שחיקת סחוס ופרמקולוגיה
According to Goh et al. (2019), osteoarthritis (OA) is a complex degenerative disease of the joint that most commonly affects the knee joint. Researchers discovered that the prevalence of osteoarthritis in the general population has been increasing over the last decade and is expected to continue to rise in the future, owing to the aging population.
Authors state that this is not an isolated injury to the articular cartilage but rather overall damage to the various articular structures, including articular cartilage, synovium, sub-cartilage bone, crescents, intra-articular ligaments, and even the joint capsule.
Furthermore, while pain is the most common symptom of the disease, significant difficulty in mobility and weight-bearing is also common. These worsen as the disease progresses, resulting in significant functional impairment and reduced quality of life. (Goh et al., 2019)
Physical therapy, painkillers, and pharmacological drugs in the form of tablets and injections are often used in OA treatment, including nonsurgical treatment. Options primarily consist of oral nonsteroidal anti-inflammatory drugs, medications that sustain articular cartilage-like amino sugars, and intraarticular (IA) injections of glucocorticoids and hyaluronic acid. However, those procedures may cause severe adverse effects. (Laudy et al., 2015)
Platelet-rich plasma (PRP), an autologous (self-blood product) containing a high concentration of platelets, is a treatment that has recently been introduced in addition to steroids and various types of hyaluronic acid injections.
Laudy et al. (2015) explain that PRP, as a treatment option for osteoarthritis, improves chondrocyte function and proliferation while negatively inhibiting inflammatory pathways.
In addition, according to Zhang et al. (2022), The concentration of platelets is 3–5 times more than in typical blood, resulting in increased proteoglycan stiffness and type 2 collagen in damaged articular cartilage tissue. The author emphasizes that platelets are a never-ending source of growth factors like Platelet-Derived Growth Factor, Transforming Growth Factor, Vascular Endothelial Growth Factor, Basic Fibroblast Growth Factor, Insulin-like Growth Factor, Hepatocyte Growth Factor, and Endothelial Growth Factor.
The procedure is simple, using a laboratory centrifuge or cell separators. It is simple to process platelets from autologous blood. This growth factor treatment's application is safe and less invasive.
In order to evaluate the efficacy and safety of PRP injections in patients with OA of the knee over both a long and short duration, Laudy et al. (2015) conducted a systematic review of the literature. They include ten full-text studies involving individuals older than 18 diagnosed with OA in randomized controlled or nonrandomized controlled clinical trials. PRP injections were used as interventions compared to the placebo, exercise therapy, and IA injections of hyaluronic acid and corticosteroid as control treatment. Three IA injections were administered in most studies on a one- to three-weekly schedule. The writers point out that all studies had a moderate to high risk of bias. This results in limited evidence that PRP injections reduce pain significantly more than placebo injections.
In addition, Zhang et al. (2022) study was conducted to see how IA injections with PRP affected knee osteoarthritis. All the patients underwent PRP injections into the afflicted areas every week for three treatments. In this trial, 250 patients were recruited, including 130 in the PRP group and 120 in the control group. This research indicates a high degree of evidence and quality, which might conclude that PRP is beneficial in treating knee osteoarthritis.
To summarize, PRP is an effective and safe treatment method that assists in the inhibition of inflammatory procedures while also accelerating the tissue repair process. In order to provide a more significant result, future clinical studies should include more samples and extend the follow-up duration. In addition to practice and manual techniques to improve function and reduce pain, physiotherapists should be knowledgeable in all invasive intervention methods that may be used as part of the rehabilitation process.
Goh, S.-L., Persson, M. S. M., Stocks, J., Hou, Y., Lin, J., Hall, M. C., Doherty, M., & Zhang, W. (2019). Efficacy and potential determinants of exercise therapy in knee and hip osteoarthritis: A systematic review and meta-analysis. Annals of Physical and Rehabilitation Medicine, 62(5), 356–365. https://doi.org/10.1016/j.rehab.2019.04.006
Laudy, A. B. M., Bakker, E. W. P., Rekers, M., & Moen, M. H. (2015a). Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: A systematic review and meta-analysis. In British Journal of Sports Medicine (Vol. 49, Issue 10, pp. 657–672). BMJ Publishing Group. https://doi.org/10.1136/bjsports-2014-094036
Zhang, B., Yu, J., Fan, D., Bao, L., & Feng, D. (2022). Effect of Intraarticular Injection of Platelet-Rich Plasma on Knee Osteoarthritis: A Multicenter Retrospective Clinical Study. Journal of Healthcare Engineering, 2022. https://doi.org/10.1155/2022/1788153