Complete the 2 tables(A and B) using the article attached. see the example for guidance.   


Altamura, S. A., Di Martino, A., Andriolo, L., Boffa, A., Zaffagnini, S., Cenacchi, A., … & Filardo, G. (2020). Platelet-Rich Plasma for Sport-Active Patients with Knee Osteoarthritis: Limited Return to Sport. BioMed Research International, 2020.

Chen, P., Huang, L., Ma, Y., Zhang, D., Zhang, X., Zhou, J., … & Wang, Q. (2019). Intra- articular platelet-rich plasma injection for knee osteoarthritis: a summary of meta- analyses. Journal of orthopaedic surgery and research, 14(1), 385.

Calis, H; Sutbeyaz, T; Guler, E; Halici, C; Sayan, H; Koc, A; Konk, M & Yazicioglu, J (2015) Efficacy of Intra-Articular Autologous Platelet Rich Plasma Application in Knee Osteoarthritis

Evans, A., Ibrahim, M., Pope, R., Mwangi, J., Botros, M., Johnson, S. P., & Al Kassis, S. (2020). Treating hand and foot osteoarthritis using a patient’s own blood: A systematic review and meta-analysis of platelet-rich plasma. Journal of Orthopaedics, 18, 226-236.

Gobbi, A., Lad, D., & Karnatzikos, G. (2015). The effects of repeated intra-articular PRP injections on clinical outcomes of early osteoarthritis of the knee. Knee Surgery, Sports Traumatology, Arthroscopy, 23(8), 2170-2177.

Görmeli, G., Görmeli, C. A., Ataoglu, B., Çolak, C., Aslantürk, O., & Ertem, K. (2017). Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy, 25(3), 958-965.

Huang, G; Hua, S; Yanh, T; Ma, J; Yu, W & Chen X. (2017). Platelet‑rich plasma shows beneficial effects for patients with knee osteoarthritis by suppressing inflammatory factors 3096- 3102, 2018

Huang, Y., Liu, X., Xu, X., & Liu, J. (2019). Intra-articular injections of platelet-rich plasma, hyaluronic acid or corticosteroids for knee osteoarthritis. Der Orthopäde, 48(3), 239- 247.

Kanchanatawan, W., Arirachakaran, A., Chaijenkij, K., Prasathaporn, N., Boonard, M., Piyapittayanun, P., & Kongtharvonskul, J. (2016). Short-term outcomes of platelet- rich plasma injection for treatment of osteoarthritis of the knee. Knee Surgery, Sports Traumatology, Arthroscopy, 24(5), 1665-1677.

Kanchanatawan, W., Arirachakaran, A., Chaijenkij, K., Prasathaporn, N., Boonard, M., Piyapittayanun, P., & Kongtharvonskul, J. (2016). Short-term outcomes of platelet- rich plasma injection for treatment of osteoarthritis of the knee. Knee Surgery, Sports Traumatology, Arthroscopy, 24(5), 1665-1677.

Kenmochi, M. (2020). Clinical outcomes following injections of leukocyte-rich platelet-rich plasma in osteoarthritis patients. Journal of Orthopaedics, 18, 143-149.

Kolcaba, K. A. T. H. A.


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Czub, M., & Piskorz, J. (2018). Body Movement Reduces Pain Intensity in Virtual Reality–Based Analgesia. International Journal of Human–Computer Interaction, 34(11), 1045-1051.

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Frieden, T. R., & Houry, D. (2016). Reducing the risks of relief—the CDC opioid-prescribing guideline. New England Journal of Medicine, 374(16), 1501-1504.

Garrett, B., Taverner, T., & McDade, P. (2017). Virtual reality as an adjunct home therapy in chronic pain management: an exploratory study. JMIR medical informatics5(2), e11.

Gold, J. I., & Mahrer, N. E. (2018). Is virtual reality ready for prime time in the medical space? A randomized control trial of pediatric virtual reality for acute procedural pain management. Journal of pediatric psychology43(3), 266-275.

