The comparison of prp alone, supervised exercise alone, and prp combined with supervised exercise in management of knee osteoarthritis

Background Platelet-rich plasma (PRP) has sparked widespread interest as a regenerative adjunct therapy, and it is increasingly being used to treat knee osteoarthritis (OA). There is a scarcity of reports on the characterization of injected products, as well as a scarcity of exercise protocols following PRP injections, despite the rising number of studies in the present PRP literature. Objectives The purpose of this study was to compare the efficacy of PRP with a supervised exercise program and reveal if the combination of the two treatments is effective in the management of knee OA. Methods This is a randomized, single-blinded, prospective, three-arm clinical trial. The PRP group received three weekly injections of fresh, leukocyte-poor PRP. The exercise group followed a structured and supervised exercise regimen for six weeks. These therapies were given in conjunction with the third group. The primary outcome was the change in overall average knee pain scores (on an 11-point numeric pain rating scale, with higher scores indicating worse pain) over a 24-week time period. The secondary outcomes were changes on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), durations of the functional performance tests, and health-related quality of life. For statistical analysis, the mixed model with repeated measurements (ANOVA) was performed. Results A total of eight-hundred four patients with mild to moderate knee osteoarthritis were randomly allocated to three groups. There was a significant group-by-time interaction for overall knee pain (p<0.001). Pain reduction from baseline to 24 weeks was greater in PRP&Exercise group (Δ -5.40, 95%CIs -5.28 to -4.39). There were significant group-by-time interactions on the WOMAC total score, durations of the functional performance tests, and physical component of SF-12 (p<0.012). Exercise group and PRP&Exercise group had statistically greater impact than PRP alone, with large to very large effect sizes in terms of pain, self-reported function and functional performance tests (p<0.012, ηp2>0.14). Conclusion PRP demonstrated short-term efficacy comparable to exercise or a combination of PRP and exercise; however, when compared to the other groups, it demonstrated a negative tendency in terms of long-term clinical improvements. PRP alone is not as effective as supervised exercise; however, if a patient has difficulties maintaining exercise programs for any reason, PRP can be offered as an alternative option. References [1]Whittle SL, Johnston RV, McDonald S, Paterson KL, Buchbinder R. Autologous blood product injections including platelet-rich plasma for osteoarthritis of the knee. Cochrane Database Syst Rev. 2019;2019(5):CD013341. [2]Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and cartilage. 2019;27(11):1578-1589. [3]Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & rheumatology (Hoboken, NJ). 2020;72(2):220-233. [4]Kon E, Di Matteo B, Delgado D, et al. Platelet-rich plasma for the treatment of knee osteoarthritis: an expert opinion and proposal for a novel classification and coding system. Expert opinion on biological therapy. 2020;20(12):1447-1460. Acknowledgements: NIL. Disclosure of Interests None Declared.