Effectiveness of a Single High Dose of Platelet-Rich Plasma (PRP) Injection Over Corticosteroid and Hyaluronic Acid Injections on Osteoarthritis, Chronic Tendinitis and Tennis Elbow Treatment
Background: Corticosteroid, hyaluronic acid (HA) injections and Anti-inflammatory agents are considered as non-invasive treatments for knee osteoarthritis (OA), Chronic Tendinitis (CT) and Tennis elbow (TE) that are supposed to provide symptomatic relief and to help surgical delay intervention. Platelet rich plasma (PRP) is a biological component shown to be beneficial for different orthopedic dysfunctionalities treatment. The presence of GFs in PRPs such as transforming growth factor-β, insulin-like growth factor 1co-stimulate the mesenchymal stem cells and fibroblasts secretions and promotes the fibrin matrix formation which effectively drive the healing process, induces regenerative response and lead to the damage structure repair in orthopedics trauma. Methods: Three groups of a total of 30 patients presenting OA, CT and TE diagnosis, non-responding to corticosteroid, HA and non-steroid anti-inflammatory treatments were randomized to undergo one intra-articular injections of single high dose of PRP. The efficacy of Intra-articular PRP Injections was evaluated before the injection and one month after. The efficiency assessment score was based on [1] Knee injury and Osteoarthritis Outcome Score, [2] Physical Function Short Form (KOOS-PS) Arabic (KSA) version LK 1.0, [3] HOOS-Physical Function Short form (HOOS-PS), and [4] Macdermid patient-rated Tennis Elbow. Results: A significant reduction of pain and a marked improvement in movements was observed in the 3 patient’s groups, PRP-injected patients showed significantly higher values compared with baseline: (p < 0.005 vs baseline), improve functional status and reduce clearly the articular dysfunctions over the time. In our study, single High dose injection of PRP provided an overall superior clinical improvement compared with HA and corticosteroid treatments over the time and the different follow-up checkpoints of the study.
References
[1]
Shergill, R. and Choudur, H.N. (2018) Ultrasound-Guided Interventions in Lateral Epicondylitis. JCR: Journal of Clinical Rheumatology, 25, e27-e34. https://journals.lww.com/jclinrheum/Abstract/2019/04000/Ultrasound_Guided_Interventions_in_Lateral.10.aspx
[2]
Sisk, D. and Fredericson, M. (2020) Taping, Bracing, and Injection Treatment for Patellofemoral Pain and Patellar Tendinopathy. Current Reviews in Musculoskeletal Medicine, 13, 537-544. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340692/
[3]
Pavone, V., Vescio, A., Mobilia, G., Dimartino, S., Di Stefano, G., Culmone, A., et al. (2019) Conservative Treatment of Chronic Achilles Tendinopathy: A Systematic Review. Journal of Functional Morphology and Kinesiology, 4, Article No. 46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7739415/
[4]
Šmíd, P., Hart, R., Komzák, M., Paša, L. and Puskeiler, M. (2018) Treatment of the Shoulder Impingement Syndrome with PRP Injection. Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca, 85, 261-265. https://pubmed.ncbi.nlm.nih.gov/30257756/
[5]
Kwong, C.A., Woodmass, J.M., et al. (2021) Platelet-Rich Plasma in Patients with Partial-Thickness Rotator Cuff Tears or Tendinopathy Leads to Significantly Improved Short-Term Pain Relief and Function Compared with Corticosteroid Injection: A Double-Blind Randomized Controlled Trial. Arthroscopy, 37, 510-517. https://www.arthroscopyjournal.org/article/S0749-8063(20)30893-8/fulltext
[6]
Raeissadat, S.A., Ghazi Hosseini, P., Bahrami, M.H., Salman Roghani, R., Fathi, M., Gharooee Ahangar, A., et al. (2021) The Comparison Effects of Intra-Articular Injection of Platelet Rich Plasma (PRP), Plasma Rich in Growth Factor (PRGF), Hyaluronic Acid (HA), and Ozone in Knee Osteoarthritis; A One Year Randomized Clinical Trial. BMC Musculoskeletal Disorders, 22, Article No. 134. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7860007/
[7]
Aggarwal, A.K., Poornalingam, K., Jain, A. and Prakash, M. (2021) Combining Platelet-Rich Plasma Instillation With Core Decompression Improves Functional Outcome and Delays Progression in Early-Stage Avascular Necrosis of Femoral Head: A 4.5- to 6-Year Prospective Randomized Comparative Study. The Journal of Arthroplasty, 36, 54-61. https://www.arthroplastyjournal.org/article/S0883-5403(20)30766-X/fulltext
[8]
Chinese Orthopaedic Association (2010) Diagnosis and Treatment of Osteoarthritis. Orthopaedic Surgery, 2, 1-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583445/
[9]
Mehl, J., Imhoff, A.B. and Beitzel, K. (2018) Osteoarthritis of the Shoulder: Pathogenesis, Diagnostics and Conservative Treatment Options. Der Orthopäde, 47, 368-376. https://doi.org/10.1007/s00132-018-3542-7
[10]
Skou, S.T. and Roos, E.M. (2019) Physical Therapy for Patients with Knee and Hip Osteoarthritis: Supervised, Active Treatment Is Current Best Practice. Clinical and Experimental Rheumatology, 37, 112-117.