Gromala, D., Tong, X., Choo, A., Karamnejad, M., & Shaw, C. D. (2015, April). The virtual meditative walk: virtual reality therapy for chronic pain management. In Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems (pp. 521-524). ACM.

Groenewald, C. B., & Palermo, T. M. (2015). The price of pain: the economics of chronic adolescent pain. Pain management, 5(2), 61-64.

Gupta, A., Scott, K., & Dukewich, M. (2018). Innovative technology using virtual reality in the treatment of pain: does it reduce pain via distraction, or is there more to it? Pain Medicine, 19(1), 151-159.

Hah, J. M., Bateman, B. T., Ratliff, J., Curtin, C., & Sun, E. (2017). Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic. Anesthesia and analgesia, 125(5), 1733-1740.

Hoffman, H. G., Meyer, W. J., 3rd, Ramirez, M., Roberts, L., Seibel, E. J., Atzori, B., … Patterson, D. R. (2014). Feasibility of articulated arm mounted Oculus Rift Virtual Reality goggles for adjunctive pain control during occupational therapy in pediatric burn patients. Cyberpsychology, behavior and social networking, 17(6), 397–401. doi:10.1089/cyber.2014.0058.

JahaniShoorab, N., Za


The Efficacy of Platelet-Rich Plasma Injection in the
Management of Hip Osteoarthritis: A Systematic Review
Ivan Medina-Porqueres* & Patricia Alvarez-Juarez

Department of Physical Therapy, University of Malaga, Malaga, Spain


Ivan Medina-Porqueres, Physical Therapy Section, Department of Physical Therapy, Faculty of Health Sciences, University of Malaga,

Arquitecto Francisco Peñalosa St, 29010, Malaga, Spain. Tel: 0034 951 952 858. Fax: 0034 951 952 864.

Email: [email protected]

Published online 24 July 2015 in Wiley Online Library ( DOI: 10.1002/msc.1115


Osteoarthritis (OA) is a progressively debilitating

condition that is associated with pain and morbidity.

It is associated with ageing and most often affects the

joints of the knees, hips, fingers and lower spine region

(Hochberg et al., 2013). It is estimated that about 10%

of men and 18% of women aged over 60 years have

symptomatic OA. Eighty per cent of those with OA will

have limitations in movement, and 25% cannot

perform major daily activities of life (Murray and

Lopez, 1997). According to the World Health Organi-

zation, OA is commonly regarded as the most frequent

cause of functional disability, and about 80% of people

over the age of 65 years show radiological symptoms of

OA (World Health Organization, 2007). This condition

has an adverse impact on patient mobility and quality

of life. Researchers have reported that the hip is the

second most common weight-bearing joint – after the

knee – to be affected by OA, affecting approximately

5% of adults aged 60 years or older (Scott, 2010), and

there is an upward trend in the incidence of hip

osteoarthritis (HOA).

The current main objectives of HOA management

are to relieve pain, educate the patients about their

disease, restore function, minimize the progression of

the disease and maintain health-related quality of life

(Zhang et al., 2010). Currently, there is no known

cure for HOA, so the main therapeutic strategy is

symptomatic. Several treatment modalities are avail-

able, involving both conservative and operative

approaches. Non-operative management includes

analgesics, non-steroidal anti-inflammatory drugs

(NSAIDS), cyclooxygenase-2 inhibitors, glucocorti-

coids, opioids (Hitzeman and Athale, 2010), cartilage

protective agents (e.g. diacerin, glucosamine and

chondroitin) (Bruyere and Reginster, 2007) as well as

physiotherapy (Bennell et al., 2014), exercise (Fransen



doi: 10.5606/ArchRheumatol.2015.5293
Arch Rheumatol 2015;30(3):198-205

Efficacy of Intra-Articular Autologous Platelet Rich Plasma
Application in Knee Osteoarthritis


Ali KOÇ,3 Metin KONK,4 Jülide Aksel YAZICIOĞLU1

1Department of Physical Medicine and Rehabilitation, Kayseri Training and Research Hospital, Kayseri, Turkey
2Department of Biochemistry, Kartal Yavuz Selim State Hospital, İstanbul, Turkey

