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Question clinique
Is leukocyte-rich plasma less effective than leukocyte-poor plasma when injected into the knees of adults with osteoarthritis?
L’Essentiel
In this study limited by the absence of a placebo wing, leukocyte-rich and leukocyte-poor PRP injections were comparably effective in relieving pain in adults with mild to moderate knee osteoarthritis. Since it is unclear whether this treatment is any better than placebo, the American College of Rheumatology strongly recommends against using PRP injections. 1b
Référence
Plan de l'etude: Randomized controlled trial (double-blinded)
Financement: Unknown/not stated
Cadre: Outpatient (specialty)
Sommaire
Although meta-analyses on the effectiveness of platelet-rich plasma (PRP) injections are discordant and the American College of Rheumatology makes a strong recommendation against its use, these authors explored the possibility that the presence of leukocytes makes these injections less effective. They recruited 192 adults with mild to moderate knee osteoarthritis (based on x-ray results), had at least 4 months of pain or swelling, and had failed to improve after at least 2 months of nonoperative treatment. The authors randomized the patients to receive 3 weekly injections of leukocyte-rich plasma or 3 weekly injections of leukocyte-poor plasma. There was no sham or placebo group. Researchers uninvolved in the injections and unaware of treatment allocation evaluated the participants at baseline and then at 2, 6, and 12 months. After 12 months, the participants in each group improved at each interval and there was no significant difference in the degree of improvement from baseline, regardless of treatment. The authors report that adverse events were generally mild, infrequent, and occurred with similar frequency in each group. The study was designed to be able to detect clinically meaningful differences. The findings are comparable with those reported in a recent network meta-analysis of 23 studies with 2260 participants. Of course, all this is specious if PRP injections are no more effective than placebo.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Commentaires
PRP knee injections
high leukocyte PRP injections no better then low leuk PRP injections