委員會創傷骨科與多發傷學組, 中國醫藥教育學會骨質疾病專業委員會修復重建學組, 中國老年學和老年醫學學會老年病分會骨科專家委員會, 等. 中國老年膝關節骨關節炎診療及智能矯形康復專家共識. 臨床外科雜志, 2019, 27(12): 1105-1110.
4.	周謀望. 骨科康復臨床的新進展. 華西醫學, 2018, 33(10): 1197-1200.
5.	梁翼, 李敏. 骨關節炎非手術治療進展. 華西醫學, 2016, 31(5): 801-802.
6.	中華醫學會骨科分會關節外科學組, 吳階平醫學基金會骨科學專家委員會. 膝骨關節炎階梯治療專家共識(2018年版). 中華關節外科雜志(電子版), 2019, 13(1): 124-130.
7.	Lin KY, Yang CC, Hsu CJ, et al. Intra-articular injection of platelet-rich plasma is superior to hyaluronic acid or saline solution in the treatment of mild to moderate knee osteoarthritis: a randomized, double-blind, triple-parallel, placebo-controlled clinical trial. Arthroscopy, 2019, 35(1): 106-117.
8.	中國醫療保健國際交流促進會骨科分會. 關節腔注射富血小板血漿治療膝骨關節炎的臨床實踐指南(2018年版). 中華關節外科雜志(電子版), 2018, 12(4): 1-5.
9.	Laudy AB, Bakker EW, Rekers M, et al. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br J Sports Med, 2015, 49(10): 657-672.
10.	Alsousou J, Thompson M, Harrison P, et al. Effect of platelet-rich plasma on healing tissues in acute ruptured achilles tendon:a human immunohistochemistry study. Lancet, 2015, 385(Suppl 1): S19.
11.	Huang Z, Du S, Qi Y, et al. Effectiveness of ultrasound guidance on intraarticular and periarticular joint injections: systematic review and meta-analysis of randomized trials. Am J Phys Med Rehabil, 2015, 94(10): 775-783.
12.	Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and therapeutic criteria committee of the American Rheumatism Association. Arthritis Rheum, 1986, 29(8): 1039-1049.
13.	Angoorani H, Mazaherinezhad A, Marjomaki O, et al. Treatment of knee osteoarthritis with platelet-rich plasma in comparison with transcutaneous electrical nerve stimulation plus exercise: a randomized clinical trial. Med J Islam Repub Iran, 2015, 29: 223.
14.	KELLGREN JH, LAWRENCE JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis, 1957, 16(4): 494-502.
15.	Xing D, Xu Y, Liu Q, et al. Osteoarthritis and all-cause mortality in worldwide populations: grading the evidence from a meta-analysis. Sci Rep, 2016, 6: 24393.
16.	Le ADK, Enweze L, DeBaun MR, et al. Current clinical recommendations for use of platelet-rich plasma. Curr Rev Musculoskelet Med, 2018, 11(4): 624-634.
17.	Moussa M, Lajeunesse D, Hilal G, et al. Platelet rich plasma (PRP) induces chondroprotection via increasing autophagy, anti-inflammatory markers, and decreasing apoptosis in human osteoarthritic cartilage. Exp Cell Res, 2017, 352(1): 146-156.
18.	Textor J. Platelet-rich plasma (PRP) as a therapeutic agent: platelet biology, growth factors and a review of the literature. Platelet-Rich Plasma, 2014: 61-94.
19.	Campbell KA, Saltzman BM, Mascarenhas R, et al. Does intra-articular platelet-rich plasma injection provide clinically superior outcomes compared with other therapies in the treatment of knee osteoarthritis? A systematic review of overlapping meta-analyses. Arthroscopy, 2015, 31(11): 2213-2221.
20.	李明, 張長青, 艾自勝, 等. 關節內注射富血小板血漿對膝關節軟骨退行性變的治療作用. 中國修復重建外科雜志, 2011, 25(10): 1192-1196.
21.	Pourcho AM, Smith J, Wisniewski SJ, et al. Intraarticular platelet-rich plasma injection in the treatment of knee osteoarthritis: review and recommendations. Am J Phys Med Rehabil, 2014, 93(11 Suppl 3): S108-S121.
22.	袁林, 郭燕慶, 于洪波, 等. 富血小板血漿治療Ⅱ-Ⅲ期膝骨關節炎的療效評價. 中華關節外科雜志(電子版), 2016, 10(4): 386-392.

