Disclosures: Vinny Francio, MD: Nothing to disclose.

Objective: To review the criteria and clinical guidelines for PRP injections for musculoskeletal knee pain.

Design: Narrative review of 44 peer-reviewed articles from 2009-2019.

Setting: N/A

Participants: N/A

Interventions: N/A

Main Outcome Measures: N/A

Results: PRP is recommended for refractory patellar tendinosis and mild to moderate symptomatic knee osteoarthritis (KOA) in patients under 50 years old who have failed conservative treatment, such as exercise, non-steroidal medications, and intra-articular corticosteroids (IACS). IACS can result in marginal, yet statistically significant pain reduction for KOA, with effects lasting up to 6 months. However, time and dose-dependent chondrotoxic effects of IACS may be worsened by the addition of local anesthetics. A 2016 review paper found that PRP injections of KOA resulted in significant clinical improvements up to 12 months post-injection. Outcomes and WOMAC (knee OA index) scores were significantly better after PRP versus hyaluronic acid injections at 3 and 12 months post-injection. A 2018 RCT comparing PRP and IACS for symptomatic KOA concluded that PRP is safe and effective up to 6 months and demonstrated favorable outcomes including WOMAC scores, pain scale, and overall functional performance. Conversely, IACS had a shorter response with lower scores at 2- and 6-month follow-ups.

Conclusions: Current indications for PRP are limited to mild to moderate symptomatic osteoarthritis (OA) and refractory patellar tendinosis. Although no major long-term or permanent complications have been reported, transient side effects such as post-injection swelling and pain, short duration nausea, and dizziness have been reported in up to 20% of recipients. PRP benefits have been shown to last from 6-12 months and include functional improvement and pain relief. However, prior to implementing this intervention as first-line therapy, further high quality RCTs are needed specifically addressing functional improvement, impact on delaying joint replacement, readiness availability of PRP to patients, insurance barriers, rehabilitation strategies, and the optimization of dosage, timing, and frequency.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/when-to-consider-intra-articular-platelet-rich-plasma-prp-injections-for-the-treatment-of-knee-pain-a-narrative-review/