10.2.9 - Autologous Conditioned Plasma® Injections Provide Overall Limited Benefit for the Treatment of Knee Osteoarthritis
- J. Korpershoek (Utrecht, NL)
- J. Korpershoek (Utrecht, NL)
- L. Vonk (Teltow, DE)
- G. Filardo (Bologna, IT)
- E. Kester (Utrecht, NL)
- N. Van Egmond (Leusden, NL)
- D. Saris (Rochester, US)
- R. Custers (Utrecht, NL)
Abstract
Purpose
Autologous Conditioned Plasma (ACP®) (Arthrex®) is a commercially available platelet concentrate with positive results in available literature. We investigated the improvement after three injections with ACP® in a tertiary referral centre. Moreover, we studied the influence of the composition of the injections and of different patient factors as predictors of patient reported outcome measures.
Methods and Materials
We prospectively documented 261 patients (308 knees) receiving ACP® treatment for knee osteoarthritis (Figure 1). The improvement up to 12 months’ follow-up was measured using the Knee injury and Osteoarthritis Outcome Score (KOOS). ACP® composition was analysed for 100 patients. We evaluated the predictive value of age, sex, history (meniscus injury, anterior cruciate ligament rupture, cartilage defect, tibial plateau fracture), Kellgren and Lawrence grade, body mass index, and composition of ACP® using generalized estimating equations.
Results
KOOS improved from 36.7±13.6 at baseline (n=273) to 43.6±17.5 at 3 months (n=268), 43.6±17.8 at 6 months (n=238) and 42.0±17.7 at 12 months (n=216) (all p<0.01). An improvement above the minimal clinically important difference (MCID) was reached in 41% of patients after 6 months. Composition of the ACP® was variable (Figure 2), but did not correlate with KOOS. Among the evaluated factors, younger and more active patients presented lower improvements, while older age led to a higher clinical benefit (B=0.2, p=0.03). The lack of history of traumatic knee injury (B=3.8, p=0.04) also predicted better outcomes. No other factor significantly predicted outcomes in this series.
Conclusion
Treatment with ACP® leads to a significant improvement in KOOS, but this improvement is lower than previously reported in literature and does not reach the MCID in the majority of patients. Middle-aged patients with non-traumatic knee osteoarthritis may present better outcomes. The composition of ACP® varies between patients and within the evaluated range it does not predict outcomes. Patient selection might improve the potential of platelet concentrates.