1. Tang X, Wang S, Zhan S, et al. The prevalence of symptomatic knee osteoarthritis in China: results from the China health and retirement longitudinal study. Arthritis Rheumatol, 2016, 68(3): 648-653.
2. 中華醫學會骨科學分會關節外科學組. 骨關節炎診療指南(2018年版). 中華骨科雜志, 2018, 38(12): 705-715.
3. 中國醫師協會急救復蘇專業委員會創傷骨科與多發傷學組, 中國醫藥教育學會骨質疾病專業委員會修復重建學組, 中國老年學和老年醫學學會老年病分會骨科專家委員會, 等. 中國老年膝關節骨關節炎診療及智能矯形康復專家共識. 臨床外科雜志, 2019, 27(12): 1105-1110.
4. 周謀望. 骨科康復臨床的新進展. 華西醫學, 2018, 33(10): 1197-1200.
5. 梁翼, 李敏. 骨關節炎非手術治療進展. 華西醫學, 2016, 31(5): 801-802.
6. 中華醫學會骨科分會關節外科學組, 吳階平醫學基金會骨科學專家委員會. 膝骨關節炎階梯治療專家共識(2018年版). 中華關節外科雜志(電子版), 2019, 13(1): 124-130.
7. Lin KY, Yang CC, Hsu CJ, et al. Intra-articular injection of platelet-rich plasma is superior to hyaluronic acid or saline solution in the treatment of mild to moderate knee osteoarthritis: a randomized, double-blind, triple-parallel, placebo-controlled clinical trial. Arthroscopy, 2019, 35(1): 106-117.
8. 中國醫療保健國際交流促進會骨科分會. 關節腔注射富血小板血漿治療膝骨關節炎的臨床實踐指南(2018年版). 中華關節外科雜志(電子版), 2018, 12(4): 1-5.
9. Laudy AB, Bakker EW, Rekers M, et al. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br J Sports Med, 2015, 49(10): 657-672.
10. Alsousou J, Thompson M, Harrison P, et al. Effect of platelet-rich plasma on healing tissues in acute ruptured achilles tendon:a human immunohistochemistry study. Lancet, 2015, 385(Suppl 1): S19.
11. Huang Z, Du S, Qi Y, et al. Effectiveness of ultrasound guidance on intraarticular and periarticular joint injections: systematic review and meta-analysis of randomized trials. Am J Phys Med Rehabil, 2015, 94(10): 775-783.
12. Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and therapeutic criteria committee of the American Rheumatism Association. Arthritis Rheum, 1986, 29(8): 1039-1049.
13. Angoorani H, Mazaherinezhad A, Marjomaki O, et al. Treatment of knee osteoarthritis with platelet-rich plasma in comparison with transcutaneous electrical nerve stimulation plus exercise: a randomized clinical trial. Med J Islam Repub Iran, 2015, 29: 223.
14. KELLGREN JH, LAWRENCE JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis, 1957, 16(4): 494-502.
15. Xing D, Xu Y, Liu Q, et al. Osteoarthritis and all-cause mortality in worldwide populations: grading the evidence from a meta-analysis. Sci Rep, 2016, 6: 24393.
16. Le ADK, Enweze L, DeBaun MR, et al. Current clinical recommendations for use of platelet-rich plasma. Curr Rev Musculoskelet Med, 2018, 11(4): 624-634.
17. Moussa M, Lajeunesse D, Hilal G, et al. Platelet rich plasma (PRP) induces chondroprotection via increasing autophagy, anti-inflammatory markers, and decreasing apoptosis in human osteoarthritic cartilage. Exp Cell Res, 2017, 352(1): 146-156.
18. Textor J. Platelet-rich plasma (PRP) as a therapeutic agent: platelet biology, growth factors and a review of the literature. Platelet-Rich Plasma, 2014: 61-94.
19. Campbell KA, Saltzman BM, Mascarenhas R, et al. Does intra-articular platelet-rich plasma injection provide clinically superior outcomes compared with other therapies in the treatment of knee osteoarthritis? A systematic review of overlapping meta-analyses. Arthroscopy, 2015, 31(11): 2213-2221.
20. 李明, 張長青, 艾自勝, 等. 關節內注射富血小板血漿對膝關節軟骨退行性變的治療作用. 中國修復重建外科雜志, 2011, 25(10): 1192-1196.
21. Pourcho AM, Smith J, Wisniewski SJ, et al. Intraarticular platelet-rich plasma injection in the treatment of knee osteoarthritis: review and recommendations. Am J Phys Med Rehabil, 2014, 93(11 Suppl 3): S108-S121.
22. 袁林, 郭燕慶, 于洪波, 等. 富血小板血漿治療Ⅱ-Ⅲ期膝骨關節炎的療效評價. 中華關節外科雜志(電子版), 2016, 10(4): 386-392.

West China Medical Journal

A retrospective study of the effect of ultrasound-guided intra-articular injection of platelet-rich plasma in the treatment of knee osteoarthritis

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