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.	中华医学会骨科学分会关节外科学组. 骨关节炎诊疗指南(2018年版). 中华骨科杂志, 2018, 38(12): 705-715.
3.	中国医师协会急救复苏专业委员会创伤骨科与多发伤学组, 中国医药教育学会骨质疾病专业委员会修复重建学组, 中国老年学和老年医学学会老年病分会骨科专家委员会, 等. 中国老年膝关节骨关节炎诊疗及智能矫形康复专家共识. 临床外科杂志, 2019, 27(12): 1105-1110.
4.	周谋望. 骨科康复临床的新进展. 华西医学, 2018, 33(10): 1197-1200.
5.	梁翼, 李敏. 骨关节炎非手术治疗进展. 华西医学, 2016, 31(5): 801-802.
6.	中华医学会骨科分会关节外科学组, 吴阶平医学基金会骨科学专家委员会. 膝骨关节炎阶梯治疗专家共识(2018年版). 中华关节外科杂志(电子版), 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.	中国医疗保健国际交流促进会骨科分会. 关节腔注射富血小板血浆治疗膝骨关节炎的临床实践指南(2018年版). 中华关节外科杂志(电子版), 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, 张长青, 艾自胜, 等. 关节内注射富血小板血浆对膝关节软骨退行性变的治疗作用. 中国修复重建外科杂志, 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, 郭燕庆, 于洪波, 等. 富血小板血浆治疗Ⅱ-Ⅲ期膝骨关节炎的疗效评价. 中华关节外科杂志(电子版), 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. 中华医学会骨科学分会关节外科学组. 骨关节炎诊疗指南(2018年版). 中华骨科杂志, 2018, 38(12): 705-715.
3. 中国医师协会急救复苏专业委员会创伤骨科与多发伤学组, 中国医药教育学会骨质疾病专业委员会修复重建学组, 中国老年学和老年医学学会老年病分会骨科专家委员会, 等. 中国老年膝关节骨关节炎诊疗及智能矫形康复专家共识. 临床外科杂志, 2019, 27(12): 1105-1110.
4. 周谋望. 骨科康复临床的新进展. 华西医学, 2018, 33(10): 1197-1200.
5. 梁翼, 李敏. 骨关节炎非手术治疗进展. 华西医学, 2016, 31(5): 801-802.
6. 中华医学会骨科分会关节外科学组, 吴阶平医学基金会骨科学专家委员会. 膝骨关节炎阶梯治疗专家共识(2018年版). 中华关节外科杂志(电子版), 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. 中国医疗保健国际交流促进会骨科分会. 关节腔注射富血小板血浆治疗膝骨关节炎的临床实践指南(2018年版). 中华关节外科杂志(电子版), 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, 张长青, 艾自胜, 等. 关节内注射富血小板血浆对膝关节软骨退行性变的治疗作用. 中国修复重建外科杂志, 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, 郭燕庆, 于洪波, 等. 富血小板血浆治疗Ⅱ-Ⅲ期膝骨关节炎的疗效评价. 中华关节外科杂志(电子版), 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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