Platelet-Rich Plasma Versus Hyaluronic Acid Injections for the Treatment of Knee Osteoarthritis: Results at 5 Years of a Double-Blind, Randomized Controlled Trial.
BACKGROUND
Platelet-rich plasma (PRP) injections have been proposed as a new conservative option for knee degeneration to provide symptomatic relief and delay surgical intervention. Although the current literature provides some evidence on the benefits of this technique compared with viscosupplementation, no studies have been performed to compare their long-term effects.


PURPOSE
To compare the long-term clinical outcomes provided by intra-articular injections of either PRP or hyaluronic acid (HA) to treat knee degenerative disease.


STUDY DESIGN
Randomized controlled trial; Level of evidence, 1.


METHODS
Patients with a history of chronic symptomatic knee degenerative changes and osteoarthritis (Kellgren-Lawrence grade 0-3) were enrolled: 192 patients were randomized to undergo 3 blinded weekly intra-articular injections of either PRP or HA. Patients were prospectively evaluated before the injection and then at 2, 6, 12, and 24 months and a mean of 64.3 months (SD, 7.8 months) of follow-up. Evaluation was based on International Knee Documentation Committee (IKDC) subjective (main outcome), EuroQol visual analog scale, and Tegner scores; 167 patients reached the final evaluation.


RESULTS
Both treatments were effective in improving knee functional status and symptoms over time: Mean ± SD IKDC subjective score improved significantly for both PRP and HA groups ( P < .0005) and remained stable over time up to 24 months (from 53.3 ± 14.3 to 67.3 ± 18.1 and from 50.3 ± 13.2 to 62.1 ± 20.8 for PRP and HA groups, respectively). At final evaluation, a significant IKDC reduction was observed in both treatment groups, with the PRP group still presenting significantly higher values compared with baseline: PRP 60.5 ± 19.0 ( P < .001 vs baseline), HA 55.7 ± 18.8 (not significant vs baseline). A comparative analysis showed no significant intergroup difference in any of the clinical scores at any follow-up point. The median duration of patient subjective perception of symptomatic relief was 9 months for HA and 12 months for PRP (not significant). The only significant difference was observed in the rate of reintervention at 24 months, which was significantly lower in the PRP group (22.6% vs 37.1%, P = .036).


CONCLUSION
Both treatments were effective in improving knee functional status and symptoms over time. PRP did not provide an overall superior clinical improvement compared with HA in terms of either symptomatic-functional improvement at different follow-up points or effect duration.


REGISTRATION
NCT01670578 (ClinicalTrials.gov identifier).
['Di Martino|Alessandro|A|', 'Di Matteo|Berardo|B|', 'Papio|Tiziana|T|', 'Tentoni|Francesco|F|', 'Selleri|Filippo|F|', 'Cenacchi|Annarita|A|', 'Kon|Elizaveta|E|', 'Filardo|Giuseppe|G|']
D000328:Adult D000368:Aged D004311:Double-Blind Method D005260:Female D006801:Humans D006820:Hyaluronic Acid D007270:Injections, Intra-Articular D007719:Knee Joint D008297:Male D008875:Middle Aged D020370:Osteoarthritis, Knee D053657:Platelet-Rich Plasma D011446:Prospective Studies D016896:Treatment Outcome D055676:Viscosupplementation D064232:Visual Analog Scale
platelet-rich plasma injections osteoarthritis viscosupplementation intra-articular cartilage growth factors