Do platelet-rich plasma or hyaluronic acid intra-articular injections work better for treating knee osteoarthritis?

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Injections are commonly used to treat knee pain in football. This randomised controlled trial from the American Journal of Sports Medicine compares two of the more common types of injection, platelet rich plasma (PRP) and hyaluronic acid (HA) and found little difference between the two options at five-year follow-up1.

Osteoarthritis (OA) commonly occurs in footballers who have a history of joint trauma or surgery, typically presenting with activity-related pain and swelling, and loss of movement. Playing football at a high level also appears to be an independent risk factor for developing OA. Joint injections are a popular treatment option as they are less invasive than surgery and are reported to give good symptomatic relief. The efficacy of these injections, especially in the longer term, has not been well established.

This randomised controlled, double-blind study of 192 patients compared the efficacy of PRP with HA injections over a longer follow-up period than studies that have been conducted to date (up to five years). Patients with chondral disease or established OA (Kellgren-Lawrence grade 0-3) were included. Patient received a single injection of either PRP or HA. Both treatments had a statistically significant improvement at two months post injection which remained stable at all time points up to two years. From this point the improvement declined (but remained better than baseline) until final follow-up. Those treated with PRP injections were less likely to have a second intervention (either another injection or surgery within the first two years).

Given that chondral disease can be difficult to treat, these findings are potentially encouraging with both PRP and HA providing symptomatic relief (especially in the first two years). The study methodology (a double blind RCT) appears robust. The method used to produce the PRP was also well described. The lack of a true placebo group is a clear limitation of this study as it is unclear whether these treatments are actually better than observation. The fact that both groups did actually improve over the study period is however encouraging. We should remember that an earlier FastFact showed that saline injections can be effective treatments too.

To learn more about knee injuries and their management among football players complete the ‘knee module’ in the FIFA Diploma in Football Medicine.

1Di Martino A, Di Matteo B, Papio T, Tentoni F, Selleri F, Cenacchi A, Kon E, Filardo G. 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. 2019; 47(2): 347-354.

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Dr Adamu M
21 février 2019 19:29

Is pooled prp used or the athlete’s blood? It is a good study as you said but they should have included a saline group! I hope one day we can also try bone marrow aspirate for serious interarticular injuries!

Kenneth Syvertsen
22 février 2019 9:02

It is sad to see that they are doing such a study without a placebo group…….

22 février 2019 17:10

Adamu and Kennsy – agree 100%.

It’s tough to say without access to the full article but it is likely that these were athletes (the population is not described in the abstract or summary above) considering who published the article. It is likely that careers/college scholarships were on the line and a placebo would not work well in that group.

Maybe a moderator or someone with full article access can post about the population that was studied…

Mark Fulcher
26 février 2019 9:21
Reply to  drlabelle

They were not athletes actually. Some generalisations here for brevity. The average age of the patients was mid-50’s. The PRP group were slightly older. Male:female was about 2:1. Average BMI for both groups was about 27.0.

Mark Fulcher
26 février 2019 9:18

Indeed. In their defence I suspect that their hypothesis was that PRP was going to be better than HA. Many of the studies with shorter followup periods have suggested this. As it turned out though the lack of a true placebo is a severe limitation of the study and makes it hard to interpret the results.

Kostis Sidiropoulos
23 février 2019 11:35

Without placebo group??
That’s why I believe that we can’t be sure about how much and IF the prp helps an athlete.
We do not have really studies for the benefits of prp.
So why should we try it?

Mark Fulcher
26 février 2019 9:15

I can’t disagree with you Kostis. There are however an increasing number of RCT’s that do show a benefit of PRP over placebo – although the evidence is not overwhelming. The downside is low (apart from what is often a high cost). It is probably worth considering when good quality rehabilitation is not working and when there has been a clear discussion about the possible outcome.

Mark Fulcher
26 février 2019 9:16

Sorry. This is one of the articles that I alluded to below. One or two PRP injections were better than saline. Two injections of PRP was no better than one.

26 février 2019 23:52

RECTUS FEMORISINJURY Généralement les les lésions musculaires doivent être prises au sérieux quelque soit la gravité pour le cas précis du quadriceps ou les traumas sont très fréquents les premiers soins s’avèrent importants. Ne jamais faire une échographie les minutes qui suivent la lésions ne jamais donner AINS les minutes qui suivent la lésion. Faire l échographie quelques heures après pour éviter une éventuelle hemorragie Être sur de l absence d une collection sanguine puisse sque dans les cas de déchirure MUSCULAIRE il y’a toujours une rupture des petits vaisseaux. Le traitement est d abord medical avec un repos de… Lire la suite »

Hamza Ben Maaoui
03 mars 2019 12:44
Reply to  Bangoura

Mr Bangoura, je pense que vous devez poster vos commentaires en anglais prochainement afin que les autres membres interagissent avec vous, la plupart d’entre eux sont des anglophones

03 mars 2019 17:52

Mr HAMZA Ben merci pour la remarque je suis francophone je maîtrise pas l anglais

Hamza Ben Maaoui
16 mars 2019 16:33
Reply to  Bangoura

En tout cas, nous avons beaucoup appris de vous Mr Bangoura à travers les commentaires sur les différents sujets que vous postez régulièrement..

Keita cosgrove
Keita cosgrove
23 novembre 2019 10:31

I suffered from severe soreness in my right knee and swollen joints which eventually developed into such a painful condition, I could not lift my leg or put weight on it to walk. After trying several treatments, I finally went to a care clinic where x-rays showed advanced Arthritis/OA. My condition worsened with severe pains and stiffness, so a friend introduced me to Herbal Health Point (ww w. herbalhealthpoint. c om) and their Arthritis Formula treatment protocol, I immediately started on the treatment, few weeks into the treatment the pain and stifness were completely gone and I had regained complete use of… Lire la suite »