Single Intra-Articular Platelet-Rich Growth Factor Injection for Knee Osteoarthritis: Is It Effective in Severe Patients?
DOI:
https://doi.org/10.56929/jseaortho-2025-0235Keywords:
PRGF, single intra-articular injection, severe, knee osteoarthritisAbstract
Purpose: This study evaluated the clinical outcomes of intra-articular (IA) platelet-rich growth factor (PRGF) in patients with varying severities of knee osteoarthritis (KOA) using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. It also examined whether IA PRGF could delay or prevent surgical intervention in patients with severe KOA.
Methods: In this analytical observational cohort study, 120 patients with KOA, without systemic inflammatory disease or other intra-articular lesions, were classified using the Kellgren-Lawrence (KL) grading system. PRGF, a combination of leukocyte-rich platelet-rich plasma (LR-PRP) and injectable platelet-rich fibrin (iPRF), was prepared using the PP, GF, and ALPAS systems. A single 7 mL IA PRGF injection was administered. WOMAC scores were assessed at baseline, 1 week, and 1, 3, 6, and 12 months post-injection.
Results: Ninety-six female and 21 male patients (mean age: 64.9±8.3 years) were included. Based on KL grading, 38 patients were classified as mild (grade I-II), 44 as moderate (grade III), and 35 as severe (grade IV). All groups showed a decline in WOMAC scores after PRGF injection. Although baseline scores were highest in the severe group, the pattern of score reduction was similar across all severities. WOMAC scores at 3 months were lower in the mild and moderate groups than in the severe group. At 12 months, all groups maintained significantly reduced scores compared to baseline.
Conclusions: A single IA PRGF injection effectively improves pain, stiffness, and function in patients with severe KOA, with outcomes comparable to those in mild and moderate cases over 12 months of follow-up.
Metrics
References
Lane NE, Brandtz K, Hawker G, et al. OARSI-FDA initiative: defining the disease state of osteoarthritis. Osteoarthritis Cartilage 2011;19:478-82.
Zhang Y, Chen X, Tong Y, et al. Development and prospect of intra-articular injection in the treatment of osteoarthritis: A review. J Pain Res 2020;13:1941-55.
Tarantino D, Mottola R, Palermi S, et al. Intra-articular collagen injections for osteoarthritis: A narrative review. Int J Environ Res Public Health 2023;20:4390.
Leng Ip H, Nath DK, Sawleh SH, et al. Regenerative medicine for knee osteoarthritis – the efficacy and safety of intra-articular platelet-rich plasma and mesenchymal stem cells injections: A literature review. Cureus 2020;12:e10575.
Bendinelli P, Matteucci E, Dogliotti G, et al. Molecular basis of anti-inflammatory action of platelet-rich plasma on human chondrocytes: mechanisms of NF-κB inhibition via HGF. J Cell Physiol 2010;225:757-66.
Turajane T, Cheeva-akrapan V, Saengsirinavin P, et al. Composition of platelet-rich plasma prepared from knee osteoarthritic patients: platelets, leukocytes, and subtypes of leukocyte. Cureus 2023;15:e36399.
Cheeva-akrapan V, Turajane T. The 36-month survival analysis of conservative treatment using platelet-rich plasma enhanced with injectable platelet-rich fibrin in patients with knee osteoarthritis. Cureus 2023;15:e35632.
Riboh JC, Saltzman BM, Yanke AB, et al. Effect of leukocyte concentration on the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis. Am J Sports Med 2016;44:792-800.
Martino AD, Matteo BD, Papio T, et al. Platelet-rich plasma versus hyaluronic acid injections for the treatment of knee osteoarthritis: Results at 5 years of a double-blind, randomized controlled trial. Am J Sports Med 2019;47:347-54.
Getgood A, Henson F, Brooks R, et al. Platelet-rich plasma activation in combination with biphasic osteochondral scaffolds-conditions for maximal growth factor production. Knee Surg Sports Traumatol Arthrosc 2011;19:1942-7.
Turajane T, Thitiset T, Honsawek S, et al. Assessment of chondrogenic differentiation potential of autologous activated peripheral blood stem cells on human early osteoarthritic cancellous tibial bone scaffold. Musculoskelet Surg 2014;98:35-43.
Vilchez-Cavazos F, Millan-Alanıs JM, Blazquez-Saldan J. Comparison of the clinical effectiveness of single versus multiple injections of platelet-rich plasma in the treatment of knee osteoarthritis: A systematic review and meta-analysis. Orthop J Sports Med 2019;7:2325967119887116.
Yurtbay A, Say F, Çinka H, et al. Multiple platelet-rich plasma injections are superior to single PRP injections or saline in osteoarthritis of the knee: the 2-year results of a randomized, double-blind, placebo-controlled clinical trial. Arch Orthop Trauma Surg 2022;142:2755-68.
Subramanyam K, Alguvelly R, Mundargi A. Single versus multi-dose intra-articular injection of platelet rich plasma in early stages of osteoarthritis of the knee: A single-blind, randomized, superiority trial. Arch Rheumatol 2021;36:326-34.
Kao DS, Zhang SW, Vap AR. A systematic review on the effect of common medications on platelet count and function: which medications should be stopped before getting a platelet-rich plasma injection?. Orthop J Sports Med 2022;10:23259671221088820.
Etulain J, Mena HA, Meiss R, et al. An optimised protocol for platelet rich plasma preparation to improve its angiogenic and regenerative properties. Scientific Reports 2018;8:1513.
Aizawa H, Kawabata H, Sato A. A comparative study of the effects of anticoagulants on pure platelet-rich plasma quality and potency. Biomedicines 2020;8:42.
Cheeva-akrapan V, Turajane T. The role of plasma, platelets, and growth factors in knee osteoarthritis: The evidence-based medicine 2022. JseaOrtho 2022;46:31-8
Turajane T, Cheeva-akrapan V, Saengsirinavin P, et al. Safety and Efficacy of Platelet Rich Growth Factors (PRGF) in managing knee osteoarthritis after failed conservative treatment: Evidence from real practice. J Southeast Asian Med Res 2019;3:1-7.
Turajane T, Saengsirinavin P, Sriratanavudhi C, et al. A prospective, randomized, controlled trial comparing clinical outcomes of intraarticular platelet plasma concentrate and growth factors versus corticosteroid injections in the treatment of knee osteoarthritis. BKK Med J 2021;17:9-14.
Turajane T, Saengsirinavin P, Sriratanavudhi C, et al. Outcome of using platelet, plasma and growth factors as an orthobiologic derivative to avoid invasive surgical procedures for treating knee osteoarthritis among elderly patients. J Southeast Asian Med Res 2022;6:e0105.
Sucuoğlu H, Üstünsoy S. The short-term effect of PRP on chronic pain in knee osteoarthritis. Agri 2019;31:63-9.
Akan Ö, Sarıkaya NÖ, Koçyiğit H. Efficacy of platelet-rich plasma administration in patients with severe knee osteoarthritis: can platelet-rich plasma administration delay arthroplasty in this patient population?. Int J Clin Exp Med 2018;11:9473-83.
Raeissadat SA, Ghorbani E, Taheri MS, et al. MRI changes after platelet rich plasma injection in knee osteoarthritis (randomized clinical trial). J Pain Res 2020;13:65-73.
Ngarmukos S, Tanavalee C, Amarase C, et al. Two or four injections of platelet-rich plasma for osteoarthritic knee did not change synovial biomarkers but similarly improved clinical outcomes. Sci Rep 2021;11:23603.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 The Royal College of Orthopaedic Surgeons of Thailand
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