[11]
Wei, Q., Kong, N., Liu, X., Tian, R., Jiao, M., Li, Y., et al. (2021) Correction to: Pirfenidone Attenuates Synovial Fibrosis and Postpones the Progression of Osteoarthritis by Anti-Fibrotic and Anti-Inflammatory Properties in Vivo and in Vitro. Journal of Translational Medicine, 19, Article No. 434. https://doi.org/10.1186/s12967-021-03106-8
[12]
Vargas Negrín, F., Medina Abellán, M.D., Hermosa Hernán, J.C. and de Felipe Medina, R. (2014) Tratamiento del paciente con artrosis Treatment of patients with osteoarthritis. Atención Primaria, 46, 39-61. https://doi.org/10.1016/S0212-6567(14)70043-5
[13]
Robinson, P., McEwan, J., Adukia, V. and Prabhakar, M. (2018) Osteoarthritis and Arthroplasty of the Hip and Knee. British Journal of Hospital Medicine, 79, C54-C59. https://doi.org/10.12968/hmed.2018.79.4.C54
[14]
Dakin, S.G., Newton, J., Martinez, F.O., Hedley, R., Gwilym, S., Jones, N., et al. (2018) Chronic Inflammation Is a Feature of Achilles Tendinopathy and Rupture. British Journal of Sports Medicine, 52, 359-367. https://doi.org/10.1136/bjsports-2017-098161
[15]
Agergaard, A.S., Svensson, R.B., Malmgaard-Clausen, N.M., Couppé, C., Hjortshoej, M.H., Doessing, S., et al. (2021) Clinical Outcomes, Structure, and Function Improve with Both Heavy and Moderate Loads in the Treatment of Patellar Tendinopathy: A Randomized Clinical Trial. The American Journal of Sports Medicine, 49, 982-993. https://doi.org/10.1177/0363546520988741
[16]
Belk, J.W., Kraeutler, M.J., Houck, D.A., Goodrich, J.A., Dragoo, J.L. and McCarty, E.C. (2021) Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The American Journal of Sports Medicine, 49, 249-260. https://doi.org/10.1177/0363546520909397
[17]
Abdelkader, N.A., Helmy, M.N.K., Fayaz, N.A. and Saweeres, E.S.B. (2021) Short- and Intermediate-Term Results of Extracorporeal Shockwave Therapy for Noninsertional Achilles Tendinopathy. Foot & Ankle International, 42, 788-797. https://doi.org/10.1177/1071100720982613
[18]
Heinemeier, K.M., Øhlenschlæger, T.F., Mikkelsen, U.R., Sønder, F., Schjerling, P., Svensson, R.B., et al. (1985) Effects of Anti-Inflammatory (NSAID) Treatment on Human Tendinopathic Tissue. Journal of Applied Physiology, 123, 1397-1405. https://doi.org/10.1152/japplphysiol.00281.2017
[19]
Willegger, M., Hirtler, L., Schwarz, G.M., Windhager, R.H. and Chiari, C. (2021) Peroneal Tendon Pathologies: From the Diagnosis to Treatment. Der Orthopäde, 50, 589-604. https://doi.org/10.1007/s00132-021-04116-6
[20]
Ma, K.L. and Wang, H.Q. (2020) Management of Lateral Epicondylitis: A Narrative Literature Review. Pain Research and Management, 2020, Article ID: 6965381. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222600/
[21]
Duncan, J., Duncan, R., Bansal, S., Davenport, D. and Hacker, A. (2019) Lateral Epicondylitis: The Condition and Current Management Strategies. British Journal of Hospital Medicine, 80, 647-651. https://doi.org/10.12968/hmed.2019.80.11.647
[22]
Buchanan, B.K. and Varacallo, M. (2022) Tennis Elbow. StatPearls, Treasure Island, FL. http://www.ncbi.nlm.nih.gov/books/NBK431092/
[23]
Rothschild, B. (2013) Mechanical Solution for a Mechanical Problem: Tennis Elbow. World Journal of Orthopedics, 4, 103-106. https://doi.org/10.5312/wjo.v4.i3.103
[24]
Lai, W.C., Erickson, B.J., Mlynarek, R.A. and Wang, D. (2018) Chronic Lateral Epicondylitis: Challenges and Solutions. Open Access Journal of Sports Medicine, 9, 243-251. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214594/
[25]
O’Connell, B., Wragg, N.M. and Wilson, S.L. (2019) The Use of PRP Injections in the Management of Knee Osteoarthritis. Cell and Tissue Research, 376, 143-152. https://doi.org/10.1007/s00441-019-02996-x
[26]
Madhi, M.I., Yausep, O.E., Khamdan, K. and Trigkilidas, D. (2020) The Use of PRP in Treatment of Achilles Tendinopathy: A Systematic Review of Literature. Study Design: Systematic Review of Literature. Annals of Medicine and Surgery, 55, 320-326. https://doi.org/10.1016/j.amsu.2020.04.042
