PRP and Articular Cartilage: A Clinical Update

Table 1

Studies concerning PRP application in cartilage surgery.

PRP and cartilage surgery
Authors	Year	Number of cases; (age and range in y)	Study	Level of evidence	Type of PRP	Procedure and observations	Clinical results
Sánchez et al. [42]	2003	1; (age 12)	Case report	IV	/	Arthroscopic reattachment of the loose chondral body and PRP injection between the crater and the fixed fragment.	Excellent functional outcome, rapid resumption of symptom-free athletic activity.
Haleem et al. [41]	2010	5; (age 21–37)	Case series	IV	L-PRP (?)	MSC seeded in a platelet rich fibrin glue; femoral condyle cartilage lesions (size 3–12 cm^2).	Improvement at 6 and 12 months postoperatively in Lysholm and Revised Hospital for Special Surgery Knee (RHSSK) scores.
Giannini et al. [63]	2010	25; (mean age )	Retrospective comparative study	III	P-PRF	Bone marrow concentrate and P-PRF either by mixing with a porcine collagen powder or by loading a esterified hyaluronic acid-derivative membrane; talar osteochondral lesions (mean size >1.5 cm^2).	Improvement in AOFAS score from preoperatively to 12 months and from 12 to 36 months.
Dhollander et al. [53]	2011	5; (age 24–45)	Case series	IV	L-PRP	PRP gel inserted beneath a collagen I/III membrane after the microfracture procedure; patellar focal cartilage lesions (size 1–3 cm^2).	Improvement in VAS, KOOS and Kujala patellofemoral score at 1 and 2 years; no difference in Tegner activity scale during the 24-month follow-up.
Lee et al. [44]	2013	24; (age 40–50)	Randomized, prospectively designed study	II	L-PRP	PRP injection at the end of the microfracture procedure for femoral condyle cartilage defects up to 4 cm^2 of size.	Better improvements in VAS and IKDC scores compared to control group at 2 years postop.
Guney et al. [46]	2013	19; (age 18–63)	Randomized, prospectively designed study	II	L-PRP	PRP injection 6–24 h after the microfracture procedure for talar osteochondral lesion (diameter less than 20 mm).	Better improvements in VAS, AOFAS, FAAM overall pain domain, and FAAM 15-min walking domain at 16 months compared to control group.
Manunta and Manconi [45]	2013	10; (age 30–55)	Randomized clinical study	II	L-PRP	3 PRP injections (1 week after surgery, then at an interval of 1 month); medial femoral condyle cartilage defects (Outerbridge II and III).	Better improvement at 6 and 12 months in IKDC score compared to control group.
Giannini et al. [62, 64]	2009, 2013	49; (mean age )	Case series	IV	P-PRF	Bone marrow concentrate and P-PRF either by mixing with a porcine collagen powder or by loading a esterified hyaluronic acid-derivative membrane; talar osteochondral lesions (mean size 2 cm^2).	Improvement in AOFAS score from preoperatively to 24 months, slight decrease at 36 and 48 months; inverse relationship at 24 months between the area of the lesion (< or >2 cm^2) and the AOFAS score and at 48 months between the time from trauma to surgery and the AOFAS score.
Buda et al. [65, 66]	2010, 2013	20; (age 15–50)	Case series	IV	P-PRF	Hyaluronic acid membrane filled with bone-marrow concentrate; a layer of P-PRF applied onto the implanted material; femoral condyle lesions ICRS III and IV.	Improvement at 29 months postoperatively in IKDC and KOOS scores.
Siclari et al. [54, 55]	2012, 2014	52; (age 31–65)	Case series	IV	P-PRP	PGA-HA scaffolds soaked by PRP to cover the defect site previously treated by microfracture procedure; femoral and tibial condyle cartilage lesions (size 1.5–5 cm^2).	Improvement at 12 and 24 months postoperatively in KOOS scores.

y = years; PRP = Platelet-Rich Plasma; MSC = Mesenchymal Stem Cells; P-PRP = Pure PRP, with a low content of leukocyte; L-PRP = Leukocyte rich PRP; P-PRF = Pure Platelet-Rich Fibrin.