[en] Purpose There has been much debate regarding the use of intra-articular injections of platelet-rich plasma (PRP) as symptomatic treatment for knee osteoarthritis. The objective of this consensus was to develop guidelines for PRP injections in knee osteoarthritis according to the French National Authority for Health recommendations.
Methods Fifteen physicians from different French-speaking countries (10 rheumatologists, 4 specialists in rehabilitation and sports medicine and 1 radiologist) were selected for their expertise in the areas of PRP and osteoarthritis. A comprehensive literature review was conducted on Medline including all published therapeutic trials, open studies, meta-analysis and systematic reviews focusing on the effects of PRP in knee OA, as well as fundamental studies concerning the characteristics of the various types of PRP and their mechanisms, indexed before April 2019. Using the method recommended by the French National Authority for Health inspired by the Delphi consensus process, 25 recommendations were finally retained and evaluated. The recommendations were classified as appropriate or not appropriate, with strong or relative agreement, or uncertain if a consensus was not achieved.
Results Among the 25 recommendations selected, the main ones are the following: (1) Intra-articular injections of PRP are an effective symptomatic treatment for early to moderate knee osteoarthritis. This recommendation was considered appropriate with a relative agreement (Median = 8; rank = 6–9). Level of evidence 1A. (2) A PRP treatment sequence in knee osteoarthritis may include 1–3 injections. This recommendation was considered appropriate with a strong agreement (Median = 9; rank = 7–9). Level of evidence 1A. (3) Leucocytes-poor PRP should be preferred in knee osteoarthritis. This recommendation was considered appropriate with a relative agreement (Median = 8; rank = 5–9). Level of evidence 5. (4) Intra-articular PRP knee injections should be performed under ultrasound or fluoroscopic guidance. This recommendation was considered uncertain with no consensus (Median = 8; rank = 3–9). Level of evidence 5. (5) PRP should not be mixed with an anesthetic or intra-articular corticosteroid. This recommendation was considered appropriate with a relative agreement (Median = 9; rank = 6–9). Level of evidence 5
Conclusion Those 25 recommendations should standardize and facilitate the use of IA PRP injections, which are considered by experts as an effective treatment especially in early or moderate knee OA. Although a strong or relative agreement from the experts was obtained for most of the recommendations, many of them had a very low level of evidence (Level 5) and were principally based on the clinical experience of the experts.
Disciplines :
Laboratory medicine & medical technology Rheumatology Orthopedics, rehabilitation & sports medicine
Author, co-author :
Eymard, F
Ornetti, P
Maillet, J
Noël, E
Adam, P
Legré-Boyer, V
Boyer, T
Allali, F
Gremeaux, V
Kaux, Jean-François ; Université de Liège - ULiège > Département des sciences de la motricité > Médecine physique, réadaptation et traumatologie du sport
Abhishek A (2016) Calcium pyrophosphate deposition disease: a review of epidemiologic findings. Curr Opin Rheumatol 28:133–139
Ahlbäck S, Rydberg J (1980) X-ray classification and examination technics in gonarthrosis. Lakartidningen 77(2091–2093):2096
Ahmad HS, Farrag SE, Okasha AE, Kadry AO, Ata TB, Monir AA, Shady I (2018) Clinical outcomes are associated with changes in ultrasonographic structural appearance after platelet-rich plasma treatment for knee osteoarthritis. Int J Rheum Dis 21:960–966
