The use of platelet-rich plasma (PRP) for knee osteoarthritis is a widely used treatment option, but it is still highly controversial. There is a lack of specific recommendations regarding its use depending on the patient’s age, the degree or localisation of the osteoarthritis or the treatment of concomitant joint effusions.
A group of experts from ESSKA (European Society of Sports Traumatology, Knee Surgery, and Arthroscopy) and ICRS (International Cartilage Regeneration and Joint Preservation Society) under the leadership of Prof. Kon from Italy has therefore adopted a consensus to answer the questions [1]. The aim of this consensus was to develop evidence- and expert-based as well as patient-oriented recommendations for the use of intra-articular injections of platelet-rich plasma (PRP) for knee osteoarthritis.
The so-called RAND / UCLA Appropriateness Method was used to achieve a consensus and develop recommendations for certain patient categories. This combines the best available scientific evidence with the collective judgement of the expert panel. The following scenarios were defined on the basis of the criteria: initial treatment vs. first injection treatment vs. second injection treatment, age (< 50 / 50 – 65 / 66 – 80 / >80), tibiofemoral vs. patellofemoral involvement, degree of osteoarthritis (Kellgren-Lawrence / KL 0 – I / II – III / IV) and joint effusion (dry knee, mild to moderate or severe effusion). Of the 216 scenarios, the indication for the use of PRP in knee osteoarthritis was considered appropriate in 84 (38.9 %), inappropriate in 9 (4.2 %) and uncertain in 123 (56.9 %).
The parameters with the highest agreement were:
- PRP after failed injectable treatments (62.5 %)
- PRP after failed conservative treatments
- PRP for KL 0-III scenarios (58.3 %)
The highest uncertainty in the use of PRP was found in:
- as first-line treatment without prior therapy (91.7 % uncertainty)
- in KL IV osteoarthritis (87.5 % uncertainty)
These recommendations for the use of PRP in the treatment of knee osteoarthritis are intended to provide a useful reference for clinical practice. PRP injections are considered suitable for patients aged ≤ 80 years with knee osteoarthritis of grades KL 0-III after failed conservative non-injecting or injecting treatments, whereas they are not considered suitable as a first-line treatment or for osteoarthritis of grade KL IV.
Literature
[1] Platelet-rich plasma injections for the management of knee osteoarthritis: The ESSKA-ICRS consensus. Recommendations using the RAND/UCLA appropriateness method for different clinical scenarios.Kon E, de Girolamo L, Laver L, Andriolo L, Andia I, Bastos R, Beaufils P, Biant L, Bøe B, Boffa A, Cugat R, Di Martino A, Erggelet C, Iosifidis M, Kocaoglu B, Magalon J, Marinescu R, Nehrer S, Niemeyer P, Ostojić M, Piontek T, Sánchez M, Sas K, Skarpas G, Tischer T, Vonk L, Filardo G. Knee Surg Sports Traumatol Arthrosc. 2024 Jul 4. doi: 10.1002/ksa.12320.
Autoren
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.
