Platelet-rich Plasma for Thumb Carpometacarpal Joint Osteoarthritis
Condition: Thumb Carpometacarpal Joint Osteoarthritis
MeSH terms: Osteoarthritis
Study type: Observational

Summary: 
      The purpose of this study is to investigate a case series of patients treated with
      Platelet-rich plasma for thumb carpometacarpal joint osteoarthritis. Carpometacarpal
      arthritis is a highly prevalent condition with significant effects on quality of life and
      function. Meanwhile, platelet-rich plasma has been demonstrated to be an effective treatment
      for various musculoskeletal conditions.
    

Detailed description: 
      The first carpometacarpal (CMC) joint at the base of the thumb is one of the most commonly
      affected joints by osteoarthritis (OA), with a prevalence ranging from 15-36% in females and
      5-11% in males. It is also functionally debilitating, with symptoms including diminished
      range of motion, weakness, deformity, instability, and pain. Despite the prevalence of first
      CMC OA, as well as the emerging evidence of platelet-rich plasma (PRP) efficacy for various
      musculoskeletal conditions, there is a paucity of studies investigating the two. To our
      knowledge, there are three studies in the literature, resulting in a total of 27 patients
      with first CMC OA receiving PRP to date1.

      Common nonsurgical treatment options for management of this condition include oral and
      topical NSAIDs, hand therapy, activity modifications, splinting and intra-articular
      injections. Injections have traditionally consisted of corticosteroids demonstrating variable
      efficacy and viscosupplementation resulting in conflicting results. Surgical options include
      trapeziectomy with ligament reconstruction and tendon interposition, fusion, and less
      commonly, implant arthroplasty.

      PRP is defined as an autologous, concentrated mix of platelets and inflammatory mediators
      suspended in plasma, obtained by centrifuging a patient's whole blood. It is hypothesized
      that PRP stimulates recruitment, proliferation, and differentiation of regenerative cells via
      release of various growth factors such as platelet-derived growth factor-AB and -BB,
      transforming growth factor-β1, insulin-like growth factor-1, fibroblast growth factor-basic,
      epidermal growth factor, vascular endothelial growth factor, and interleukin (IL)-12. The
      platelets in PRP have anti-inflammatory properties with modulators including IL-1 receptor
      antagonist, soluble tumor necrosis factor receptor I and II, IL-4, IL-10, IL-13 and
      interferon γ. Although PRP has been used for numerous musculoskeletal conditions, varying
      methods of extraction, different types of PRP, and lack of standardized reporting on the
      detailed biologic makeup of PRP has caused difficulties with interpretation and comparison of
      studies investigating its use. For these reasons, there has been a call for the
      standardization of PRP in clinical use.

      The primary aim of this study was to assess (1) outcomes of PRP injection among patients with
      first CMC OA, and (2) the biologic characteristics of PRP injectate. The secondary aims were
      to describe the injection technique used at our institution and analyze the relationships
      between patient demographics, PRP biologic characteristics, and patient outcomes.
    

Intervention name(s): Platelet-rich plasma
Intervention type(s): Biological
Intervention description(s): Platelet-rich plasma injection for first CMC OA
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Those with CMC OA who received PRP injections