Platelet-Rich Plasma Intra-articular Knee Injections Show No Superiority Versus Viscosupplementation: A Randomized Controlled Trial
Platelet-Rich Plasma Intra-articular Knee Injections Show No Superiority Versus Viscosupplementation: A Randomized Controlled Trial
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DOI：
10.1177/0363546515582027
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发表时间：
2015-07-01
影响因子：
4.8
通讯作者：
Kon, Elizaveta
中科院分区：
文献类型：
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作者：
Filardo, Giuseppe;Di Matteo, Berardo;Kon, Elizaveta
背景：骨关节炎是一种常见的疾病，几乎一半的人会在一生中的某个时候因疼痛和功能能力下降而受到影响。正在提出新的非手术治疗方案来治疗早期的关节退行性变，以提供症状缓解和延迟手术干预。目的：评价富含血小板血浆(PRP)注射治疗膝关节退行性变与透明质酸(HA)的益处，透明质酸(HA)是目前这种疾病最常见的注射治疗方法。研究设计：随机对照试验；方法：共筛选出443例患者，其中192例按以下标准纳入研究：(1)单侧有症状的膝关节有慢性疼痛(至少4个月)或肿胀的病史；(2)退行性改变的影像表现(Kellgren-Lawrence评分0~3分，X线片或MRI证据为退行性软骨病)。患者每周接受3次PRP或HA关节内注射。使用国际膝关节文件委员会(IKDC)的主观评分(主要结果)、膝关节损伤和骨关节炎结果评分、EuroQol视觉模拟评分和Tegner评分对患者在基线、2、6和12个月的随访中进行前瞻性评估。结果：2例患者在注射HA后出现严重疼痛和肿胀，而PRP组未发现重大不良事件。然而，PRP在注射后总体上表现出明显更多的肿胀和疼痛。两种治疗方法在改善膝关节功能状态和减轻症状方面都被证明是有效的：PRP组的IKDC评分在12个月时从52.4±14.1上升到66.2+/-16.7(P<；0.0005)，HA组从49.6+/-13.0上升到64.2+/-18.0(P<；0.0005)。所有使用的临床评分也观察到了类似的趋势。两种治疗方法的比较分析显示，在任何一项临床评分的随访评估中，组间均无显著差异。结论：与HA相比，PRP并不能提供更好的临床改善，因此对于膝关节软骨退行性变和骨关节炎患者，PRP不应被作为注射治疗的首选。
Background: Osteoarthritis (OA) is a common disease that will affect almost half the population at some point in their lives through pain and decreased functional capacity. New nonoperative options are being proposed to treat earlier stages of joint degeneration to provide symptomatic relief and delay surgical intervention.Purpose: To evaluate the benefit provided by platelet-rich plasma (PRP) injections to treat knee joint degeneration in comparison with hyaluronic acid (HA), the most common injective treatment currently adopted for this condition.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: A total of 443 patients were screened, and 192 of them were enrolled in the study according to the following inclusion criteria: (1) unilateral symptomatic knee with history of chronic pain (at least 4 months) or swelling and (2) imaging findings of degenerative changes (Kellgren-Lawrence score of 0-3 at radiographs or MRI evidence of degenerative chondropathy). Patients underwent 3 weekly intra-articular injections of either PRP or HA. Patients were prospectively evaluated at baseline and then at 2, 6, and 12 months of follow-up using the International Knee Documentation Committee (IKDC) subjective score (main outcome), Knee injury and Osteoarthritis Outcome Score, EuroQol visual analog scale, and Tegner score. Range of motion, transpatellar circumference, patient satisfaction, and adverse events were also recorded.Results: Two patients reported severe pain and swelling after HA injections, while no major adverse events were noted in the PRP group. However, PRP presented overall significantly more postinjection swelling and pain. Both treatments proved to be effective in improving knee functional status and reducing symptoms: the IKDC score in the PRP group rose from 52.4 14.1 to 66.2 +/- 16.7 at 12 months (P < .0005), and in the HA group it rose from 49.6 +/- 13.0 to 64.2 +/- 18.0 at 12 months (P < .0005). A similar trend was observed for all the clinical scores used. The comparative analysis of the 2 treatments showed no significant intergroup difference at any follow-up evaluation in any of the clinical scores adopted.Conclusion: PRP does not provide a superior clinical improvement with respect to HA, and therefore it should not be preferred to viscosupplementation as injective treatment of patients affected by knee cartilage degeneration and OA.