Precision Assessment of Platelet Rich Plasma for Joint Preservation

Completed

Brief Summary: Knee Osteoarthritis (OA) is a leading cause of premature disability in Veterans who develop knee OA at higher rates and younger ages than the population in general. For those with symptomatic early knee OA, who are years to decades away from meeting clinical indications for knee replacement surgery, knee injections have been a key treatment option. In recent years, platelet rich plasma (PRP) injections have gained increasing attention for improving pain and function in patients with knee OA. Basic science studies also suggest that PRP may also potentially stimulate repair responses to articular cartilage. However, the mechanisms of action of PRP in the treatment of knee OA are unknown. Because autologous blood is used, the PRP composition differs between patients. It is also unknown whether these differences in PRP composition affect clinical outcomes. This study will address these gaps and provide critical new and objective information on PRP treatment effects in Veterans and additional women with early knee OA important to improving clinical use of this new treatment.

Detailed Description: Because very little is known about either the mechanisms of action or objective clinical outcomes of PRP treatment for knee OA, the investigators propose a prospective "pre-post" study that will permit us to identify areas where more rigorous clinical outcomes and mechanistic research may be warranted. The proposed work includes special elements of: (1) quantitative metrics to assess clinical outcomes, (2) correlation of candidate beneficial proteins with clinical outcomes, and (3) proteomic evaluation of the injected PRP. This work will use an innovative multi-disciplinary, personalized approach to evaluate the effects of PRP composition on both function, as assessed by patient-reported outcomes and gait analysis, and cartilage matrix structure as assessed by quantitative MRI

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

inflammatory arthritis, gout or recurrent pseudogout
symptomatic OA of other lower extremity joints
BMI >35 kg/m2
use of walking, orthopedic, or prosthetic assistive device
severe systemic disease defined as American Society of Anesthesiologists (ASA) 3 or above56
inability to have MRI
pregnant or intending to become pregnant during the study
predominantly patellofemoral disease

Primary Outcome Measures

Name	Time	Method
Change from baseline WOMAC Pain Score	6 months	Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score is determined through patient reported outcomes using a standardized questionnaire to evaluate the condition of osteoarthritis of the knee. The WOMAC Pain scale consists of 5 questions, with each response valued on an ordinal scale of 0-4, and with at total score of 20. Higher numbers indicate more symptoms and physical disabilities.
Change from baseline Walking Speed	6 months	Walking speed has been linked to pain and function in patients with osteoarthritis.
Change from baseline Knee Flexion Moment	6 months	Knee Flexion Moment is a physiological parameter calculated via gait analysis. The knee flexion moment is the moment needed to bend the knee while in the stance phase of walking. The knee flexion moment has been linked to pain and function in patients with osteoarthritis.
Change from baseline T2	6 months	Quantitative MRI mapping
Change from baseline WOMAC Function Score	6 months	Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score is determined through patient reported outcomes using a standardized questionnaire to evaluate the condition of osteoarthritis of the knee. The WOMAC Function scale consists of 17 questions, with each response valued on an ordinal scale of 0-4, and with at total score of 68. Higher numbers indicate more symptoms and physical disabilities.

Secondary Outcome Measures

Name	Time	Method
Change from baseline MOAKS	6 months	The MRI Osteoarthritis Knee Score (MOAKS) score is a semi-quantitative whole joint morphologic assessment of knee joint tissues in 14 subregions. Assessments are based on presence of Bone Marrow Lesions within the subregional volume (scale of 0-3, where none=0 and \>66%=3), articular cartilage loss (scale of 0-3, where none=0 and \>75%=3), presence of osteophytes in 12 of the 14 regions (scale of 0-3, where none=0 and large=3), Hoffa's synovitis and synovitis-effusion (scale of 0-3, where normal=0 and capsular distention=3), meniscus extrusion grading (scale of 0-3, where \<2mm=0and \>5mm=3), meniscus morphologic features present (Y/N; signal, tear, maceration, cyst, hypertrophy): ligaments and tendons (scale of 0-1, where normal=0 and complete tear/abnormality=1), and periarticular features = present or not (Hunter et al, 2011 Osteoarthritis Cartilage, 19:990-1002).

Locations (1): VA Palo Alto Health Care System, Palo Alto, CA
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Palo Alto, California, United States