PRP Research

Effect of intra-articular platelet rich plasma injection (PRP)
in patients with osteoarthritis with osteochondral lesions of

knee: a Prospective interventional study.
Dr. Mahesh Choudhary

M.S (Ortho)
Specialist Grade I (PMR)
• Osteoarthritis is a chronic disease with defective integrity of articular cartilage.
• Damage to the articular cartilage and subchondral bone leads to increased
symptoms.
• Current modalities in management include lifestyle modification, analgesics,
physical therapy, exercises and corticosteroid injections.
• Osteochondral lesions are supposed to be less amenable to above measures.
• Current study proposes the use of PRP in such lesions.
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HOW PRP WORKS
• Inhibit inflammation and slow down the progression of osteoarthritis.

• Stimulate the formation of new cartilage.
• Increase the production of natural lubricating fluid in the joint, thereby easing
painful joint friction.
• Contain proteins that alter a patient's pain receptors and reduce pain sensation.
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• Although there are studies published documenting pain reduction and
improvement in function after PRP injection in knee OA patients.
• However, the documentation of the MRI changes after PRP injection is scarce.
• This study focuses on evaluation with evidence based parameter such as MRI.
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Aim
To study the effect of 2 PRP injections given at 3 weeks interval on osteochondral
lesions of the knee in osteoarthritis knee using the following outcome measures:
1) Visual analogue scale [VAS]

2) Knee injury and osteoarthritis outcome score [KOOS score]
3) MRI knee
KOOS score can be freely used and is available in Hindi, English and Marathi language.
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Materials and methods
• This is a prospective interventional study which will be carried out at AIIPMR,

Mumbai under the department of Physical Medicine and Rehabilitation.
• Patients visiting the OPD will be screened and enrolled for the study, to include a
total of 30 procedure limbs, based on inclusion and exclusion criteria.
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Inclusion criteria
1) Age 30 to 60 years
2) Knee osteoarthritis stage 1 to 3 according to ACR guidelines
3) Osteochondral lesions on MRI
4) Hemoglobin >10 gm%
5) Platelet count >1.5 lakh/ c.mm
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Exclusion criteria
1) Anaemia
2) Any bleeding dyscrasias or coagulopathies
3) Uncontrolled diabetes mellitus
4) Having a medical condition that could worsen or spread with injections, such
as an active infection, a metastatic disease, or skin diseases
5) Pregnancy
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6 ) Undergoing anticoagulation therapy
7) History of any steroid or any other injection in the knee within 6 months.
8) History of any surgical intervention done in the knee up to 6 months before.
9) History of any prior trauma to the knee before the symptom onset.
10) Autoimmune or rheumatic disease involving the knee
11) Any neurological deficit in the lower limb
12) Severe mechanical deformity ( Varus or valgus > 15 degrees)
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Name
Age/gender
Address
Contact number
Side involved
Duration of symptoms
Comorbidities eg Hypertension,
diabetes
Blood Investigations
1. Haemoglobin
2. Platelet Count
3. FBS
4. PPBS
5. ESR
6. CRP
X ray findings
[Kellgren Lawrence staging]
MRI Findings
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FOLLOW UP
Baseline 1 week 1 month 3 months 6 months
VAS
KOOS
MRI
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Analysis
VAS and KOOS score findings will be analysed by ANOVA and findings of MRI
will be analysed by paired t test.
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Review of literature
1.Van buul gm, koevoet wlm, kops n, et al. platelet-rich plasma releasate inhibits inflammatory processes in osteoarthritic chondrocytes.
am j sports med. 2011;39:2362–2370.
2. Drengk a, zapf a, sturmer ek, et al. influence of platelet-rich plasma on chondrogenic differentiation and proliferation of chondrocytes
and mesenchymal stem cells. cells tissues organs. 2009;189:317–326.
3.Anitua e, sanchez m, nurden at, et al. platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte
growth factor production by synovial fibroblasts from arthritic patients. rheumatology (oxford). 2007;46:1769–1772.
4.Descalzi f, ulivi v, cancedda r, piscitelli f, luongo l, guida f, gatta l, maione s, di marzo v. platelet-rich plasma exerts antinociceptive
activity by a peripheral endocannabinoid-related mechanism. tissue eng part a. 2013 oct;19(19-20):2120-9. doi:
10.1089/ten.tea.2012.0557. epub 2013 jun 6. pubmed pmid: 23578218.
5.The international cellular medical society. guidelines for the use of platelet rich plasma. adopted 2011. www.cellmedicinesociety.org.
6.Oliver emmanuel yausep,a,∗ imad madhi,b and dionysios trigkilidasb. platelet rich plasma for treatment of osteochondral lesions of
the talus: a systematic review of clinical trials. j orthop. 2020 mar-apr; 18: 218–225
7.Michael r. baria md mba a, ryan barnes md b, david flanigan md b, christopher kaeding md. platelet-rich plasma induced healing of a
chronic osteochondral defect of the knee. journal of cartilage & joint preservation .10 may 2023, 100132
8.Xuetao xie, changqing zhang & rocky s tuan. biology of platelet-rich plasma and its clinical application in cartilage repair. arthritis
research & therapy volume 16, article number: 204 (2014) published: 25 february 2014.
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THANKYOU
11/02/2023 16

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Effect of intra-articular platelet rich plasma injection (PRP)

in patients with osteoarthritis with osteochondral lesions of

Dr. Mahesh Choudhary

• Inhibit inflammation and slow down the progression of osteoarthritis.

1) Visual analogue scale [VAS]

• This is a prospective interventional study which will be carried out at AIIPMR,

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