Researchers comment on PRP for knee osteoarthritis

Article summary:
Researchers suggest that Platelet Rich Plasma Injections (PRP) are an effective treatment for patients with knee osteoarthritis. The treatments are considered safe, economical and more importantly provide good and long-lasting symptomatic relief to patients with knee pain.

Much of the research surrounding Platelet Rich Plasma Therapy treatments for knee osteoarthritis is considered preliminary or sometimes “controversial,” because the treatment itself is considered somewhat controversial. Surgeons and practitioners know how difficult it can be to choose a treatment for cartilage injuries such as osteochondral fractures, avascular necrosis, osteochondritis and degenerative processes like osteoarthritis and rheumatisms.

All mentioned have a common problem: The inability to heal and regenerate cartilage. 1

However, as research continues to come in, the positive effects of platelet rich plasma injection for improved function, pain and quality of life in patients with osteoarthritis of the knee has been shown. 2

Regenerative medicine is the science that studies the regeneration of tissues such as knee cartilage through use of growth factors such as PRP, or the platelet-rich plasma, obtained from a withdrawal of the patient’s blood and concentrating the platelets for injection.

The importance of an experienced PRP physician, one with extensive clinical experience in treating patients with injection therapies, can make the difference between PRP treatments working or not working. Some believe PRP is a one time injection. This is not always the case.  A new study says that PRP was more effective after three treatments than a single treatment of PRP or a single treatment of  hyaluronic acid.3

At the Magaziner Center for Wellness We take a holistic view of the body, even from an orthopaedic standpoint. We believe it is crucial to obtain recovery from an injury or to cure chronic pain; PRP cannot be given just into that injured joint. We need to look at joints above and below the injury, and make sure they are stable. If these areas are left unstable, and not treated with PRP, then the original injury has a greater chance to recur.

We believe that PRP must correct both the injury and the mechanics of the body. For example, if you are suffering from knee pain, and only treat the knee, but fail to realize that the foot and ankle are unstable, then eventually the knee will become re-injured!

PRP treatment showed positive effects in patients with knee osteoarthritis in multi-studies

Here is a recent study where the patients received two injections of PRP as the “complete treatment.” Even in this limited treatment positive results were recorded.

Researchers in Italy looked at active lifestyle patients with cartilage lesions and evaluated the effectiveness of PRP injections.

Of the 50 patients studied, 25 had a previous surgery for cartilage repair. The other 25 had no surgical history.

Conclusions: “The PRP treatment showed positive effects in patients with knee osteoarthritis. Operated and nonoperated patients showed significant improvement by means of diminishing pain and improved symptoms and quality of life.

Clinical Relevance: There are only a few studies of PRP treatment for cartilage on osteoarthritic knees. Different PRP products might be more or less appropriate to treat different types of tissues and pathologies. The clinical efficacy of PRP remains under debate, and a standardized protocol has not yet been established.”4

In a December 2015 published paper, investigators released their findings on the “PRP Knee protocol”

Here are their observations:

  • The effectiveness of a single injection was found to be significantly lower than that of two or three injections.
  • In a study administering a single injection of PRP, a longer sustained period of pain relief was observed in milder cases of osteoarthritis
  • As joint degeneration increases, factors such as decrease of viable cells, muscle function deficiency, joint instability due to increased ligament laxity, decrease in anabolic response to growth factors, loss of chondrocyte and thinning of cartilage plate may diminish the effectiveness. (This is why the holistic view of treatment should be favored as a treatment program.)
  • One study showed that PRP administered three times at weekly intervals to patients with grade 3 and 4 knee OA reported improvements in their quality of life, and reduced levels of pain, and had increased cartilage thickness as measured by ultrasonography at the 6-month follow up.

In the studies conducted so far, the lack of standardization of PRP dosing regimens makes it difficult to compare outcomes of studies for the evaluation of clinical effectiveness. Considering the evidence, this minimally invasive injection procedure appears to be safe and effective, and since PRP injections biologically change the articular cartilage, they may be a worthwhile treatment option even in moderate knee osteoarthritis.

In conclusion, PRP is an effective and reliable treatment for functional status and pain for Grade 3 osteoarthritis, and a minimum of two injections appears to be appropriate.5

What all this research shows is that for the best chance for PRP to work for your knee pain, you need a doctor experienced in offering the treatment. PRP injection is not cortisone, it is a growth and repair mechanism and as such requires observation after treatment, adjustments after treatment, supportive treatments to treat the whole. A single injection of PRP will offer lead to non-conclusive results – people in pain need a “conclusion.”

At the Magaziner Center for Wellness we use protocols established based on empirical observation and science combined with  clinical experience with our patients.

•Both Dr. Scott Greenberg and Dr. Allan Magaziner are skilled in providing PRP and prolotherapy treatments. Dr. Greenberg performs, on average, 4,000 procedures every year and has treated some high profile athletes.

Do you have questions about PRP for knee osteoarthritis?

Call US  856-424-8222 OR email us at:

1. Torrero JI, Aroles F, Ferrer D. Treatment of knee chondropathy with platelet rich plasma. Preliminary results at 6 months of follow-up with only one injection. J Biol Regul Homeost Agents. 2012 Apr-Jun;26(2 Suppl 1):71S-78S.

2. Rayegani SM, et al Does intra articular platelet rich plasma injection improve function, pain and quality of life in patients with osteoarthritis of the knee? A randomized clinical trial. Orthop Rev (Pavia). 2014 Sep 18;6(3):5405. doi: 10.4081/or.2014.5405. eCollection 2014.

3. Görmeli G, et al.. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc. 2015 Aug 2. [Epub ahead of print]

4. Gobbi A, Karnatzikos G, Mahajan V, Malchira S. Platelet-rich plasma treatment in symptomatic patients with knee osteoarthritis: preliminary results in a group of active patients. Sports Health. 2012 Mar;4(2):162-72.

5. Kavadar G, Demircioglu DT, Celik MY, Emre TY. Effectiveness of platelet-rich plasma in the treatment of moderate knee osteoarthritis: a randomized prospective study. J Phys Ther Sci. 2015 Dec;27(12):3863-7. doi: 10.1589/jpts.27.3863. Epub 2015 Dec 28.