3Department of Radiology, Kayseri Training and Research Hospital, Kayseri, Turkey
4Department of Biochemistry, Kayseri Training and Research Hospital, Kayseri, Turkey

Received: August 15, 2014 Accepted: December 13, 2014 Published online: March 06, 2015

Correspondence: Havva Talay Çalış, M.D. Kayseri Eğitim ve Araştırma Hastanesi Fizik Tedavi ve Rehabilitasyon Kliniği, 38010 Kocasinan, Kayseri, Turkey.
Tel: +90 352 – 336 88 84 e-mail: [email protected]

©2015 Turkish League Against Rheumatism. All rights reserved.

Osteoarthritis (OA) is a chronic, non-inflammatory
rheumatologic disease which affects the synovial
joints. It is characterized with joint cartilage
degeneration, subchondral bone changes, and
synovitis.1 Nonsteroid antiinflammatory drugs,
glucosamine, chondroitin sulfate and hyaluronic
acid are generally used for reducing inflammation
and relieving pain in patients with OA. However,
these have limited effect on reducing chondrocyte
degeneration and improving regeneration.2
Medications protecting or healing the cartilage

are still at experimental stage. These include
applications of cytokine inhibitors, gene therapy,
artificial chondrocytes, and growth factor (GF).3

Growth factor increases the synthesis of
chondrocyte matrix and stimulates chondrogenic
cell proliferation.4 It reduces the activation of
nuclear factor kappa B which has an important
role in the pathogenesis of OA, by inhibition
of inflammatory process which is induced by
interleukin-1 beta.5 Platelet alpha granules contain

Objectives: This study aims to evaluate the efficacy of autologous platelet rich plasma applications on pain, functional status, and cartilage
regeneration in advanced knee osteoarthritis.
Patients and methods: A total of 82 patients (13 males, 69 females; mean age 63.5±9.3 years; range 40 to 88 years) with chronic knee pain for the
last one year, who had grade 3-4 knee osteoarthritis according to Kellgren-Lawrence Scale and visual analog scale value of higher than 5, who did not
receive physical therapy for the last six months, and did not respond to treatment despite use of nonsteroidal antiinflammatory drugs and analgesics
at least for the last three

1CliniCal MediCine insights: arthritis and MusCuloskeletal disorders 2015:8

Open Access: Full open access to
this and thousands of other papers at

Clinical Medicine
Insights: Arthritis and
Musculoskeletal Disorders

Knee osteoarthritis (OA) is a chronic progressive disease
affecting more than 20% of people older than 45 years.1
According to the survey of the causes of productive work time

loss in the United States, OA is the second most common
cause of work performance loss after low back pain.2 With
an increase in life expectancy, it is estimated that the need
for knee arthroplasty would rise more than six times by 2030,

Knee Osteoarthritis Injection Choices: Platelet- Rich Plasma (PRP) Versus
Hyaluronic Acid (A one-year randomized clinical trial)

seyed ahmad raeissadat1, seyed Mansoor rayegani2, hossein hassanabadi3,
Mohammad Fathi4, elham ghorbani5, Marzieh Babaee5 and kamran azma6
1Physical Medicine and Rehabilitation Department, Clinical Development Center of Shahid Modarres Hospital, Shahid Beheshti University of
Medical Sciences, Tehran, Iran. 2Physical Medicine and Rehabilitation Department, PM & R Research Center of Shohada-e-Tajrish Hospital,
Shahid Beheshti University of Medical Sciences, Tehran, Iran. 3Physical Medicine and Rehabilitation Department, Mashhad University of
Medical Sciences, Mashhad, Iran. 4Anesthesiology Department, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences,
Tehran, Iran. 5Physical Medicine and Rehabilitation Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 6Physical
Medicine and Rehabilitation Department, AJA University of Medical Sciences, Tehran, Iran.

