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Original Investigation
November 23/30, 2021

Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial

Author Affiliations
  • 1Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
  • 2Rheumatology Department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
  • 3Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  • 4Rheumatology Department, Alfred Hospital, Melbourne, Victoria, Australia
  • 5Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia
  • 6Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
  • 7Imaging @ Olympic Park, Melbourne, Victoria, Australia
  • 8Castlereagh Imaging, Sydney, New South Wales, Australia
  • 9Monash Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  • 10Biomarker Discovery Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
  • 11Department of Physical Medicine and Rehabilitation, University of Medicine, Mandalay, Mandalay, Myanmar
JAMA. 2021;326(20):2021-2030. doi:10.1001/jama.2021.19415
Visual Abstract. Effect of Intra-articular Platelet-Rich Plasma vs Placebo on Pain and Cartilage Volume in Patients With Knee Osteoarthritis
Effect of Intra-articular Platelet-Rich Plasma vs Placebo on Pain and Cartilage Volume in Patients With Knee Osteoarthritis
Key Points

Question  Does intra-articular injection of platelet-rich plasma (PRP), compared with placebo saline injection, improve symptoms and joint structure in patients with knee osteoarthritis?

Findings  In this randomized clinical trial that included 288 adults aged 50 years or older with mild to moderate radiographic knee osteoarthritis, treatment with PRP vs placebo injection resulted in a mean change in knee pain scores of −2.1 vs −1.8 on an 11-point scale (range, 0-10) and a mean change in medial tibial cartilage volume of −1.4% vs −1.2% at 12 months. Neither comparison was statistically significant.

Meaning  Among adults with mild to moderate knee osteoarthritis, treatment with PRP vs saline injection did not significantly improve knee pain or slow disease progression.

Abstract

Importance  Most clinical guidelines do not recommend platelet-rich plasma (PRP) for knee osteoarthritis (OA) because of lack of high-quality evidence on efficacy for symptoms and joint structure, but the guidelines emphasize the need for rigorous studies. Despite this, use of PRP in knee OA is increasing.

Objective  To evaluate the effects of intra-articular PRP injections on symptoms and joint structure in patients with symptomatic mild to moderate radiographic medial knee OA.

Design, Setting, and Participants  This randomized, 2-group, placebo-controlled, participant-, injector-, and assessor-blinded clinical trial enrolled community-based participants (n = 288) aged 50 years or older with symptomatic medial knee OA (Kellgren and Lawrence grade 2 or 3) in Sydney and Melbourne, Australia, from August 24, 2017, to July 5, 2019. The 12-month follow-up was completed on July 22, 2020.

Interventions  Interventions involved 3 intra-articular injections at weekly intervals of either leukocyte-poor PRP using a commercially available product (n = 144 participants) or saline placebo (n = 144 participants).

Main Outcomes and Measures  The 2 primary outcomes were 12-month change in overall average knee pain scores (11-point scale; range, 0-10, with higher scores indicating worse pain; minimum clinically important difference of 1.8) and percentage change in medial tibial cartilage volume as assessed by magnetic resonance imaging (MRI). Thirty-one secondary outcomes (25 symptom related and 6 MRI assessed; minimum clinically important difference not known) evaluated pain, function, quality of life, global change, and joint structures at 2-month and/or 12-month follow-up.

Results  Among 288 patients who were randomized (mean age, 61.9 [SD, 6.5] years; 169 [59%] women), 269 (93%) completed the trial. In both groups, 140 participants (97%) received all 3 injections. After 12 months, treatment with PRP vs placebo injection resulted in a mean change in knee pain scores of −2.1 vs −1.8 points, respectively (difference, −0.4 [95% CI, −0.9 to 0.2] points; P = .17). The mean change in medial tibial cartilage volume was −1.4% vs −1.2%, respectively (difference, −0.2% [95% CI, −1.9% to 1.5%]; P = .81). Of 31 prespecified secondary outcomes, 29 showed no significant between-group differences.

Conclusions and Relevance  Among patients with symptomatic mild to moderate radiographic knee OA, intra-articular injection of PRP, compared with injection of saline placebo, did not result in a significant difference in symptoms or joint structure at 12 months. These findings do not support use of PRP for the management of knee OA.

Trial Registration  Australian New Zealand Clinical Trials Registry Identifier: ACTRN12617000853347

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