Assirelli E, Filardo G, Mariani E, Kon E, Roffi A, Vaccaro F, Marcacci M, Facchini A, Pulsatelli L (2015) Effect of two different preparations of platelet-rich plasma on synoviocytes. Knee Surg Sports Traumatol Arthrosc 23:2690–2703
Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ, Espinosa R, Haugen IK, Lin J, Mandl LA, Moilanen E, Nakamura N, Snyder-Mackler L, Trojian T, Underwood M, McAlindon TE (2019) OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil 27:1578–1589
Berkoff DJ, Miller LE, Block JE (2012) Clinical utility of ultrasound guidance for intra-articular knee injections: a review. Clin Interv Aging 7:89–95
Braun HJ, Kim HJ, Chu CR, Dragoo JL (2014) The effect of platelet-rich plasma formulations and blood products on human synoviocytes: implications for intra-articular injury and therapy. Am J Sports Med 42:1204–1210
Buendía-López D, Medina-Quirós M, Fernández-Villacañas Marín MÁ (2018) Clinical and radiographic comparison of a single LP-PRP injection, a single hyaluronic acid injection and daily NSAID administration with a 52-week follow-up: a randomized controlled trial. J Orthop Traumatol 19:3
Bum Park Y, Ah Choi W, Kim Y-K, Chul Lee S, Hae Lee J (2012) Accuracy of blind versus ultrasound-guided suprapatellar bursal injection. J Clin Ultrasound 40:20–25
Burns PB, Rohrich RJ, Chung KC (2011) The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg 128:305–310
Camurcu Y, Sofu H, Ucpunar H, Kockara N, Cobden A, Duman S (2018) Single-dose intra-articular corticosteroid injection prior to platelet-rich plasma injection resulted in better clinical outcomes in patients with knee osteoarthritis: a pilot study. J Back Musculoskelet Rehabil 31:603–610
Carofino B, Chowaniec DM, McCarthy MB, Bradley JP, Delaronde S, Beitzel K, Cote MP, Arciero RA, Mazzocca AD (2012) Corticosteroids and local anesthetics decrease positive effects of platelet-rich plasma: an in vitro study on human tendon cells. Arthroscopy 28:711–719
Cerza F, Carnì S, Carcangiu A, Di Vavo I, Schiavilla V, Pecora A, De Biasi G, Ciuffreda M (2012) Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis. Am J Sports Med 40:2822–2827
Chang K-V, Hung C-Y, Aliwarga F, Wang T-G, Han D-S, Chen W-S (2014) Comparative effectiveness of platelet-rich plasma injections for treating knee joint cartilage degenerative pathology: a systematic review and meta-analysis. Arch Phys Med Rehabil 95:562–575
Chen CPC, Cheng C-H, Hsu C-C, Lin H-C, Tsai Y-R, Chen J-L (2017) The influence of platelet rich plasma on synovial fluid volumes, protein concentrations, and severity of pain in patients with knee osteoarthritis. Exp Gerontol 93:68–72
Chouhan DK, Dhillon MS, Patel S, Bansal T, Bhatia A, Kanwat H (2019) Multiple platelet-rich plasma injections versus single platelet-rich plasma injection in early osteoarthritis of the knee: an experimental study in a guinea pig model of early knee osteoarthritis. Am J Sports Med 47:2300–2307
Cole BJ, Karas V, Hussey K, Pilz K, Fortier LA (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. Am J Sports Med 45:339–346
Conrozier T, Monfort J, Chevalier X, Raman R, Richette P, Diraçoglù D, Bard H, Baron D, Jerosch J, Migliore A, Henrotin Y (2018) EUROVISCO recommendations for optimizing the clinical results of viscosupplementation in osteoarthritis. Cartilage 11:47–59
Cooper C, Chapurlat R, Al-Daghri N, Herrero-Beaumont G, Bruyère O, Rannou F, Roth R, Uebelhart D, Reginster J-Y (2019) Safety of oral non-selective non-steroidal anti-inflammatory drugs in osteoarthritis: what does the literature say? Drugs Aging 36:15–24
