Platelet-rich plasma for the treatment of knee osteoarthritis: an expert opinion and proposal for a novel classification and coding system

ABSTRACT

Introduction

Platelet-rich plasma (PRP) is able to modulate the joint environment by reducing the inflammatory distress and promoting tissue anabolism. Therefore, it has gained increasing popularity among clinicians in the treatment of osteoarthritis (OA), and it is currently proposed beside consolidated options such as viscosupplementation.

Areas covered

A systematic review of all available meta-analyses evaluating intra-articular PRP injections in patients affected by knee OA was performed, to understand how this biologic treatment approach compares to the traditional injective therapies available in clinical practice. Moreover, a novel coding system and ‘minimum reporting requirements’ are proposed to improve future research in this field and promote a better understanding of the mechanisms of action and indications.

Expert opinion

The main limitation in the current literature is the extreme variability of PRP products used, with often paucity or even lack of data on the biologic features of PRP, which should not be considered as a simple substance, but rather a ‘procedure’ requiring accurate reporting of the characteristics of the product but also all preparation and application modalities. This approach will aid in matching the optimal PRP product to specific patient factors, leading to improved outcomes and the elucidation of the cost-effectiveness of this treatment.

KEYWORDS:

• Prp
• growth factors
• osteoarthritis
• hip
• knee
• injection
• classification

Declaration of interest

Elizaveta Kon is speaker for Fidia (Italy) and Zimmer Biomet; paid consultant for Cartiheal (Israel) and Green Bone. Owns stock in Cartiheal (Israel), Geistlich and Zimmer Biomet. Brian J. Cole has royalties from Arthrex, Inc. and Elsevier Publishing. Is paid consultant for Arthrex, Inc and Regentis. Owns stock in Bandgrip Inc, Ossio and Regentis. Has received research support from Aesculap/B.Braun, Arthrex, Inc, National Institutes of Health (NIAMS & NICHD) and Regentis. Has received financial or material support from Athletico, JRF Ortho and Smith & Nephew. Jason L. Dragoo is speaker for Ossur. Is paid consultant for Beckman Dickenson; Biomet; Breg; CONMED Linvatec; DePuy, a Johnson & Johnson Company; DJ Orthopaedics; Flexion Therapeutics; Genzyme; Harvest Technologies; Joint Restoration Foundation (JRF); KCRN Research; Moximed; Ossur; Regeneration Technologies, Inc.; RNL Bio; Sideline Sports Docs, LLC; Zimmer. Has received research support from CONMED Linvatec; Linvatec; Ossur; RTI; Zimmer. Has received financial or material support from Emcyte; Harvest Technologies and RTI. Lisa a. Fortier has royalties from Arthrex, Inc. Is paid consultant for Arthrex, Inc. Has received research support from Arthrex, Inc. Jeremy Malagon has received honorarium from Macopharma, Fidia and Horiba. Allan Mishra has royalties from DePuy, a Johnson & Johnson Company and Zimmer. Scott Rodeo has received consulting fees from Flexion, has received speaking fees from Smith & Nephew, has received honoraria from Fidia Pharma, has received royalties from Zimmer Biomet, and has stock/stock options in Ortho Regenerative Technologies. Steven Sampson has been a paid speaker for Sonosite. Berardo Di Matteo, Andrea Dorotei, Giuseppe Filardo, Alberto Giuffrida, Chris H Jo, Gerard a Malanga, Norimasa Nakamura, Diego Delgado, Mikel Sánchez have nothing to disclose. 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 apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper is not funded.