IntroductIon: Knee osteoarthritis (OA) is the most common articular disease. Different methods are used to alleviate the symptoms of patients
with knee OA, including analgesics, physical therapy, exercise prescription, and intra-articular injections (glucocorticoids, hyaluronic acid [HA], etc). New
studies have focused on modern therapeutic methods that stimulate cartilage healing process and improve the damage, including the use of platelet-rich
plasma (PRP) as a complex of growth factors. Due to the high incidence of OA and its consequences, we decided to study the long-term effect of intra-
articular injection of PRP and HA on clinical outcome and quality of life of patients with knee OA.
Method: This non-placebo-controlled randomized clinical trial involved 160 patients affected by knee OA, grade 1–4 of Kellgren–Lawrence scale.
In the PRP group (n = 87), two intra-articular injections at 4-week interval were applied, and in the HA group (n = 73), three doses of intra-articular
injection at 1-week interval were applied. All patients were prospectively evaluated before and at 12 months after the treatment by Western Ontario
and McMaster Uni

Clinical Study
Platelet-Rich Plasma for Sport-Active Patients with Knee
Osteoarthritis: Limited Return to Sport

Sante Alessandro Altamura ,1 Alessandro Di Martino ,1 Luca Andriolo ,1

Angelo Boffa,1 Stefano Zaffagnini,1 Annarita Cenacchi,2 Maria Stella Zagarella,2

and Giuseppe Filardo 3

1Clinica Ortopedica e Traumatologica II IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
2Servizio Trasfusionale Unico Metropolitano, Bologna, Italy
3Applied and Translational Research (ATR) Center IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

Correspondence should be addressed to Alessandro Di Martino; [email protected]

Received 6 June 2019; Revised 25 November 2019; Accepted 18 December 2019; Published 31 January 2020

Academic Editor: Willeke F. Daamen

Copyright © 2020 Sante Alessandro Altamura et al. -is is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.

Objective. To evaluate a cohort of sport-active patients suffering from cartilage degeneration and OA, in terms of clinical outcome
and return to sport (RTS) after platelet-rich plasma (PRP) injective treatment. Design. -is study included forty-seven sport-active
patients≤50 years old with unilateral symptomatic knee cartilage degeneration or OA. Patients received 3 PRP injections and were
prospectively evaluated at baseline and then at 2, 6, 12, and 24 months follow-up by IKDC subjective EQ-VAS, and Tegner scores.
Furthermore, patients were asked about their RTS, in terms of return to any sport level or to their activity level before symptoms
onset. Results. IKDC subjective score improved significantly at all follow-ups, changing from 59.2±13.6 to 70.6±13 at 12 months
and to 76.7±12.5 at 24 months (p<0.0005). A similar outcome was observed with the EQ-VAS score. Tegner score improved
from 3.6±1.4 to 4.8±0.9 at 24 months (p<0.0005), but only 76.6% of patients returned to some sport activity and 48.9% to the
same activity level. A lower presymptoms Tegner score was associated with a higher RTS rate, both at any level (p � 0.024) and at
the same presymptoms level (p<0.0005). Conclusions. Sport-active patients affected by knee OA can benefit from PRP injections,
with pain and function improvement over time. However, results are less satisfactory in terms of RTS since only half can achieve
the same sport level as before the onset of symptoms. Patients undergoing PRP treatment should be made aware of their low
chances to go back to high-impact sport activities.

1. Introduction

Osteoarthritis (OA) is a common orthopaedic condition
characterized by joint pain and decreased function, generally

Knee Surg Sports Traumatol Arthrosc (2017) 25:958–965
DOI 10.1007/s00167-015-3705-6

1 3


Multiple PRP injections are more effective than single injections
and hyaluronic acid in knees with early osteoarthritis: a
randomized, double‑blind, placebo‑controlled trial

Gökay Görmeli1 · Cemile Ayşe Görmeli2 · Baybars Ataoglu3 · Cemil Çolak4 ·
Okan Aslantürk1 · Kadir Ertem1

Received: 23 November 2014 / Accepted: 9 July 2015 / Published online: 2 August 2015
© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

injected with one dose of PRP or HA. In the early OA sub-
groups, significantly better clinical results were achieved in
the patients treated with three PRP injections, but there was
no significant difference in the clinical results of patients
with advanced OA among the treatment groups.
Conclusion The clinical results of this study suggest
IA PRP and HA treatment for all stages of knee OA. For
patients with early OA, multiple (3) PRP injections are
useful in achieving better clinical results. For patients
with advanced OA, multiple injections do not significantly
improve the results of patients in any group.
Level of evidence I.