Curtis E, Fuggle N, Shaw S, Spooner L, Ntani G, Parsons C, Corp N, Honvo G, Baird J, Maggi S, Dennison E, Bruyère O, Reginster J-Y, Cooper C (2019) Safety of cyclooxygenase-2 inhibitors in osteoarthritis: outcomes of a systematic review and meta-analysis. Drugs Aging 36:25–44
Dai W-L, Zhou A-G, Zhang H, Zhang J (2017) Efficacy of platelet-rich plasma in the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials. Arthroscopy 33:659–670.e1
Dernek B, Kesiktas FN, Duymus TM, Aydin T, Isiksacan N, Diracoglu D, Aksoy C (2017) Effect of platelet concentration on clinical improvement in treatment of early stage-knee osteoarthritis with platelet-rich plasma concentrations. J Phys Ther Sci 29:896–901
Di Martino A, Di Matteo B, Papio T, Tentoni F, Selleri F, Cenacchi A, Kon E, Filardo G (2018) Platelet-rich plasma versus hyaluronic acid injections for the treatment of knee osteoarthritis: results at 5 years of a double-blind, randomized controlled trial. Am J Sports Med 47:347–354
Dohan Ehrenfest DM, Rasmusson L, Albrektsson T (2009) Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol 27:158–167
Durant TJS, Dwyer CR, McCarthy MBR, Cote MP, Bradley JP, Mazzocca AD (2017) Protective nature of platelet-rich plasma against chondrocyte death when combined with corticosteroids or local anesthetics. Am J Sports Med 45:218–225
Duymus TM, Mutlu S, Dernek B, Komur B, Aydogmus S, Kesiktas FN (2017) Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options. Knee Surg Sports Traumatol Arthrosc 25:485–492
Evanson JR, Guyton MK, Oliver DL, Hire JM, Topolski RL, Zumbrun SD, McPherson JC, Bojescul JA (2014) Gender and age differences in growth factor concentrations from platelet-rich plasma in adults. Mil Med 179:799–805
Eymard F, Chevalier X, Conrozier T (2017) Obesity and radiological severity are associated with viscosupplementation failure in patients with knee osteoarthritis. J Orthop Res 35:2269–2274
Fawzy RM, Hashaad NI, Mansour AI (2017) Decrease of serum biomarker of type II collagen degradation (Coll2-1) by intra-articular injection of an autologous plasma-rich-platelet in patients with unilateral primary knee osteoarthritis. Eur J Rheumatol 4:93–97
Fice MP, Miller JC, Christian R, Hannon CP, Smyth N, Murawski CD, Cole BJ, Kennedy JG (2019) The role of platelet-rich plasma in cartilage pathology: an updated systematic review of the basic science evidence. Arthroscopy 35:961–976.e3
Filardo G, Kon E, Pereira Ruiz MT, Vaccaro F, Guitaldi R, Di Martino A, Cenacchi A, Fornasari PM, Marcacci M (2012) Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach. Knee Surg Sports Traumatol Arthrosc 20:2082–2091
Filardo G, Kon E, Matteo DI, B, DI Marino A, Sessa A, Merli ML, Marcacci M, (2013) Leukocyte-poor PRP application for the treatment of knee osteoarthritis. Joints 1:112–120
Filardo G, Di Matteo B, Di Martino A, Merli ML, Cenacchi A, Fornasari P, Marcacci M, Kon E (2015) Platelet-rich plasma intra-articular knee injections show no superiority versus viscosupplementation: a randomized controlled trial. Am J Sports Med 43:1575–1582
Fitzpatrick J, Bulsara MK, McCrory PR, Richardson MD, Zheng MH (2017) Analysis of platelet-rich plasma extraction: variations in platelet and blood components between 4 common commercial kits. Orthop J Sports Med 5:2325967116675272
Gato-Calvo L, Magalhaes J, Ruiz-Romero C, Blanco FJ, Burguera EF (2019) Platelet-rich plasma in osteoarthritis treatment: review of current evidence. Ther Adv Chronic Dis 10:2040622319825567
Glass F, Lippton H, Kadowitz PJ (1980) Differential effects of local anesthetics and propranolol on arachidonic acid and adenosine 5’-diphosphate-induced aggregation in rabbit platelets. Prostaglandins Med 5:85–92
