Abstract

The new treatment approach in knee osteoarthritis: Efficacy of cellular matrix combination of platelet rich plasma with hyaluronic acid versus two different types of hyaluronic acid (HA)

Author(s): Branko Barac, Nemanja Damjanov & Ana Zekovic

Osteoarthritis pathogenesis is a complex process associated with decreased ability to regenerate cartilage mainly due to lack of physiological vascularization. One of the most commonly affected joints is the knee.

Purpose: The aim of this study was to compare the efficacy of intra-articular (IA) injections of platelet rich plasma (PRP) combined with hyaluronic acid (HA) prepared with the Cellular Matrix device versus IA injections with two different types of hyaluronic acid for treatment of knee osteoarthritis.

Material and methods: This is a prospective, randomized, double-blind, controlled study on 53 patients (90 knees) suffering from knee osteoarthritis, divided in 3 groups. The first group comprised 19 patients (30 knees) treated with 3 IA injections, one every second week, of Cellular Matrix (CM) PRP-HA combination. The second group of 19 patients (30 knees) was treated with 3 weekly IA injections of 2% noncross- linked sodium hyaluronate (ArthroVisc^®, AV) and the third group of 15 patients (30 knees) treated with 3 weekly IA injections of 2% non-cross-linked sodium hyaluronate with mannitol (Ostenil^® Plus, OP). All groups were homogeneous concerning gender, age and Kellgren Lawrence scale (I to III). For all patients visual analog pain scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), The International Knee Documentation Committee (IKDC) score (“well-being” scale for all 4 scores between 0 and 100) and ultrasound (US) cartilage thickness on lateral, trochlear, and medial compartments, with normal range values from 2 to 2.5 mm, were measured at the beginning of the treatment (baseline) and at each follow up visit, that is at 2, 6 and 12 months after the last injection.

Results: A statistically significant difference (p<0.05) in the CM group was found compared to AV and OP group in the values of VAS, WOMAC, KOOS and IKDC after two months, although an improvement, compared to baseline values, was observed for the indicated parameters in all groups. A high statistically significant difference (p<0.01) was obtained in the CM group compared to the AV and OP group for VAS, WOMAC, KOOS and IKDC after 6 and 12 months. In both groups of patients treated with hyaluronic acid, a deterioration of values for VAS, WOMAC, KOOS and IKDC score was seen at 12 months in relation to values at 6 months. The CM treated group showed statistically significant improvement (p<0.05) of the cartilage thickness after 2, 6 and 12 months in the medial and highly statistically significant improvement (p<0.01) in the lateral segments of knee cartilage in comparison to baseline values.

Conclusion: The Cellular Matrix PRP-HA combination (CM-PRP-HA) might be one of the most potent, safe, fast and novel therapeutic option for osteoarthritis of the knee (Kellgren–Lawrence grade I to III), as well as a useful tool for postponing arthroplasty surgery when it is necessary. For further investigations, we need larger prospective double-blind studies with MRI quantification of CM-PRP-HA effects on cartilage. Taking all this in consideration we are very close to believe that the future therapeutic option for osteoarthritis, will be combining therapeutic effects of Cellular Matrix CM-PRP-HA with bone marrow mesenchymal stem.