Effects Of Platelet Rich Plasma On Subchondral Bone Marrow Edema And Biomarkers In Synovial Fluid Of Knee

Background:Platelet-rich plasma(PRP)is a new therapy for the treatment of knee osteoarthritis.Most studies at home and abroad have proved that PRP is effective in the treatment of early knee osteoarthritis.However,the mechanism of PRP for the treatment of osteoarthritis is still unclear.Subchondral bone and inflammatory microenvironment play an important role in the pathogenesis of knee osteoarthritis.Subchondral bone edema and infiltration of inflammatory factors are also closely related to knee pain.Can platelet-rich plasma alleviate joint pain and retard the progression of arthritis by inhibiting inflammatory response and reducing subchondral bone edema?Objective:To investigate the effect of platelet rich plasma(PRP)on subchondral bone marrow edema and the level of biomarkers in synovial fluid of early knee osteoarthritis.Explore the possible mechanism of platelet rich plasma in the treatment of knee osteoarthritis.Methods:81 patients with early knee osteoarthritis were randomly divided into two groups according to the number of hospitalization odd-even,45 cases were treated with platelet rich plasma(PRP group),and 36 cases were treated with sodium hyaluronate(SH group).The PRP group was injected with PRP 5ml three times a week.SH group was injected with 5ml SH every week for a total of 3 times.Follow-up observation after treatment,VAS pain score and WOMAC score were used to evaluate clinical effect.The changes of subchondral bone marrow edema before and after treatment were evaluated by MRI imaging at 3 months after treatment.Synovial fluid was extracted before each knee cavity injection to detect the changes in the content of TNFa,IL-6,MCP-1,MMP-1,MMP-3,MMP-9 and other biomarkers in synovial fluid.Results:All 81 patients completed the corresponding treatment and received more than 1 year follow-up,without serious complications.After treatment,the VAS score and WOMAC score of 2 groups were significantly decreased,with statistical significance at different time points(P<0.05).The scores of VAS and WOMAC in PRP group were better than those in SH group.After treatment,MRI showed that subchondral bone edema in both groups was reduced to varying degrees,and the reduction was more obvious in the PRP group than in the other groups.After treatment,the contents of TNFa,IL-6,MCP-1,MMP-1,MMP-3 and MMP-9 in 2 groups were decreased,and there was statistical significance between different time points(P<0.05).After treatment,the levels of TNFα,IL-6,MCP-1,MMP-1,MMP-3 and MMP-9 in PRP group were significantly lower than those in SH group.Conclusion:The intraarticular injection of PRP and SH in knee osteoarthritis has a certain short-term effect,and the effect of PRP is better than that of SH.Intra-articular injection of PRP can significantly reduce subchondral bone marrow edema of knee joint,and reduce the levels of TNFα,IL-6,MCP-1,MMP-1,MMP-3,and MMP-9 in synovial fluid.