Platelet-rich plasma (PRP) as an effective biological regenerative therapy in mild to moderate knee osteoarthritis: One year follow up.
The exact mechanism of osteoarthritis (OA) is complex and not quite clear. Some of the manifestations include articular cartilage degradation and reactive formation of subchondral bone with mild synovitis of the joint capsule. Treatment of OA is marred by the fact that the articular cartilage has a poor blood supply, which means a low regenerative capacity, and therefore a limited potential for repair. The treatment is orientated on means to reduce patient symptoms and delay the progression of the degenerative process as there is no definitive cure for OA. Due to the lack of effectiveness of conventional management options, current research focuses on targeting biological pathways that promote and facilitate change in the homeostasis of joint and accelerate joint healing and repair.
In recent years Platelet-rich plasma (PRP) is emerged as a promising treatment modality otherwise known as “Orthobiologics”. PRP enhances tissue recovery, by catalysing the body’s natural healing response and tissue repair process. Platelet release numerous bioactive protein growth factors which can potentially change the joint environment in OA. PRP has been shown to promote and facilitate chondral remodelling and chondrocyte (Cartilage cell) proliferation as it increases the synthesis of collagen.
PRP works by aiming to restore a highly favourable and balanced environment for angiogenesis (new blood vessels) by increasing natural hyaluronic acid (HA) secretion, and at the same time as reducing inflammatory cells. PRP has been used in the treatment of osteoarthritis for a good number of years and has shown very promising success with clinical and radiological outcomes. Also, both in comparison to pharmaco- logical and non-pharmacological treatment modalities, showing better long-term outcomes in comparison to drugs and steroid.
Excitingly, PRP treatment has shown a very good promise as an agent of tissue repair and regeneration. Looking at the primary outcome measure i.e., pain, this recent study below observed that there was a significant reduction in mean pain score. Although there was albeit a small rise in mean pain scores at the final 1-year follow-up even then, the final pain scores were still significantly lower than the baseline pain scores. In this study, improvement was shown to continue until 1 year follow-up. The study used fresh PRP preactivated by CaCl2 before injection which has been found to be better than thawed PRP. The authors believe that there slightly better results are due to standardised technique which has gradually evolved and should be the preferred standard technique for further clinical use.
The improvement in symptoms can be explained by modulating the joint environment and affecting the concentration of cytokinin and inflammatory cascades. During this time, patients can be put on active physical rehabilitation therapy programme to sustain the improvement to avoid replacement surgery. furthermore, Intra-articular infiltration of autologous PRP is very safe and well tolerated by The vast majority patients.
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