Osteoarthritis of the knee – PRP

The injection of platelet-rich plasma (PRP) for osteoarthritis of the knee is repeatedly the subject of controversial debate. Thus the objective of the ESSKA (European Society of Sports Traumatology, Knee Surgery & Arthroscopy) was to draw up a European consensus on the use of PRP for osteoarthritis of the knee.

To this end the current scientific litera­ture was analysed and combined with expert opinion to formulate informative statements on the use of PRP. We used a precise methodical procedure based on a modified Delphi process (scientific adviser Philippe Beaufils, France). Under the leadership of Laura de Girolamo (Italy) and Lior Laver (Israel) a steering group (12 specialists from 9 European countries) formulated questions and answers based on the literature search on the subject areas 1) PRP – Rationale and Indication, 2) PRP – Preparation and Characterisation, and 3) PRP – Protocol. The questions were then eva­luated in a two-stage process by another rating group (22 specialists) until consensus was reached. In the concluding stage a third group reviewed the geographic adaptation to the various European countries. After this complex process a total of 28 questions and answers, including an overview of the literature, were drawn up. The discussions included questions such as the dependence on the degree of osteoarthritis, the age of the patients, use during the inflammatory phase, preventive use, a comparison with corticosteroids or hyaluronic acid, the superiority of leucocyte-rich or leucocyte-poor PRP, and many others. The original version of the most important statement on the clinical evidence on the use of PRP is cited here.

QUESTION 1: Does current clinical evidence support the use of PRP for knee OA?

Does current clinical evidence support the use of PRP for knee OA?

Statement: Clinical evidence confirms the efficacy of PRP in the treatment of knee osteoarthritis (OA). Level I and II clinical studies, as well as additional prospective studies, support the safety and clinical benefit of PRP for knee OA, which was shown in comparison to both placebo (saline) and control treatments such as hyaluronic acid or corticosteroids (CS). The efficacy of PRP in the treatment of knee OA has been also supported by meta-analyses and confirms the findings of preclinical research. The consensus group can therefore conclude that there is enough preclinical and clinical evidence to recommend/support the use of PRP in knee OA (see following questions addressing PRP specifications and in­dications).

The answer is based on 5 meta-analyses, one RCT, and one systematic review. The complete consensus can be downloaded free of charge from the homepage of the ESSKA.

Chairpersons: Laura de Girolamo, Lior Laver

STEERING AND LITERATURE GROUP MEMBERS: Philippe Beaufils (France) – ESSKA Consensus Projects Advisor, Mikel Sanchez (Spain), Giuseppe Filardo (Italy), Ramon Cugat (Spain), Thomas Tischer (Germany), Jeremy Magalon (France), Rodica Marinescu (Romania), Marko Ostojic (Bosnia), Ferran Abat (Spain), Elizaveta Kon (Italy), Ricardo Bastos (Portugal), Baris Kocaoglu (Turkey), Michael Iosifidis (Greece)

Autoren

Univ.-Prof. Dr. med. Thomas Tischer

ist Facharzt für Orthopädie und Unfallchirurgie mit Zusatzbezeichnungen u.a. Sportmedizin und spezielle orthopädische Chirurgie. Er ist Chefarzt der Klinik für Orthopädie und Unfallchirurgie, Malteser Waldkrankenhaus St. Marien, Erlangen. Außerdem ist Prof. Tischer Präsident der GOTS sowie Kongresspräsident des GOTS­Kongresses 2024 in Nürnberg.