Newsletter #8 February 2022

Each month, find new publications about regenerative medicine

K. Bennell, l’arroseur arrosé with the Restore paper published in the JAMA

PRP in knee osteoarthritis (KOA) has developed substantially in recent years, which can be seen both in the scientific literature and in clinical practice. Experts agree that PRP can be proposed after failure of well-conducted oral and topic symptomatic treatments and appropriate physiotherapy. Clinicians consider  PRP as an effective treatment for symptomatic early or moderate KOA and that it might be used in severe forms of KOA, particularly in cases with contraindications to surgery.

The publication of the Restore study results in the November 23, issue of JAMA¹ has generated many comments and questions in the medical community.

One of the issues raised is the lack of interim data on the primary clinical endpoint of knee pain assessed at 2 and 12 months by a numeric rating scale. This information is disturbing because in the Paterson et al. (2018) article detailing the outline of the study it is clearly stated that pain intensity was, very logically, assessed at 2, 6, 9 and 12 months.

In recent years, several meta-analyses have compared PRP with other KOA treatment modalities.

Two level I meta-analysis compared PRP with placebo or hyaluronic acid.

In a summary of meta-analysis, Chen et al. (2019) concluded that for short-term follow-up (≤1 year), intra-articular PRP injection is more effective in terms of pain relief and function improvement in the treatment of KOA patients than HA and placebo with the same safety³.

Tan et al. (2021) published recently in Arthroscopy a meta-analysis of 26 randomized controlled trials compared intra-articular injections of PRP with HA in KOA and concluded that PRP could significantly reduce pain and improve function⁴.

The significant protocol deviation not reported in the publication has serious consequences, insofar as it could moderate the conclusions of the study and must be clarified.

1.    Bennell KL, Paterson KL, Metcalf BR, et al. 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. JAMA. 2021;326(20):2021–2030
2.    Paterson, K.L., Hunter, D.J., Metcalf, B.R. et al. Efficacy of intra-articular injections of platelet-rich plasma as a symptom- and disease-modifying treatment for knee osteoarthritis – the RESTORE trial protocol. BMC Musculoskelet Disord 19, 272 (2018).
3.    Chen, P., Huang, L., Ma, Y. et al. Intra-articular platelet-rich plasma injection for knee osteoarthritis: a summary of meta-analyses. J Orthop Surg Res 14, 385 (2019).
4.    Tan J, Chen H, Zhao L, Huang W. Platelet-Rich Plasma Versus Hyaluronic Acid in the Treatment of Knee Osteoarthritis: A Meta-analysis of 26 Randomized Controlled Trials. Arthroscopy. 2021 Jan;37(1):309-325

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