Comparison Of Clinical Efficacy Between Single And Double Injection Of Leukocyte-poor Platelet-rich Plasma In The Treatment Of Knee Osteoarthritis

BackgroundWith the gradual extension of human life and the increasing obesity,the cost of treatment for knee osteoarthritis is increasing.Between 1995 and 2008,the incidence of OA increased from 21 million to 27 million in the United States,and it is expected to reach 2030.It will increase to 67 million in the year,which is a huge burden for human society.Knee osteoarthritis(KOA)is a chronic degenerative disease Chara-cterized by progressive destruction of articular cartilage.The clinical manifes-taions are knee pain,weakness,and varying degrees of activity.Articular cartilage reduces the damage of articular cartilage by reducing friction and absorbing buffer stress.Due to its avascular and aneural nature,articular cartilage exhibits limited spontaneous healing and repair.Platelet-Rich Plasma(PRP)is defined as the presence of platelets in plasma that are higher than whole blood,typically between 150,000 and 300,000 platelets per microliter of plasma.PRP contains a high concen-tration of platelets,which contain more than 1,100 proteins such as growth factors..Plateleta-granules contains anti-inflammatory cyto-kines and growth factors,and insulin-like growth factor 1(IGF-1),insulin-like growth factor 2(IGF-2),vascular endothelial growth factor(VEGF),transforming growth factor-beta(TGF-?).Fibroblast growth factor(FGF),Platelet derived growth factor(PDGF).These factors are released at the tissue healing site,helping to stimulate the growth of autologous chondrocytes and mesenchymal stem cells,as well as extracellular matrix formation,such as proteoglycans and type I and type II collagen.PRP plays a key role in maintaining tissue homeostasis and regulating inflammation and coagulation in the body,such as inhibition of chondrocyte apoptosis,remodeling of bone vessels,regulation of inflammation,and synthesis of collagen.PRP preparation is divided into Leukocyte-rich platelet-rich plasma(LR-PRP)and leukocyte-poor platelet-rich plasma(LP-PRP)according to the number of white blood cells.Increased white blood cell concentration increases the expression of catabolic cytokines and inflammatory factors,which is detrimental to tissue repair.Many studies have shown that the best evidence for the use of PRP in the treatment of knee arthritis is the use of LP-PRP rather than LR-PRP.ObjectiveComparison of the effects of single injection and two injections of LP-PRP on knee osteoarthritis.MethodsSixty patients with clinically and radiographically confirmed knee osteoarthritis who were admitted to the Department of Rehabilitation Medicine of the Second Hospital of Shandong University were randomly divided into three groups.The control group was given physical therapy for one week,the PRP1 group was given a single PRP injection,and the PRP2 group was given two PRP injections at intervals of one week.The PRP1 group and the PRP2 group were also given physical therapy for one week after the first injection.The main observation index was after treatment VAS,IKDC scores for one month,second month,and third month.Results1.The pre-treatment general data,Kellgren-Lawrence knee grading,basic VAS,and IKDC scores of the three groups were not statistically significant(P>0.05).2.The VAS and IKDC scores at 1 month,2 months,and 3 months of follow-up were statistically significant(P<0.05).3.In the PRP1 group,the VAS and IKDC scores in the first month of follow-up were not statistically significant compared with the baseline scores.The VAS and IKDC scores at the 2nd and 3rd months were statistically significant.4.Comparison of PRP2 group showed that the VAS and IKDC scores of the first month,the second month and the third month of follow-up were statistically significant.5.There was no significant difference in VAS scores between the PRP1 group and the first month after treatment(P>0.05).The remaining PRP1 group and the PRP2 group showed statistical data before and after treatment(P<0.05).ConclusionsLP-PRP is effective in the treatment of KOA.Patients who received double-dose LP-PRP injections and physical therapy had better VAS and IKDC scores than single injection and physical therapy and physical therapy,so that double-injection of LP-PRP was better than single-shot.