Platelet-Rich Plasma vs Prolotherapy in the Management Of Knee Osteoarthritis: Randomized Placebo-Controlled Trial

Abstract

Objective: Osteoarthritis (OA) is an age-dependent disease caused by degenerative and healing processes in subchondral tissue of articular and bone cartilage, resulting in an alteration of its biomechanical properties that eventually causes pain, stiffness, and decreased articular function. The aim of this study is to compare the in vivo the efficacy of platelet-rich plasma (PRP) and prolotherapy with that of placebo in the treatment of knee osteoarthritis(OA).
Materials and Methods: From January 2015 to September 2015, 100 consecutive patients who had a history of chronic (>3 months) pain or swelling radiographically documented grades I to III gonarthrosis (graded according to the Kellgren–Lawrence classification scale for tibiofemoral joint degeneration) were enrolled. The exclusion criteria included severe OA (grade IV according to the Kellgren–Lawrence classification (22)), received an intra-articular injeciton of hyalurinic acid agents within 6 months, previous lower extremity surgery, systemic disorders (diabetes, rheumatic diseases, severe cardiovascular diseases, haematological diseases, infections), presence of any concomitant knee lesion causing pain or swelling. In this randomized placebo-controlled clinical trial patients with knee osteoarthritis were randomly assigned into 3 groups: participants in Group 1 received prolotheraphy, participants in Group 2 received intra-articular injections of PRP and participants in Group 3 received saline injection. Demographic findings and Western Ontario and McMaster Universities arthritis index (WOMAC) were recorded before each injection and 3 and 6 months after the first injection.
Results: Group 1 comprised 20 patients with a mean age 66,00±5,79, Group 2 comprised 18 patients with a mean age 64,16±6,36 and Group 3 comprised 20 patients with a mean age 62,00±6,46. Groups were similar in terms of age, gender and body mass index (p>0,05). Baseline total WOMAC scores and WOMAC subscales of the groups were also similar (p>0,05). Although total WOMAC scores and WOMAC subscales improved in Group 1 and Group 1 after treatment, none of these improvements reached statistical significance (p>0,05). Moreover, post-treatment total WOMAC scores and subscales of WOMAC were similar in all groups (p>0,05).
Conclusion: Our findings does not support the use of PRP or prolotherapy as a first- or second-line treatment for knee OA.