Comparative Efficacy of Leukocyte-Poor Platelet-Rich Plasma, Leukocyte-Rich Platelet-Rich Plasma, Injectable Platelet-Rich Fibrin, and Corticosteroid Injections in Kellgren-Lawrence Grade 2-3 Knee Osteoarthritis: A Prospective Comparative Study.

Abstract

Introduction: The use of biologic and pharmacologic intra-articular injections for knee osteoarthritis (OA) is common for symptomatic OA, but the long-term efficacy of platelet-based therapies compared with corticosteroid injections is still controversial. Leukocyte-poor platelet-rich plasma (LP-PRP), leukocyte-rich platelet-rich plasma (LR-PRP), injectable platelet-rich fibrin (iPRF), and intra-articular corticosteroids were not different in their clinical efficacy in treating knee OA with Kellgren-Lawrence (KL) Grade 2-3.

Materials and methods: A prospective, single-center, parallel-group, comparative study with 100 patients with knee OA (Grade 2-3) who were randomly divided into 4 groups of 25 patients and received a single intra-articular injection of either LP-PRP, LR-PRP, iPRF, or corticosteroid. At baseline and 1, 3, 6, and 12 months, Visual Analog Scale (VAS) and Western Ontario and McMaster Universities OA Index (WOMAC) scores were obtained. Groups 1-4 had 2, 3, 1, and 4 losses to follow-up, respectively.

Results: VAS and WOMAC scores were significantly improved in all groups at 1 month. The initial relief was the most rapid with corticosteroid, but this effect reduced within 3 months and reverted to baseline at 12 months. The treatment effect of LP-PRP and LR-PRP was similar and was seen to last up to 12 months. iPRF showed the lowest improvement time, but the highest and longest sustained relief from pain at 6 and 12 months, with 56% VAS and 58% WOMAC reductions from baseline at 12 months.

Conclusion: In KL Grade 2-3 knee OA, platelet-based biologics, particularly iPRF, were associated with a more sustained clinical benefit than corticosteroids over 12 months, although this single-center study without a placebo control and with modest per-group sample sizes cannot establish a disease-modifying effect.