Leukocyte-rich, poor PRP injections may have similar clinical improvements for knee OA
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Published results showed intra-articular injections of leukocyte-rich platelet-rich plasma had similar clinical improvements as leukocyte-poor PRP injections in patients with symptomatic knee osteoarthritis.
Researchers randomly assigned 192 patients with symptomatic knee OA to receive three weekly injections of either leukocyte-rich PRP or leukocyte-poor PRP. Researchers evaluated IKDC subjective scores at baseline and at 2, 6 and 12 months, as well as KOOS subscales, EuroQol-VAS and Tegner scores.
Results showed the two groups had no differences in terms of absolute values or improvement in the clinical scores across all follow-up intervals. Researchers found improvements in the mean IKDC subjective score from 45.6 at baseline to 60.7 at 12-month follow-up in the leukocyte-rich PRP group and from 46.8 to 62.9 in the leukocyte-poor PRP group. Although neither group reported severe adverse events, researchers noted 12.2% of patients in the leukocyte-rich PRP group and 4.7% of patients in the leukocyte-poor PRP group reported mild adverse events. The two groups also had no statistically significant differences in terms of failures, defined as a new injective or surgical procedure due to symptom persistence or worsening, according to results.
“Both treatment groups had a low number of failures and adverse events, without significant intergroup differences,” the authors wrote. “Therefore, the presence of leukocytes did not significantly affect the clinical results obtained with PRP injections, and further studies should focus on the interaction of more biological variables, besides leukocytes, to optimize PRP treatment for knee OA.”
Perspective
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Up until recently I believed that when injecting PRP for the treatment of knee OA, I needed to use the preparation method that concentrated the platelets and removed the leukocytes (leukocyte-poor PRP). It seemed like the best method based on my experience with patients and all data I’d seen thus far. However, now there is this new double-blind randomized controlled trial by Alessandro Di Martino, MD, and colleagues to consider. It is a well-designed study that concluded leukocyte concentration does not matter with regard to adverse events or clinical outcomes during 12 months of follow-up in patients with knee OA. Both leukocyte-rich PRP and leukocyte-poor PRP showed similar clinical improvement. Perhaps it is not surprising after all. PRP is a concentrated cocktail and likely many other variables besides leukocytes are at play and contribute to its efficacy. Among other things, we still need to better understand the role of PRP volume, preparation method, platelet concentration, number and timing of injections, other patient and disease characteristics, and the role of mixing in different substances. This gives us a lot to consider for the future.
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