Keywords Hyaluronic acid · Intraarticular injection ·
Knee osteoarthritis · Platelet-rich plasma


The incidence of articular cartilage pathology is increas-
ing because of the increase in sports activities and the
prominence of physical activities in all age groups [6, 31].
Because of the continued increase in the mean age of the
active population, OA is the most common degenerative
joint disorder found in elderly individuals, and it has a sig-
nificant effect on society [3, 9].

OA is a major cause of pain and disability and is det-
rimental to quality of life. Many non-invasive treatment
options have been recommended to relieve symptoms and
extend the quality of life and years of athletic activity for
those with OA [13]. The treatment usually begins with non-
steroidal anti-inflammatory drugs (NSAIDs), which have
potential side effects that limit their use and lack clear data
about their clinical therapeutic potency [5, 33]. Topical
agents are widely used clinically for short-term use and are

Purpose To compare the effectiveness of intraarticular
(IA) multiple and single platelet-rich plasma (PRP) injec-
tions as well as hyaluronic acid (HA) injections in different
stages of osteoarthritis (OA) of the knee.
Methods A total of 162 patients with different stages of
knee OA were randomly divided into four groups receiv-
ing 3 IA doses of PRP, one dose of PRP, one dose of HA
or a saline injection (control). Then, each group was subdi-
vided into two groups: early OA (Kellgren–Lawrence grade
0 with cartilage degeneration or grade I–III) and advanced
OA (Kellgren–Lawrence grade IV). The patients were
evaluated be

1 3

Knee Surg Sports Traumatol Arthrosc (2016) 24:1665–1677
DOI 10.1007/s00167-015-3784-4


Short‑term outcomes of platelet‑rich plasma injection
for treatment of osteoarthritis of the knee

Wichan Kanchanatawan1 · Alisara Arirachakaran2 · Kornkit Chaijenkij3 ·
Niti Prasathaporn4 · Manusak Boonard5 · Peerapong Piyapittayanun2 ·
Jatupon Kongtharvonskul6

Received: 5 May 2015 / Accepted: 8 September 2015 / Published online: 19 September 2015
© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

(95 % CI −28.6, −2.3, p = 0.021), lower mean WOMAC
total scores, and 8.83 (95 % CI 5.88, 11.78, p < 0.001),
7.37 (95 % CI 4.33, 10.05, p = 0.021) higher mean IKDC
and EQ-VAS scores when compared to HA injections.
However, PRP injections had no significant differences in
WOMAC pain, stiffness and function scores, as well as
Lequesne score and adverse events when compared to HA
or placebo.
Conclusion In short-term outcomes (≤1 year), PRP injec-
tion has improved functional outcomes (WOMAC total
scores, IKDC score and EQ-VAS) when compared to HA
and placebo, but has no statistically significant difference
in adverse events when compared to HA and placebo.
This study suggests that PRP injection is more efficacious
than HA injection and placebo in reducing symptoms and
improving function and quality of life. It has the potential
to be the treatment of choice in patients with mild-to-mod-
erate OA of the knee who have not responded to conven-
tional treatment.

Purpose To compare the clinical outcomes of osteoarthri-
tis indices (WOMAC and Lequesne scores) and adverse
events in the treatment of osteoarthritis (OA) of the knee
with platelet-rich plasma (PRP) versus hyaluronic acid
(HA) or placebo.
Methods A systematic review and meta-regression were
performed to compare outcomes between PRP injections
versus HA or placebo. Relevant randomized control tri-
als were identified from Medline and Scopus from date of
inception to 13 August 2015.
Results Nine of 551 studies were eligible; 6, 5, 5, 5, 2,
2, 2 and 7 studies were included in pooling of WOMAC
total, pain, stiffness and function scores, Lequesne score,
IKDC score, EQ-VAS score and adverse events in OA
knee patients, respectively. The PRP injections had −15.4

Electronic supplementary material The online version of this
article (doi:10.1007/s00167-015-3784-4) contains supplementary
material, which is available to authorized users.