Görmeli G, Görmeli CA, Ataoglu B, Çolak C, Aslantürk O, Ertem K (2017) Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc 25:958–965
Grant GJ, Ramanathan S, Patel N, Turndorf H (1989) The effects of local anesthetics on maternal and neonatal platelet function. Acta Anaesthesiol Scand 33:409–412
Guide méthodologique consensus formalise.pdf [Internet]. Available from: https://www.has-sante.fr/upload/docs/application/pdf/2011-01/guide_methodologique_consensus_formalise.pdf
Guillibert C, Charpin C, Raffray M, Benmenni A, Dehaut F-X, El Ghobeira G, Giorgi R, Magalon J, Arniaud D (2019) Single injection of high volume of autologous pure PRP provides a significant improvement in knee osteoarthritis: a prospective routine care study. Int J Mol Sci 20:1327
Han Y, Huang H, Pan J, Lin J, Zeng L, Liang G, Yang W, Liu J (2019) Meta-analysis comparing platelet-rich plasma vs hyaluronic acid injection in patients with knee osteoarthritis. Pain Med 20:1418–1429
Huang P-H, Wang C-J, Chou W-Y, Wang J-W, Ko J-Y (2017) Short-term clinical results of intra-articular PRP injections for early osteoarthritis of the knee. Int J Surg 42:117–122
Huang Y, Liu X, Xu X, Liu J (2019) Intra-articular injections of platelet-rich plasma, hyaluronic acid or corticosteroids for knee osteoarthritis: a prospective randomized controlled study. Orthopade 48:239–247
Jang S-J, Kim J-D, Cha S-S (2013) Platelet-rich plasma (PRP) injections as an effective treatment for early osteoarthritis. Eur J Orthop Surg Traumatol 23:573–580
Jo CH, Lee SY, Yoon KS, Shin S (2017) Effects of platelet-rich plasma with concomitant use of a corticosteroid on tenocytes from degenerative rotator cuff tears in interleukin 1β-induced tendinopathic conditions. Am J Sports Med 45:1141–1150
Joshi Jubert N, Rodríguez L, Reverté-Vinaixa MM, Navarro A (2017) Platelet-rich plasma injections for advanced knee osteoarthritis: a prospective, randomized, double-blinded clinical trial. Orthop J Sports Med 5:2325967116689386
Kanchanatawan W, Arirachakaran A, Chaijenkij K, Prasathaporn N, Boonard M, Piyapittayanun P, Kongtharvonskul J (2016) Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 24:1665–1677
Kavadar G, Demircioglu DT, Celik MY, Emre TY (2015) Effectiveness of platelet-rich plasma in the treatment of moderate knee osteoarthritis: a randomized prospective study. J Phys Ther Sci 27:3863–3867
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502
Khatab S, van Buul GM, Kops N, Bastiaansen-Jenniskens YM, Bos PK, Verhaar JA, van Osch GJ (2018) Intra-articular injections of platelet-rich plasma releasate reduce pain and synovial inflammation in a mouse model of osteoarthritis. Am J Sports Med 46:977–986
Khoshbin A, Leroux T, Wasserstein D, Marks P, Theodoropoulos J, Ogilvie-Harris D, Gandhi R, Takhar K, Lum G, Chahal J (2013) The efficacy of platelet-rich plasma in the treatment of symptomatic knee osteoarthritis: a systematic review with quantitative synthesis. Arthroscopy 29:2037–2048
Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, Callahan L, Copenhaver C, Dodge C, Felson D, Gellar K, Harvey WF, Hawker G, Herzig E, Kwoh CK, Nelson AE, Samuels J, Scanzello C, White D, Wise B, Altman RD, DiRenzo D, Fontanarosa J, Giradi G, Ishimori M, Misra D, Shah AA, Shmagel AK, Thoma LM, Turgunbaev M, Turner AS, Reston J (2020) 2019 American college of rheumatology/arthritis foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol 72:220–233
Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M (2010) Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc 18:472–479
