Platelet-rich plasma injections for knee osteoarthritis

Evidence-based recommendations on platelet-rich plasma injections for knee osteoarthritis in adults. This involves taking plasma from a small amount of the persons own blood and injecting it into the knee.

# Recommendations
Current evidence on platelet-rich plasma injections for knee osteoarthritis raises no major safety concerns. However, the evidence on efficacy is limited in quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.Find out what special arrangements mean on the NICE interventional procedures guidance page.
Clinicians wishing to give platelet-rich plasma injections for knee osteoarthritis should:
Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the procedure's safety and efficacy, as well as any uncertainties about these. Provide them with clear information to support shared decision making. In addition, the use of NICE's information for the public on platelet-rich plasma injections for knee osteoarthritis is recommended.
Audit and review clinical outcomes of all patients having platelet-rich plasma injections for knee osteoarthritis, including details of the methods used to prepare and administer the platelet-rich plasma injections. NICE has identified relevant audit criteria and has developed NICE's interventional procedure outcomes audit tool (which is for use at local discretion).
Further research should be in the form of randomised controlled trials with medium- to long-term followup, including validated measures of knee function and patient-reported outcomes.# The condition, current treatments and procedure

# The condition
Osteoarthritis of the knee is the result of progressive deterioration of the articular cartilage and menisci of the joint, usually because of trauma, and wear and tear. This leads to exposure of the bone surface. Symptoms include pain, stiffness, swelling and difficulty walking.

# Current treatments
Treatment depends on the severity of the symptoms. Conservative treatments include analgesics and corticosteroid injections to relieve pain and inflammation, and physiotherapy and prescribed exercise to improve function and mobility. When symptoms are severe, surgery may be indicated: options include upper tibial osteotomy and unicompartmental or total knee replacement.

# The procedure
Platelet-rich plasma is prepared by a clinician or a technician. Blood is taken from the patient and centrifuged to obtain a concentrated suspension of platelets in plasma. Different preparation methods may affect the concentrations of platelets and the level of contamination with red and white blood cells. Different agents such as calcium chloride or thrombin may be added.
The platelet-rich plasma is injected into the joint space in the knee, usually under ultrasound guidance. Platelets contain growth factors that are thought to stimulate chondrocyte proliferation, leading to cartilage repair. The aim is to relieve symptoms, potentially delaying the need for joint replacement surgery. This guidance refers to the use of platelet-rich plasma injections alone and not as part of a combination therapy.