Knee osteoarthritis (KOA) is a common knee degenerative disease characterized by cartilage degeneration, cartilage exfoliation, and subchondral bone hyperplasia, leading to knee pain, joint instability and functional limitations. KOA severely affects patients’ quality of life and is a major public health issue. An epidemiological survey published in Proceedings of the National Academy of Sciences (PNAS) showed that the incidence of KOA in the U.S. population has doubled since the mid-twentieth century. KOA has become a high-incidence human disease and has caused a great negative impact on people’s lives and work.
The Osteoarthritis Society International (OARSI) recommends conservative treatment rather than surgery as the first-line management solution for KOA, which emphasizes the importance of conservative treatment in the treatment of KOA. The American College of Rheumatology (ACR) has proposed a classification in which conservative treatment includes drug treatment and non-drug treatment. Non-drug treatment includes general exercise and muscle exercise, but non-drug methods often depend heavily on patient compliance and are difficult to contro. The main drug therapies include analgesics, non-steroidal anti-inflammatory drugs and corticosteroid injections. Although the above drug therapies are effective to a certain degree, there are also major side effects. In recent years, there have been an increasing number of studies on the application of intra-articular injection of platelet-rich plasma (PRP) or hyaluronic acid (HA) in the treatment of KOA. Many systematic reviews suggest that intra-articular injection of PRP, compared to HA, can alleviate pain symptoms and improve knee function in patients with KOA. However, a double-blind randomized controlled trial with a 5-year follow-up showed that the combination of HA and PRP improved pain and function in patients with a history of chronic symptomatic knee degenerative changes and osteoarthritis. An RCT showed that PRP is an effective treatment for mild to moderate KOA and that the combined use of HA and PRP is better than the use of HA (1 year) and PRP (3 months) alone. The RCT also revealed that PRP does not provide better overall clinical improvement than HA in terms of symptom-function improvement at different follow-up points or in terms of duration of effect. In recent years, an increasing number of studies have focused on the rationality of PRP combined with HA for KOA, and their mechanisms have been discussed in depth. Experimental studies comparing the migration capabilities of tendon cells and synovial fibroblasts in pure PRP solution and PRP plus HA solution have shown that mixing PRP with HA can significantly improve cell mobility. Marmotti found that the addition of HA to PRP can effectively promote the proliferation of chondrocytes and improve the ability of cartilage repair. Studies have shown that the combination of PRP and HA may benefit from its different biological mechanisms and facilitate the activity of signal molecules such as inflammatory molecules, catabolic enzymes, cytokines and growth factors, thereby playing a positive role in the treatment of KOA.
Post time: Nov-07-2022