Kon E, Mandelbaum B, Buda R, Filardo G, Delcogliano M, Timoncini A, Fornasari PM, Giannini S, Marcacci M (2011) Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Arthroscopy 27:1490–1501
Laudy ABM, Bakker EWP, Rekers M, Moen MH (2015) Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br J Sports Med 49:657–672
Lin K-Y, Yang C-C, Hsu C-J, Yeh M-L, Renn J-H (2019) Intra-articular injection of platelet-rich plasma is superior to hyaluronic acid or saline solution in the treatment of mild to moderate knee osteoarthritis: a randomized, double-blind, triple-parallel, placebo-controlled clinical trial. Arthroscopy 35:106–117
Liu X, Wang L, Ma C, Wang G, Zhang Y, Sun S (2019) Exosomes derived from platelet-rich plasma present a novel potential in alleviating knee osteoarthritis by promoting proliferation and inhibiting apoptosis of chondrocyte via Wnt/β-catenin signaling pathway. J Orthop Surg 14:470
Louis ML, Magalon J, Jouve E, Bornet CE, Mattei JC, Chagnaud C, Rochwerger A, Veran J, Sabatier F (2018) Growth factors levels determine efficacy of platelets rich plasma injection in knee osteoarthritis: a randomized double blind noninferiority trial compared with viscosupplementation. Arthroscopy 34:1530–1540.e2
Ludwig HC, Birdwhistell KE, Brainard BM, Franklin SP (2017) Use of a cyclooxygenase-2 inhibitor does not inhibit platelet activation or growth factor release from platelet-rich plasma. Am J Sports Med 45:3351–3357
Magalon J, Bausset O, Serratrice N, Giraudo L, Aboudou H, Veran J, Magalon G, Dignat-Georges F, Sabatier F (2014) Characterization and comparison of 5 platelet-rich plasma preparations in a single-donor model. Arthroscopy 30:629–638
Magalon J, Velier M, Francois P, Graiet H, Veran J, Sabatier F (2017) Comment on “responders to platelet-rich plasma in osteoarthritis: a technical analysis”. BioMed Res Int 2017:8620257
Mannava S, Whitney KE, Kennedy MI, King J, Dornan GJ, Klett K, Chahla J, Evans TA, Huard J, LaPrade RF (2019) The influence of naproxen on biological factors in leukocyte-rich platelet-rich plasma: a prospective comparative study. Arthroscopy 35:201–210
Mariani E, Canella V, Cattini L, Kon E, Marcacci M, Di Matteo B, Pulsatelli L, Filardo G (2016) Leukocyte-rich platelet-rich plasma injections do not up-modulate intra-articular pro-inflammatory cytokines in the osteoarthritic knee. PLoS ONE 11:e0156137
Mariani E, Roffi A, Cattini L, Pulsatelli L, Assirelli E, Krishnakumar GS, Cenacchi A, Kon E, Filardo G (2020) Release kinetic of pro- and anti-inflammatory biomolecules from platelet-rich plasma and functional study on osteoarthritis synovial fibroblasts. Cytotherapy. 10.1016/j.jcyt.2020.02.006 DOI: 10.1016/j.jcyt.2020.02.006
Marty M, Hilliquin P, Rozenberg S, Valat JP, Vignon E, Coste P, Savarieau B, Allaert FA (2009) Validation of the KOFUS (knee osteoarthritis flare-ups score). Jt Bone Spine 76:268–272
Mazzocca AD, McCarthy MBR, Chowaniec DM, Cote MP, Romeo AA, Bradley JP, Arciero RA, Beitzel K (2012) Platelet-rich plasma differs according to preparation method and human variability. J Bone Jt Surg Am 94:308–316
McAlindon TE, Driban JB, Henrotin Y, Hunter DJ, Jiang G-L, Skou ST, Wang S, Schnitzer T (2015) OARSI clinical trials recommendations: design, conduct, and reporting of clinical trials for knee osteoarthritis. Osteoarthr Cartil 23:747–760
Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD (2016) Efficacy of intra-articular platelet-rich plasma injections in knee osteoarthritis: a systematic review. Arthroscopy 32:495–505
Milants C, Bruyère O, Kaux J-F (2017) Responders to platelet-rich plasma in osteoarthritis: a technical analysis. BioMed Res Int 2017:7538604
