I'm going to break down everything you need to know about platelet rich plasma injections for knee arthritis backed by the most up-to-date clinical trial evidence and research hey everyone DrJeff Pang here I've co-authored research papers written blog articles for the British Journal of sports medicine and created numerous educational resources on platelet rich plasma but despite the growing evidence misinformation still persists some orthopedists still dismiss PRP While others in regenerative medicine are making exaggerated claims about its effects that's why I'm going to go over everything we currently know about PRP we'll cover platelet dosing PRP formulations outcomes data and how PRP impacts arthritis progression by the end you have a clear and uptodate understanding of everything we know about PRP injections for knee arthritis and cartilage injuries so let's first start with what is platelet rich plasma PRP is an Innovative treatment that involves the use of a patient's own cells to promote healing and induce recovery in various areas of the body we first draw your blood put it in a special tube centrifuge it your blood separates into layers and we take the layer that has all your platelets and growth factors and inject that into your knee the goal is to use your own cells to decrease pain decrease inflammation lubricate the knee and protect your cartilage the big question has always been does PRP actually work in previous years there was always some uncertainty about its Effectiveness as some clinical trials showed positive results While others did not however in the last 2 to 3 years this uncertainty has faded the most recent clinical trials have consistently shown that platelet rich plasma injections are highly effective for treating symptomatic knee osteoarthritis making it arguably one of the best treatment options available for knee arthritis Orthopedic Medical and surgical societies now have consensus statements and summary overviews confirming that PRP injections are highly effective for the treatment of knee arthritis for example the American Academy of orthopedic surgery technology overview paper writes that PRP injections have been shown to outperform Placebo injections hyaluronic acid injections corticosteroid injections exercise and physical therapy and oral medications the position statement put out by the American Medical Society for sports medicine writes that PRP in are more effective in reducing pain and improving function than steroid or hyaluronic acid injections for knee ostearthritis particularly in those who are younger and have mild to moderate disease European societies such as the European Alliance of associations of Rheumatology have also established clinical practice recommendations for PRP injections they write that number one PRP injections are an efficient treatment of early or moderate symptomatic knee Osteo number two PRP injections may be useful in severe knee ostearthritis and number three PRP injections in knee ostor threes should be proposed as a second line therapy after failure of non-pharmacological treatment like exercise or physical therapy and pharmacological therapy like oral or topical anti-inflammatory medications okay now that we've established that PRP injections work for knee arthritis I now want to point out something critical not all PRP is the same it turns out that the dose of PRP really matters just like with any medication that we use for blood pressure or diabetes there is a dose response curve and we now have a pretty good idea of the dose response curve of PRP the reason clinical trials from over 5 years ago did not show positive results with prb is because the vast majority of them used lowd dose injections this review found that studies in which PRP did not result in a good outcome in NE arthritis had a mean platelet dose of around 2 billion platelets studies that showed PRP worked extremely well had a mean platelet dose of around 5. 5 billion platelets further systematic reviews and meta analyses find that even higher doses reaching 10 billion platelets result in the most favorable clinical outcomes so how can you tell if you're receiving a high does PRP injection the key is to ask your provider how much blood is being drawn the more blood that that's being drawn the higher the platelet dose I recommend aiming for 10 billion platelets per knee arthritis injection which typically requires a 60cc blood draw this is the most important question to ask when getting a PRP injection many doctors performing PRP injections are still not yet aware of the importance of platelet dosing the next thing you want to do is ask about how the PRP is processed there are many centrifugation protocols each with its advantages and disadvantage AG es single spin techniques are faster and more time efficient but it generally recovers fewer platelets double spin centrifugation takes longer but recovers significantly more platelets leading to a higher dose so the two key things to confirm with your healthc care provider are number one are you getting a 60cc blood draw and number two is a double spin centrifugation protocol being used for Preparation once you're certain you're getting a high does PRP injection the next question you want to ask is how many treatments do you need this is where the research is still a little unclear however the current consensus is that three injections are better than one a previous randomized control trial supports this showing that patients who received three PRP injections had significantly better outcomes than those who received just one the caveat here is that each injection in that study delivered around 5 billion platelets remember the goal is to aim for 10 billion platelets per knee or arthritis injection many recent studies show that a single high does injection of over 10 billion platelets can produce excellent results lasting up to one year in patients with mild to moderate osteoarthritis the big unanswered question is how much better are the outcomes of three highdose injections compared to just one highdose injection while we're uncertain about the impact on pain and symptoms it is likely that three high does injections are more effective for modifying the progression of arthritis this study compared three highd does PRP injections spaced one week apart to Placebo injections the results showed that PRP significantly outperformed Placebo in both pain relief and improved function more importantly after 5 years the PRP group experienced nearly 50% less progression of arthritis as measured by cartilage volume on MRI scans this is the strongest argument for opting for multiple injections as we currently have no other disease modifying treatments besides exercise nutrition and weight management that can slow down the progression of arthritis while a single highd does PRP injection can address pain and symptoms it may not be as effective at slowing the progression of arthritis compared to a three shot series even more exciting is that there are now studies that suggest multiple PRP injections not only slow the progression of arthritis but could also help rebuild some cartilage in one study patients received three PRP injections at 1 month intervals and cartilage thickness was assessed at 6 months the results showed an improvement in knee cartilage thickness as measured by ultrasound from 0. 92 at Baseline to 1.
01 at 6 months another case study highlights the effects of PRP in treating a high-grade cartilage injury from osteochondritis desant at Baseline an MRI measured the cartilage defect at 2. 2x 1. 4 CM the patient patient received four ultra high does PRP injections each involving a 180cc blood draw 3 years later a follow-up MRI revealed that the defect had reduced to 0.
7x 0. 5 CM this is the first case to demonstrate the healing of a large cartilage defect in the knee after repeated PRP injections now these findings on cartilage regeneration should be viewed with caution as they do need to be replicated in much larger clinical trials however the potential for cartilage restoration and healing is exciting and highlights the promising benefits PRP may offer while PRP won't bring back your youthful knees it could slow the progression of arthritis and even promote some healing something that can't be said for any other injection treatment option currently available the last topic that I want to quickly address is stem cell treatments I get asked about this frequently and it's an area filled with misin information in the United States there are currently three types of stem cell injections available I use quotes because Recent research suggests that these products contain little to no actual stem cells this report analyzed seven commercial companies that provide amniotic fluid stem cell treatments they write that mesenchimal stem cells could not be identified in the commercial amniotic fluid products or the unprocessed amniotic fluid nucleated cells were found in only two products but most of cells were dead they conclude that amniotic fluid products should not be considered stem cell therapies and researchers should use caution when evaluating commercial claims that products contain stem cells this is why most regenerative medicine doctors use either bone Maro aspirate concentrate BAC or atopos derived stromovascular fraction or svf however a new study now raises questions about how many live stem cells are actually present in these treatments in their analysis bmax stem cells made up only 0. 22% of the total cells while svf stem cells accounted for just 1.
