Editorial Commentary: Injections for Knee Osteoarthritis: Doc, You Gotta Help Me! Chronic, progressive nonsurgical pain management.
Injections for pain treatment and management caused by osteoarthritis have been the focus of significant research for the last few decades. Systematic reviews and meta-analyses suggest that platelet-rich plasma (PRP) can provide up to 12 months of pain relief in these patients, superior to both cortisone and hyaluronic acid. There is also evidence for a synergistic effect when combining both PRP and hyaluronic acid. This form is treatment is not only shown to have superior results over cortisone, but has evidence in being able to stimulate repair and healing at the same time as reducing pain. Bone marrow aspirate concentrate (BMAC) has been shown to have greater levels of interleukin-1ra than PRP, as well as a small concentration of mesenchymal stromal cells. However, BMAC is still reasonably experimentary, and yet unproven in its efficacy, and obtaining BMAC is not as simple as taking blood, and extracting platelets. Research into the use of expanded autologous and allogenic mesenchymal stem cells continues and shows future promise. For today, PRP remains the gold standard for the treatment of pain associated with knee osteoarthritis.