High Platelet Dose PRP May be the Nonoperative Treatment of Choice for Knee Osteoarthritis

Knee osteoarthritis (OA) affects 30% of individuals over 60 and 40% over 70 years old. The incidence of radiological knee OA is 373 per 10,000 person-years, but symptomatic knee OA registers as a considerably lower rate of 50 per 10,000 person-years. For symptomatic cases that are not candidates for surgical intervention, various treatment options include exercise, weight loss, pharmacological management, bracing, physical therapy, oral supplementation, and intra-articular injection with corticosteroids, hyaluronic acid, or orthobiologics such as platelet-rich plasma (PRP). Recent network meta-analysis has affirmed superiority of PRP over the other alternatives. It appears that a mean absolute platelet count in the final product of below 2500 x106 is not effective, whereas an average platelet count of above 5000 x106 displays a positive clinical effect at both six and twelve months. Yet, aspects like the definition of PRP, whether activation is necessary, the frequency of injections, the optimal dosage, and the preparation method remain unclear.