Montañez-Heredia E, Irízar S, Huertas PJ, Otero E, Del Valle M, Prat I, Díaz-Gallardo MS, Perán M, Marchal JA, Hernandez-Lamas MDC (2016) Intra-articular injections of platelet-rich plasma versus hyaluronic acid in the treatment of osteoarthritic knee pain: a randomized clinical trial in the context of the spanish national health care system. Int J Mol Sci 17:1064
Moussa M, Lajeunesse D, Hilal G, El Atat O, Haykal H, Serhal R, Chalhoub A, Khalil C, Alaaeddine N (2017) Platelet rich plasma (PRP) induces chondroprotection via increasing autophagy, anti-inflammatory markers, and decreasing apoptosis in human osteoarthritic cartilage. Exp Cell Res 352:146–156
O’Donnell C, Migliore E, Grandi FC, Koltsov J, Lingampalli N, Cisar C, Indelli PF, Sebastiano V, Robinson WH, Bhutani N, Chu CR (2019) Platelet-rich plasma (PRP) from older males with knee osteoarthritis depresses chondrocyte metabolism and upregulates inflammation. J Orthop Res 37:1760–1770
Ornetti P, Nourissat G, Berenbaum F, Sellam J, Richette P, Chevalier X, under the aegis of the Osteoarthritis Section of the French Society for Rheumatology (Société Française de Rhumatologie, SFR) (2016) Does platelet-rich plasma have a role in the treatment of osteoarthritis? Jt Bone Spine 83:31–36
Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A (2013) Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med 41:356–364
Pinto LMA, Pereira R, de Paula E, de Nucci G, Santana MHA, Donato JL (2004) Influence of liposomal local anesthetics on platelet aggregation in vitro. J Liposome Res 14:51–59
Qiao J, An N, Ouyang X (2017) Quantification of growth factors in different platelet concentrates. Platelets 28:774–778
Raeissadat SA, Rayegani SM, Hassanabadi H, Fathi M, Ghorbani E, Babaee M, Azma K (2015) Knee osteoarthritis injection choices: platelet- rich plasma (PRP) versus hyaluronic acid (a one-year randomized clinical trial). Clin Med Insights Arthritis Musculoskelet Disord 8:1–8
Raeissadat SA, Rayegani SM, Ahangar AG, Abadi PH, Mojgani P, Ahangar OG (2017) Efficacy of intra-articular injection of a newly developed plasma rich in growth factor (PRGF) versus hyaluronic acid on pain and function of patients with knee osteoarthritis: a single-blinded randomized clinical trial. Clin Med Insights Arthritis Musculoskelet Disord 10:1179544117733452
Raeissadat SA, Ghorbani E, Sanei Taheri M, Soleimani R, Rayegani SM, Babaee M, Payami S (2020) MRI changes after platelet rich plasma injection in knee osteoarthritis (randomized clinical trial). J Pain Res 13:65–73
Rastogi AK, Davis KW, Ross A, Rosas HG (2016) Fundamentals of joint injection. AJR Am J Roentgenol 207:484–494
Riboh JC, Saltzman BM, Yanke AB, Fortier L, Cole BJ (2016) Effect of leukocyte concentration on the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis. Am J Sports Med 44:792–800
Richette P, Bardin T, Doherty M (2009) An update on the epidemiology of calcium pyrophosphate dihydrate crystal deposition disease. Rheumatology 48:711–715
Richette P, Latourte A, Frazier A (2015) Safety and efficacy of paracetamol and NSAIDs in osteoarthritis: which drug to recommend? Expert Opin Drug Saf 14:1259–1268
Saccomanno MF, Donati F, Careri S, Bartoli M, Severini G, Milano G (2016) Efficacy of intra-articular hyaluronic acid injections and exercise-based rehabilitation programme, administered as isolated or integrated therapeutic regimens for the treatment of knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24:1686–1694
Sadabad HN, Behzadifar M, Arasteh F, Behzadifar M, Dehghan HR (2016) Efficacy of platelet-rich plasma versus hyaluronic acid for treatment of knee osteoarthritis: a systematic review and meta-analysis. Electron Phys 8:2115–2122
