Do knee osteoarthritis Syrian patients improve on platelet-rich plasma injections?
Authors: Kudsi Maysoun , Tarcha Raghad , Tarcha Majd , Sinan Abdalrahim , Haidar Ghina , Btrush Sana 
Published: November 2024

Background:
Few studies are available in the medical literature on the expected benefit of platelet-rich plasma (PRP) injections for osteoarthritis knee, and most of the studies reported improvements in pain, stiffness, and function in mild and moderate degrees of osteoarthritis. There is no study in Syria concerning any data about knee osteoarthritis (KOA). In our study, we aimed to determine the extent of the benefit within 6 weeks of PRP injections in Syrian patients with osteoarthritis of the knee.

Methods:
310 Syrian patients suffering from osteoarthritis of the knee were injected with PRP at 2-week intervals for 6 weeks. Pain, function, and stiffness were calculated at baseline and after 6 weeks as well as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) tool before the start of treatment, after PRP injections, and after 6 weeks. All patients who were diagnosed with KOA, according to the classification criteria of the American College of Rheumatology, and grade 2 or 3 of Kellgren-Lawrence classification, and who were older than 18 years were included in our study, and exclusion criteria included patients with other rheumatic conditions, chronic liver or kidney disease, and malignancies.

Results:
The age was 55.96 ± 11.29 years, with 58.70% of the sample being female. The majority of patients had OA grades 2 and 3 and were overweight. The PRP injected into each patient differed slightly in the range of 5 ml. There was a reduction in WOMAC scores from the baseline between each category. This is followed by a rise at the 6-week follow-up post the third injection. None of these changes from baseline until 6 weeks post-treatment was statistically significant. The reduction in all scores up until before the third injection was given, but none of these changes from baseline until the follow-up 6 weeks after treatment were statistically significant (P < 0.001) upon Kruskal–Wallis tests. The greatest improvements were seen in patients with mild OA. A limitation of this study is that the one-center study, the limited follow-up to 12 weeks, lack of a control group. It was important for us to show its importance in the advanced stages of KOA. Further studies with a larger sample size across multiple centers, and the presence of a control group, with multivariate analysis may provide higher-level evidence for the practice.

Conclusions:
There has been no statistically significant decrease in total WOMAC, pain, stiffness, and physical function scores from baseline up until follow-up 6 weeks after treatment. The injections did not completely provide relief for any patient in this study. It must be questioned whether PRP injections are beneficial for patients with grade 3 OA and whether they only be carried out in patients with grade 2 OA. Further larger multicenter studies are needed to determine the efficacy of these injections and which grade of OA patients shall receive the greatest benefit.

Conclusion:
Despite other RCTs showing an improvement, in their setting with their treatment protocol, the results showed a trend of reduction in the WOMAC score. PRP is a safe and promising management option for symptom modification in the setting of knee OA, so it can be recommended in specific cases.