Clinical application and research of PRP in common diseases of knee joint
Platelet-rich plasma (PRP) is plasma composed mainly of platelets and white blood cells obtained by centrifugation of autologous peripheral blood. A large number of growth factors and cytokines are stored in the α granules of platelets. When platelets are activated, their α granules release a large number of growth factors. Studies have shown that these cell growth factors can promote cell differentiation, proliferation, extracellular matrix and collagen synthesis, thereby promoting the regeneration and repair of articular cartilage and ligament and other tissues. At the same time, it can also improve the inflammatory response of the lesion site and reduce the clinical symptoms of patients. In addition to these cell growth factors, PRP also contains a large number of white blood cells. These white blood cells and platelets can release a variety of antimicrobial peptides to bind to pathogens, inhibit and kill pathogens, and play an antibacterial role.
PRP has been widely used in the field of orthopedics due to its relatively simple manufacturing process, convenient use and low cost, especially in the treatment of knee diseases in recent years. This article will discuss the clinical application and research of platelet-rich plasma in knee osteoarthritis (KOA), meniscus injury, cruciate ligament injury, knee synovitis and other common knee diseases.
PRP application technology
The unactivated PRP and the activated PRP release are liquid and can be injected, and the unactivated PRP can be controlled by artificially adding calcium chloride or thrombin to control the agglutination time so that the gel can be formed after reaching the target site, so as to achieve the purpose of sustained release of growth factors.
PRP treatment of KOA
KOA is a degenerative knee disease characterized by progressive destruction of articular cartilage. Most of the patients are middle-aged and elderly. The clinical manifestations of KOA are knee pain, swelling, and activity limitation. The imbalance between synthesis and decomposition of articular cartilage matrix is the basis of the occurrence of KOA. Therefore, promoting cartilage repair and regulating the balance of cartilage matrix is the key to its treatment.
At present, most KOA patients are suitable for conservative treatment. The knee joint injection of hyaluronic acid, glucocorticoids and other drugs and oral non-steroid anti-inflammatory drugs are commonly used conservative treatment. With the deepening of research on PRP by domestic and foreign scholars, the treatment of KOA with PRP has become more and more extensive in recent years.
Mechanism of action:
1. Promote the proliferation of chondrocytes:
By measuring the effect of PRP on the viability of rabbit chondrocytes, Wu J et al. found that PRP enhanced the proliferation of chondrocytes, and speculated that PRP may protect IL-1β-activated chondrocytes by inhibiting Wnt / β-catenin signal transduction.
2. Inhibition of chondrocyte inflammatory reaction and degeneration:
When activated, PRP releases a large number of anti-inflammatory factors, such as IL-1RA, TNF-Rⅰ, ⅱ, etc. Il-1ra can inhibit IL-1 activation by blocking IL-1 receptor, and TNF-Rⅰ and ⅱ can block TNF-α related signaling pathway.
Efficacy study:
The main manifestations are relief of pain and improvement of knee function.
Lin KY et al. compared intra-articular injection of LP-PRP with hyaluronic acid and normal saline, and found that the curative effect of the first two groups was better than that of the normal saline group in the short term, which confirmed the clinical effect of LP-PRP and hyaluronic acid, and the long-term observation (after 1 year) showed that the effect of LP-PRP was better. Some studies have combined PRP with hyaluronic acid, and found that the combination of PRP and hyaluronic acid could not only relieve pain and improve function, but also confirm the regeneration of articular cartilage by X-ray.
However, Filardo G et al. believed that PRP group and sodium hyaluronate group were effective in improving knee function and symptoms through randomized controlled study, but no significant difference was found. It was found that the way of PRP administration had a certain effect on the therapeutic effect of KOA. Du W et al. treated KOA with PRP intravarticular injection and extraarticular injection, and observed VAS and Lysholm scores before medication and 1 and 6 months after medication. They found that both injection methods could improve VAS and Lysholm scores in the short term, but the effect of intra-articular injection group was better than extraarticular injection group after 6 months. Taniguchi Y et al. divided the study on the treatment of moderate to severe KOA into intraluminal injection combined with intraluminal injection of PRP group, intraluminal injection of PRP group and intraluminal injection of HA group. The study showed that the combination of intraluminal injection of PRP and intraluminal injection of PRP was better than intraluminal injection of PRP or HA for at least 18 months in improving VAS and WOMAC scores.
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Post time: Nov-04-2022