Effect of platelet-rich plasma combined with chitosan in the treatment of knee osteoarthritis and its mechanism

Objective To analyze the effect of platelet-rich plasma (PRP) combined with chitosan in the treatment of knee osteoarthritis (KOA) and its impacts on osteoblast, osteoclast and inflammatory factors.

Methods A total of 94 patients with KOA were selected as study objects, and were divided into control group and observation group according to random number table method, with 47 cases in each group. The patients in both groups were treated with arthroscopic debridement. The control group was given chitosan treatment after operation, and the observation group was given intra-articular injection of PRP combined with chitosan treatment after operation. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm knee joint function score, knee osteoarthritis severity index (ISOA) score and osteoblast and osteoclast related indexesprocollagen type Ⅰ carboxy-terminal peptide (PⅠCP), osteocalcin (BGP), bone alkaline phosphatase (BALP), collagen type Ⅰ cross-linked carboxy-terminal peptide (CTX), and tartrate-resistant acid phosphatase (TRACP5b)levels and inflammatory markerstumor necrosis factor-α (TNF-α), interleukin-1β(IL-1β), and high-sensitivity C-reactive protein (hs-CRP)of the two groups before and after treatment were recorded and compared.

Results The total effective rate in the observation group was higher than that in the control group 95.74% (45/47) versus 80.85% (38/47), P < 0.05. The total weight-bearing activity time in the observation group was earilier than that in the control group (P < 0.05). After six weeks of treatment, the each item score of WOMAC Scale (pain, joint stiffness, physical function) and ISOA score of the observation group were lower than those of the control group, and the Lysholm knee joint function scores were higher than those of the control group (P < 0.05). After 6 weeks of treatment, the levels of PⅠCP, BGP and BALP in the observation group were higher than those in the control group, while the levels of CTX, TRACP5b, TNF-α, IL-1β and hs-CRP in the observation group were lower than those in control group (P < 0.05).

Conclusion PRP combined with chitosan can effectively reduce the level of osteoclasts in KOA patients, promote the recovery of osteoblasts, restore the osteogenic and osteoclast balance, inhibit inflammation, and improve clinical efficacy.