PRP Combined With Microfracture Technique Improves Outcome for Knee Cartilage Injury: New Study Review

Arthroscopic microfracture technique has become the gold standard for treating articular cartilage injuries. However, its shortcomings have led researchers to evaluate the potential of combining this technique with an adjuvant therapy.

A recent clinical study evaluated the efficacy of platelet-rich plasma (PRP) injection combined with arthroscopic microfracture technique in 79 patients with knee articular cartilage injuries. The results showed a significant advantage of the combination therapy over the microfracture technique alone in all outcome measures.

The Challenges of Knee Cartilage Injuries

Surgeons have used the microfracture technique to repair cartilage in patients since the 1980s.

The technique involves drilling small holes through the subchondral plate, encouraging the release of mesenchymal stem cells (MSCs) of the spongy bone. Once released, the MSCs flow with the blood to the surface, where it forms a patch of fibrocartilage to cover the area of bare bone. In essence, fibrocartilage can be thought of as a scar cartilage.

Arthroscopic microfracture technique has many advantages, including:

• Minimal trauma for the patient
• Low technical requirements
• Low surgical costs
• High surgical safety
• Rapid postoperative recovery

However, the qualifications for the procedure are relatively stringent. The patient must have:

• An International Cartilage Repair Society (ICRS) score of 3
• Age < 50 years
• Cartilage defect size < 4 cm2
• No bone loss
• No high demand for exercise

As a result, not all patients qualify for the procedure.

Also, arthroscopic microfracture technique is unable to generate the original hyaline cartilage, resulting in a gradual deterioration of the cartilage within 18 to 36 months . The cartilage also cannot bear weight for a long period of time after surgery. Elderly patients are also at risk of spontaneous osteonecrosis.

To improve the long-term efficacy and safety of arthroscopic microfracture technique in the treatment of knee cartilage injuries, researchers have proposed combining the technique with a drug treatment.

Clinical Study Shows Advantage of Adding PRP to Knee Cartilage Injury Treatment

Previous studies have evaluated the efficacy of the arthroscopic microfracture technique and PRP treatment alone on knee cartilage injuries.

In the present study seventy-nine patients with knee cartilage injuries were randomized into either the control group (39 patients) or the observation group (40 patients). The control group only received the surgical treatment, while the observation group also received the PRP injection at the time of surgery.

All patients were evaluated for the following outcome measures:

• Pain level, using the Visual Analogue Scale (VAS) score
• Knee joint range of motion
• Knee symptoms, evaluated by the International Knee Documentation Committee (IKDC) questionnaire
• Motor function, rated by the postoperative Tegner Knee Motor Function Rating Scale score
• Knee function, assessed by the Lysholm Knee Scale score
• Complications

Both groups showed improvements in all clinical outcomes. But the observation group had significantly greater improvements than the control group did for all outcome measures .

Some of the improvements were immediately noticeable. The VAS scores for the observation group were lower than those of the control group at all time points. The differences in VAS scores indicate that PRP can help control pain quickly and provide a high degree of pain relief .

Previous studies have indicated that activated platelets and growth factors in PRP promote healing of injuries, resulting in improved knee mobility and function. The results of this study confirmed those findings.

The knee flexion, hyperextension, and rotation angles in the observation group were all greater than those in the control group 1 month following the surgery . The IKDC, Tegner, and Lysholm scores were also all lower in the observation group at 1, 2, and 3 months following the surgery.

Notably, the complication rate was also lower in the observation group (10%) than in the control group (28.21%), indicating that the addition of PRP can:

• Improve the safety of surgical treatment
• Reduce treatment-related complications
• Enhance the quality of repair

These results suggest that PRP enhances the benefits of the microfracture technique , to the point where some patients may achieve a faster, better recovery and near normal level of knee function .

A Safe, Effective Addition to Knee Cartilage Injury Treatment

This study shows that the combination of arthroscopic microfracture technique and PRP injection is more effective in treating knee cartilage injuries than the surgery alone.

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