* Jatupon Kongtharvonskul
[email protected]

Wichan Kanchanatawan
[email protected]

Alisara Arirachakaran


Orthopäde 2019 · 48:239–247
Published online: 8 January 2019
© Springer Medizin Verlag GmbH, ein Teil von
Springer Nature 2019

Yong Huang1 · Xiaolu Liu1 · Xinliang Xu2 · Junbin Liu2

1 School of Medicine and Life Sciences, Jinan University, Jinan, China
2 Department of Traumatology, Jining NO.1 People’s Hospital of Shandong, Jining, China

Intra-articular injections of
platelet-rich plasma, hyaluronic
acid or corticosteroids for knee
A prospective randomized controlled study


Osteoarthritis of the knee (KOA) is
a common condition associated with
pain and morbidity [1]. The increasing
number of patients with symptomatic
KOA will continue to place an increas-
ingly larger economic burden on global
healthcare systems [1]. The third Na-
tional Health and Nutrition Survey of
the USA showed that the prevalence of
symptomatic KOA was 12.1%, similar to
that in Europe [2]. According to the lat-
est Chinese epidemiological survey data,
the prevalence of symptomatic KOA in
China was 8.1%. This means that China
currently has approximately 110 million
KOA patients [3]. The prevalence of
KOA increases gradually with age. The
incidence of patients under 50 years of
age is 5.2%, while it has reached 11%
among those over 60 years old (. Fig. 1

Knee arthroplasty is a reliable and
successful surgical treatment to address
end-stage KOA. Unfortunately, the cost
of and time delay to knee replacement
is potentially prohibitive in some coun-
tries. In the USA potential overutiliza-
tion of arthroplasty is being met with
increasing scrutiny with respect to pre-
operativenonsurgicaltreatment[5]. This
includes both nonpharmacological and
pharmacological approaches. Intra-ar-
ticular (IA) corticosteroid and viscosup-
plementation injections have successful,
albeit short-term benefits according to

several meta-analyses [6, 7], randomized
controlled trials [8, 9] and large retro-
spective studies [10, 11]. Injections of
hyaluronic acid (HA) were found to cure
mild to moderate OA in patients while
platelet-rich plasma (PRP) knee injec-
tionsalsoexistinclinicaltrials. Clinically,
of IA injections of PRP, HA, and CS in
the treatment of KOA are unclear and
controversial. Moreover, no study has
directly and concurrently compared IA-
HA, IA-CS and IA-PRP in early KOA.
A prospective, randomized, controlled
trial was therefore performed to primar-
ily compare the efficacy of pain reduction
with IA-HA, IA-CS and IA-PRP in KOA.
It was hypothesized that IA-PRP would
for the treatment of KOA.

Material and methods

This study was approved by the Ethics
Committee of the Jining NO.1 People’s
Hospital of Shandong.


Thiswasaprospective, randomizedstudy
initiated in May 2016. Out of 265 pa-


Intra-articular platelet-rich plasma injections for knee
osteoarthritis: An overview of systematic reviews and risk of
bias considerations

Dan XING,1,2,* Bin WANG,3,* Wei ZHANG,1,2 Ziyi YANG,1,2 Yunfei HOU,1,2

Yaolong CHEN4,5 and Jianhao LIN1,2

1Arthritis Clinic & Research Center, Peking University People’s Hospital, 2Arthritis Institute, Peking University, Beijing, 3Department
of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, 4Evidence-Based Medicine Center, School of
Basic Medical Sciences, Lanzhou University, Lanzhou, and 5Chinese GRADE Center, Gansu, China

Objectives: Numerous systematic reviews investigating the efficacy of platelet-rich plasma (PRP) in treating knee
osteoarthritis (OA) have been recently published. The purpose of the present study was (1) to perform an over-

view of overlapping systematic reviews investigating PRP for knee OA via evaluating methodological quality and

risk of bias of systematic reviews and (2) to provide recommendations through the best evidence.