Saltzman BM, Leroux T, Meyer MA, Basques BA, Chahal J, Bach BR, Yanke AB, Cole BJ (2017) The therapeutic effect of intra-articular normal saline injections for knee osteoarthritis: a meta-analysis of evidence level 1 studies. Am J Sports Med 45:2647–2653
Sanchez C, Pesesse L, Gabay O, Delcour J-P, Msika P, Baudouin C, Henrotin YE (2012a) Regulation of subchondral bone osteoblast metabolism by cyclic compression. Arthritis Rheum 64:1193–1203
Sánchez M, Fiz N, Azofra J, Usabiaga J, Aduriz Recalde E, Garcia Gutierrez A, Albillos J, Gárate R, Aguirre JJ, Padilla S, Orive G, Anitua E (2012b) A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Arthroscopy 28:1070–1078
Shen L, Yuan T, Chen S, Xie X, Zhang C (2017) The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. J Orthop Surg 12:16
Smith PA (2016) Intra-articular autologous conditioned plasma injections provide safe and efficacious treatment for knee osteoarthritis: an FDA-sanctioned, randomized, double-blind, placebo-controlled clinical trial. Am J Sports Med 44:884–891
Su K, Bai Y, Wang J, Zhang H, Liu H, Ma S (2018) Comparison of hyaluronic acid and PRP intra-articular injection with combined intra-articular and intraosseous PRP injections to treat patients with knee osteoarthritis. Clin Rheumatol 37:1341–1350
Sundman EA, Cole BJ, Karas V, Della Valle C, Tetreault MW, Mohammed HO, Fortier LA (2014) The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med 42:35–41
Taniguchi Y, Yoshioka T, Sugaya H, Gosho M, Aoto K, Kanamori A, Yamazaki M (2019) Growth factor levels in leukocyte-poor platelet-rich plasma and correlations with donor age, gender, and platelets in the Japanese population. J Exp Orthop 6:4
Vaquerizo V, Plasencia MÁ, Arribas I, Seijas R, Padilla S, Orive G, Anitua E (2013) Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus Durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a randomized controlled trial. Arthroscopy 29:1635–1643
Vilchez-Cavazos F, Millán-Alanís JM, Blázquez-Saldaña J, Álvarez-Villalobos N, Peña-Martínez VM, Acosta-Olivo CA, Simental-Mendía M (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. Orthop J Sports Med 7:2325967119887116
Watson SP, Bahou WF, Fitzgerald D, Ouwehand W, Rao AK, Leavitt AD (2005) Mapping the platelet proteome: a report of the ISTH platelet physiology subcommittee. J Thromb Haemost 3:2098–2101
Xiong G, Lingampalli N, Koltsov JCB, Leung LL, Bhutani N, Robinson WH, Chu CR (2018) Men and women differ in the biochemical composition of platelet-rich plasma. Am J Sports Med 46:409–419
Xu Z, Luo J, Huang X, Wang B, Zhang J, Zhou A (2017) Efficacy of platelet-rich plasma in pain and self-report function in knee osteoarthritis: a best-evidence synthesis. Am J Phys Med Rehabil 96:793–800
Yin W-J, Xu H-T, Sheng J-G, An Z-Q, Guo S-C, Xie X-T, Zhang C-Q (2016) Advantages of pure platelet-rich plasma compared with leukocyte- and platelet-rich plasma in treating rabbit knee osteoarthritis. Med Sci Monit 22:1280–1290
Zhang W (2019) The powerful placebo effect in osteoarthritis. Clin Exp Rheumatol 37(Suppl 120):118–123
Zhang H, Bai Y, Liu C, Jin S, Su K, Liu Y, Lü Z (2017) Effect of intra-articular injection of platelet-rich plasma on interleukin-17 expression in synovial fluid and venous plasma of knee osteoarthritis patients. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 31:918–921
Zhang H-F, Wang C-G, Li H, Huang Y-T, Li Z-J (2018) Intra-articular platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis. Drug Des Devel Ther 12:445–453