[27]
Schwitzguebel, A.J., Bogoev, M., Nikolov, V., Ichane, F. and Lädermann, A. (2020) Tennis Elbow, Study Protocol for a Randomized Clinical Trial: Needling with and without Platelet-Rich Plasma after Failure of Up-to-Date Rehabilitation. Journal of Orthopaedic Surgery and Research, 15, Article No. 462. https://pubmed.ncbi.nlm.nih.gov/33028383/
[28]
Niemeyer, P., Fechner, K., Milz, S., Richter, W., Suedkamp, N.P., Mehlhorn, A.T., et al. (2010) Comparison of Mesenchymal Stem Cells from Bone Marrow and Adipose Tissue for Bone Regeneration in a Critical Size Defect of the Sheep Tibia and the Influence of Platelet-Rich Plasma. Biomaterials, 31, 3572-3579. https://doi.org/10.1016/j.biomaterials.2010.01.085
[29]
Kobayashi, E., Flückiger, L., Fujioka-Kobayashi, M., Sawada, K., Sculean, A., Schaller, B., et al. (2016) Comparative Release of Growth Factors from PRP, PRF, and Advanced-PRF. Clinical Oral Investigations, 20, 2353-2360. https://doi.org/10.1007/s00784-016-1719-1
[30]
Chong, D.L.W., Trinder, S., Labelle, M., Rodriguez-Justo, M., Hughes, S., Holmes, A.M., et al. (2020) Platelet-Derived Transforming Growth Factor-β1 Promotes Keratinocyte Proliferation in Cutaneous Wound Healing. Journal of Tissue Engineering and Regenerative Medicine, 14, 645-649. https://doi.org/10.1002/term.3022
[31]
Guevara-Alvarez, A., Schmitt, A., Russell, R.P., Imhoff, A.B. and Buchmann, S. (2014) Growth Factor Delivery Vehicles for Tendon Injuries: Mesenchymal Stem Cells and Platelet Rich Plasma. Muscle, Ligaments and Tendons Journal, 4, 378-385. https://doi.org/10.11138/mltj/2014.4.3.378
[32]
Uslu Güvendi, E., Aşkin, A., Güvendi, G. and Koçyiğit, H. (2018) Comparison of Efficiency between Corticosteroid and Platelet Rich Plasma Injection Therapies in Patients with Knee Osteoarthritis. Archives of Rheumatology, 33, 273-281. https://doi.org/10.5606/ArchRheumatol.2018.6608
[33]
Li, B., Zhang, Y. and Bi, L. (2020) Comparative Efficacy of Treatments for Patients with Knee Osteoarthritis: A Network Meta-Analysis. European Journal of Medical Research, 25, Article No. 27. https://doi.org/10.1186/s40001-020-00426-1
[34]
Vilchez-Cavazos, F., Millán-Alanís, J.M., Blázquez-Saldaña, J., álvarez-Villalobos, N., Peña-Martínez, V.M., Acosta-Olivo, C.A., et al. (2019) Comparison of the Clinical Effectiveness of Single versus Multiple Injections of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Orthopaedic Journal of Sports Medicine, 7, Article ID: 2325967119887116. https://doi.org/10.1177/2325967119887116
[35]
Raeissadat, S.A., Gharooee Ahangar, A., Rayegani, S.M., Minator Sajjadi, M., Ebrahimpour, A. and Yavari, P. (2020) Platelet-Rich Plasma-Derived Growth Factor vs Hyaluronic Acid Injection in the Individuals with Knee Osteoarthritis: A One Year Randomized Clinical Trial. Journal of Pain Research, 13, 1699-1711. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354951/
[36]
Jalali Jivan, S., Monzavi, S.M., Zargaran, B., Hamidi Alamdari, D., Tavakol Afshari, J., Etemad-Rezaie, A., et al. (2021) Comparative Analysis of the Effectiveness of Intra-Articular Injection of Platelet-Rich Plasma versus Hyaluronic Acid for Knee Osteoarthritis: Results of an Open-Label Trial. The Archives of Bone and Joint Surgery, 9, 487-495.
[37]
Arirachakaran, A., Sukthuayat, A., Sisayanarane, T., Laoratanavoraphong, S., Kanchanatawan, W. and Kongtharvonskul, J. (2016) Platelet-Rich Plasma versus Autologous Blood versus Steroid Injection in Lateral Epicondylitis: Systematic Review and Network Meta-Analysis. Journal of Orthopaedics and Traumatology, 17, 101-112. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882297/
[38]
Cole, B.J., Karas, V., Hussey, K., Pilz, K. and Fortier, L.A. (2017) Hyaluronic Acid versus Platelet-Rich Plasma: A Prospective, Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-Articular Biology for the Treatment of Knee Osteoarthritis. The American Journal of Sports Medicine, 45, 339-346. https://doi.org/10.1177/0363546516665809