Methods: A systematic search of systematic reviews published through Feb 2017 was conducted using the MED-
LINE, EMBASE and Cochrane Library. The methodological quality and risk of bias of included systematic

reviews were assessed by AMSTAR instrument and ROBIS tool respectively. Best evidence choice procedure was

conducted according to the Jadad decision algorithm. The systematic reviews with high quality of methodology

and low risk of bias were selected ultimately.

Results: Ten systematic reviews were eligible for inclusion. The Jadad decision making tool suggested that the
reviews with highest AMSTAR score should be selected. According to the ROBIS tool, there were 4 systematic

reviews with low risk of bias and 6 with high risk of bias. As a result, two systematic reviews conducted by Dai et

al and Meheux et al with highest AMSTAR score and low risk of bias were selected as the best evidence.

Conclusions: The present overview demonstrates that PRP is an effective intervention in treating knee OA with-
out increased risk of adverse events. Therefore, the present conclusions may help decision makers interpret and

choose PRP with more confidence.

Key words: intra-articular injection, knee osteoarthritis, overview, platelet-rich plasma, ROBIS.


Knee osteoarthritis (OA) is a common pathological

condition with rising prevalence1–3 that plagues mainly

the elderly with pain, functional damage and

impairment of life quality.4 Knee OA might have also

increased the socioeconomic burden in terms of cost of

medical care for both government and individuals. At

present, the ultimate goal of treating knee OA is to

relieve symptoms and to improve join

Contents lists available at ScienceDirect

Journal of Orthopaedics

journal homepage:

Case Report

Clinical outcomes following injections of leukocyte-rich platelet-rich plasma
in osteoarthritis patients

Masahiko Kenmochia,b,∗

a Kenmochi Orthopedic Surgery Sports Clinic, KOSSMOS Medical Corporation, 42-1 Higashi-honcho, Ota, Gunma Prefecture, Japan
b Department of Orthopaedic Surgery, Kyorin University, Tokyo, Japan


Knee osteoarthritis
Leukocyte-rich platelet-rich plasma
Knee injury and osteoarthritis outcome score
Outcome measures in rheumatology-
osteoarthritis research society international
Magnetic resonance imaging osteoarthritis
knee score
Bone mallow lesion
Multiple injection


Background: Scientists are trying to discover how to repair cartilage defects in knee osteoarthritis (KOA). In our
previous study, we found a fibrocartilage-rich cover over the defective portions of cartilage after administering
leukocyte-rich platelet-rich plasma (LR-PRP). This study aimed to investigate the efficacy of multiple injections
of LR-PRP for the treatment of KOA and determine an LR-PRP treatment protocol for KOA in actual clinical
Hypothesis: We hypothesized that using abundant LR-PRP would improve outcomes in patients with KOA.
Study design: Prospective, cross-sectional, interventional, randomized trial.
Methods: Intra-articular LR-PRP injections were administered to 50 knees. Patients received six injections of LR-
PRP in total, which were administered at 4-week intervals. Patients were evaluated based on clinical outcomes,
including visual analog scale (VAS) scores, Knee injury and Osteoarthritis Outcome Scores (KOOS), and magnetic
resonance images (MRI) and radiographic findings before treatment and at 3 and 6 months after treatment. We
investigated the recurrence of pain and presence/absence of MRI changes. Furthermore, we examined the
Outcome Measures In Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) re-
sponder criteria.
Results: The mean improvement rate, as assessed by VAS, was 61.6% (P < .0001). Concerning OMERACT-
OARSI, 37 of 50 knees (74%) were considered responders. There was a significant difference in the follow-up
MRI findings, as assessed by the MRI Osteoarthritis Knee