A new strategy to tackle severe knee osteoarthritis: Combination of intra-articular and intraosseous injections of Platelet Rich Plasma

ABSTRACT

Introduction: Knee osteoarthritis (KOA) is a mechanically induced, cytokine and enzyme-mediated disorder involving all the joint tissue of the knee. Rebuilding a physiological-homeostatic network at the tissue level following knee organ failure, such as in severe KOA, is a daunting task with therapeutic targets encompassing the articular cartilage, synovium and subchondral bone. Intraarticular infiltration of plasma rich in growth factors (PRP) has emerged as a promising symptomatic approach, although it is insufficient to reach the subchondral bone.

Areas covered: This review addresses current molecular and cellular data in joint homeostasis and osteoarthritis pathophysiology. In particular, it focuses on changes that subchondral bone undergoes in knee osteoarthritis and evaluates recent observations on the crosstalk among articular cartilage, subchondral bone and synovial membrane. In addition, we review some mechanistic aspects that have been proposed and provide the rationale for using PRP intraosseously in KOA.

Expert opinion: The knee joint is a paradigm of autonomy and connectedness of its anatomical structures and tissues from which it is made. We propose an innovative approach to the treatment of severe knee osteoarthritis consisting of a combination of intraarticular and intraosseous infiltrations of PRP, which might offer a new therapeutic tool in KOA therapy.

KEYWORDS:

• Knee osteoarthritis
• plasma rich in growth factors
• subchondral bone
• biological treatment

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Corrigendum

Article highlights.

• Knee osteoarthritis is a mechanically induced, cytokine- and enzyme-mediated cluster of disorders affecting the whole joint.

• There is an intense molecular and cellular crosstalk among AC, SB, and SM in KOA, which establishes a catabolic loop.

• Any attempt to treat KOA should address the articular cartilage, the synovial membrane, the synovial fluid and subchondral bone as therapeutic targets.

• Platelet rich plasma is a multimolecular and safe therapy, and its clinical benefits might be attributed to trophic-anabolic, antiinflammatory and analgesic effects.

• Intraosseous infiltrations of PRP modulate SB homeostasis by antioxidative stress protection, adipogenesis suppression and improvement in bone mineralization effect.

• The combination of intraarticular and intraosseous injections of PRP might offer a new therapeutic tool to address the knee joint pathology as a whole, by reaching the SM, SF and superficial zone of AC by intraarticular injections, and the deep zones of AC, and SB through PRP intraosseous infiltrations.

This box summarizes key points contained in the article.

Acknowledgements

The authors thank Naikari Martinez for assistance with histological sample analysis, and Sara Rivas for the elaboration of drawings.

Declaration of interest

E Anitua is the Scientific Director of and S Padilla, R Prado and G Orive are scientists at BTI Biotechnology Institute, a dental implant company that investigates in the fields of oral implantology and PRGF-Endoret technology. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.