Published online May 18, 2024. doi: 10.5312/wjo.v15.i5.400
Revised: February 26, 2024
Accepted: April 8, 2024
Published online: May 18, 2024
Processing time: 148 Days and 21.3 Hours
Knees are the most commonly impacted weight-bearing joints in osteoarthritis (OA), affecting millions of people worldwide. With increasing life spans and obesity rates, the incidence of knee OA will further increase, leading to a sig
Core Tip: This editorial briefly defined various autologous peripheral blood-derived orthobiologics (APBO) being explored and assessed their current state of evidence based on the most recently published clinical study for the management of knee osteoarthritis (OA). The present literature demonstrates the potential of these APBOs in reducing pain and improving function in knee OA patients; thus, they can be utilized in patients who are refractory to conservative treatment modalities. Yet, more adequately powered clinical trials with longer follow-up and comparative studies are required to establish the long-term efficacy and determine the most optimal APBO for the management of knee OA, respectively.
- Citation: Gupta A, Jain VK. Autologous peripheral blood-derived orthobiologics: Different types and their effectiveness in managing knee osteoarthritis. World J Orthop 2024; 15(5): 400-403
- URL: https://www.wjgnet.com/2218-5836/full/v15/i5/400.htm
- DOI: https://dx.doi.org/10.5312/wjo.v15.i5.400
Osteoarthritis (OA) of the knee is conventionally managed using non-pharmacological methods, pharmacological agents, and surgery in later stages or when conservative options have failed[1]. These therapies have limitations, like con
Platelet-rich plasma (PRP) is the most commonly used orthobiologic, and still its efficacy remains debatable, which is attributed to patient variables, absence of standardized formulation protocol, etc[1,2]. In addition, there is limited lite
APBOs | Ref. | Description | Most recent clinical evidence |
PRP | Xiong et al[2] | PRP is derived from whole blood and is rich in platelets, can be LR or LP, is poor in erythrocytes, and can be activated using external activators | An up-to-date systematic review and meta-analysis examined 24 RCTs with 1344 patients and reported significant improvements in the VAS, KOOS, WOMAC, and IKDC scores in the PRP group compared to the controls (saline and/or HA) |
PL | Hosseini et al[3] | PL is derived from PRP and formulated via a double freeze/thaw cycle | A recent RCT involving 50 patients reported significant improvements in VAS, WOMAC, and ROM scores at the 6-mo follow-up in the PL group compared to the baseline and PRP group |
ACS | Raeissadat et al[4] | ACS is formulated by incubating whole blood with CrSO4-coated glass beads | A recent meta-analysis investigated eight clinical studies involving 439 patients with at least 3 mo of follow-up and reported significant improvements in VAS and WOMAC scores post-treatment with ACS compared to the baseline |
GOLDIC | Tulpule et al[5] | GOLDIC is a type of ACS and involves incubating whole blood with gold particles | A recent prospective study involving 65 patients (106 knees) reported significant improvements in VAS and WOMAC scores at the 12-mo follow-up in patients treated with serial injections of GOLDIC compared to the baseline |
PRGF | Ríos Luna et al[6] | PRGF is formulated by activating erythrocyte poor and LP-PRP with CaCl2 | A recent retrospective observational study involving 79 patients (85 knees) reported significant improvements in the KOOS score at the 11-mo follow-up post-administration of PRGF compared to the baseline |
GFC | Saraf et al[7] | GFC is an acellular formulation prepared by incubating whole blood with an external platelet activator | A recent RCT involving 58 participants reported significant improvements in VAS and WOMAC scores at the 12-mo follow-up in patients treated with serial injections of GFC compared to the control |
APS | Kuwasawa et al[8] | APS is derived from and formulated by exposing LR-PRP to polyacrylamide beads | A recent retrospective study assessed 148 knees and reported significant improvement in the KOOS score at the 12-mo follow-up post-injection of APS compared to the baseline |
PRF | Cheeva-Akrapan and Turajane[9] | PRF is derived from whole blood, formulated without the use of an anticoagulant, and consists of autologous platelets and a LR fibrin matrix | A recent prospective cohort study involving 368 participants reported that nearly 80% of patients had their surgery postponed over 3 yr following the administration of PRP supplemented with PRF, supporting its utility in treating osteoarthritis patients for long-term effects |
HS | Olmos Calvo et al[10] | HS is formulated by mechanically releasing, via pressing or centrifugation, growth factors and cytokines from the PRF clot | A recent clinical study involving 24 patients reported significant improvements in Lysholm-Tegner, VAS, and KOOS scores at the 6-mo follow-up in patients treated with serial injections of HS compared to the baseline |
ACP | Korpershoek et al[11] | ACP is a single-spin LP-PRP formulation | A recent real-world prospective case series involving 260 patients (307 knees) reported significant improvement in KOOS and NPRS at the 12-mo follow-up compared to the baseline after administration of 3 weekly intra-articular injections of ACP. Interestingly, despite a statistically significant outcome for the KOOS score, the MCID was not accomplished |
The most recent clinical studies described in Table 1 are not without shortcomings. They include variability in the formu
Provenance and peer review: Invited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Orthopedics
Country/Territory of origin: United States
Peer-review report’s classification
Scientific Quality: Grade B, Grade C, Grade E
Novelty: Grade B, Grade B, Grade D
Creativity or Innovation: Grade B, Grade D, Grade D
Scientific Significance: Grade B, Grade C, Grade D
P-Reviewer: Busso C, Italy; Vaishya R, India S-Editor: Li L L-Editor: Filipodia P-Editor: Zhao YQ
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