Knee arthritis is a disease that affects bone lining called cartilage. Bone is rough like sand paper, and it is lined by cartilage which is smoother then ice. There is no cure for arthritis, but there are many treatments. In 2012, arthroscopic and related surgeons including orthopedic sports medicine specialists are trying to prevent the progression of arthritis by catching the disease early, and attempting to treat knee cartilage damage early, with a goal of prevention of knee advanced arthritis. While knee anti-aging therapy represents a dream, research advancements with regard to our understanding of biologic treatments (“biologics”), such as stem cells, orthokine, growth factors, and platelet rich plasma do show significant promise.
Arthritis is caused by various conditions, sometimes associated with complex disease, but the most common kind of knee arthritis is osteoarthritis which is similar to wear and tear. Osteoarthritis can be caused by trauma, overuse, obesity, or genetics, and usually the cause is a combination of these factors, while at other times, the cause remains unknown.
Platelet Rich plasma or PRP is a therapy where a patient’s own blood may be treated to quickly, cost-effectively, and aseptically remove blood cells. What is left behind is a liquid known as plasma which contains a patient’s own platelet’s, and platelets may be thought of as factories which produce growth factors which may have beneficial effects on healing, and symptoms of inflammation including pain, swelling, warmth, and redness.
Evidence-based medicine is pending, and current research maybe contradictory or controversial, but the purpose of platelet rich plasma research for patients with osteoarthritis is two-fold. One goal is to control symptoms such as pain as described above. The ultimate goal is to prevent progression of osteoarthritis, or even provide an arthritis cure. While an arthritis cure currently does not exist, the disease is prevalent in epidemic proportions, and so researchers are devoting enormous amounts of thought and energy to knee cartilage damage.
One area of great promise could be PRP enhancement or PRP augmentation of existing, evidence-based, minimally invasive surgical treatments, including arthroscopic or related knee cartilage repair or restorative procedures in patients with cartilage pathology. In 2012, knee arthroscopy is not a known “cure” for knee osteoarthritis, but arthroscopy is well known to help patients with early cartilage degeneration known as chondromalacia, as well as associated lesions such as meniscal tears, inflamed joint lining (synovitis), loose bodies, or torn knee ligaments such as the anterior cruciate ligament (ACL), or medial collateral ligament (MCL).
PRP is indicated for post-operative application at a surgical site. PRP comes from the patient’s own body, and while all therapies have risks, platelet rich plasma therapy is believed to be safe. Some research demonstrates that platelet rich plasma is an effective treatment for orthopaedic sports medicine or degenerative conditions such as arthritis, but future research is required before PRP can be evidence-based recommended as a treatment for osteoarthritis. Thus, under certain circumstances today, PRP could be considered a reasonably safe and potentially effective treatment option for the disease of knee cartilage degeneration or cartilage damage, including early osteoarthritis, and could potentially result in pain relief in patients with more advanced stages of the disease..
During knee arthroscopic surgery, procedures may be performed to enhance cartilage repair or restoration. Also, during surgery, frequently while patient is asleep, a small amount of blood may be drawn from the patients arm and treated to isolate platelet rich plasma (PRP), which may be injected into the knee joint at the end of the case, or during the postoperative period. There is also the potential for patients to receive knee PRP injections without first having surgery, which has been described by many of my colleagues.
Post-treatment protocols for patients with knee osteoarthritis receiving platelet rich plasma:
A post-treatment protocol is determined on a case by case basis depending on individual patient anatomy, and arthroscopic surgical or non-surgical indications and interventions. In some cases a patient may walk normally immediately, or after 1-2 days, and return to full activity a week or month, while in other cases crutches may be prescribed for 6 weeks, and return to full activities such as impact or cutting sports be postponed for 2-3 months. After surgery or initial treatment or injection, patients may receive additional knee platelet rich plasma treatments on an outpatient basis.
The goal of clinical research investigating PRP treatment of cartilage damage or knee osteoarthritis is repair or restoration of articular cartilage which could last for the rest of a patient’s life. In addition, the goal is for early improvement in a matter of weeks, with anticipated complete recovery in no more than 2-3 months, often much sooner such as one month or one week. However much remains to be discovered with regard to biologics, and cartilage research is confounded by many types of bias including unavoidable human variability, so it is difficult to generalize pending large clinical trials.
James H Lubowitz, MD
Director, New Mexico Knee Clinics of Santa Fe, Los Alamos, and Taos
Director, Taos Orthopaedic Institute, Taos Orthopaedic Institute Research Foundation, Taos Orthopaedic Institute Sportsmedicine Fellowship and Training Program
Assistant Editor-in-Chief, Arthroscopy: The Journal of Arthroscopic and Related Surgery
Editor-in-Chief, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sportsmedicine Newsletter
Patients may send their questions to Dr. Lubowitz at www.taosortho.com.