SLR - August 2022 - Nikhil Boga, DPM
Reference: Paget LDA, Reurink G, de Vos R, et al. Effect of Platelet-Rich Plasma Injections vs Placebo on Ankle Symptoms and Function in Patients with Ankle Osteoarthritis: A Randomized Clinical Trial. JAMA. 2021;326(16):1595–1605Level of Evidence: I
Scientific Literature Review
Reviewed by: Nikhil Boga, DPM
Residency Program: DVA Puget Sound Healthcare System
Podiatric Relevance: Platelet Rich Plasma (PRP) was first described in the 1980’s as plasma with a platelet count above what is normally found in blood. It has been used for several foot and ankle pathologies including plantar fasciitis, ankle sprains, wound healing and tendinopathies. Ankle osteoarthritis is difficult to manage conservatively and ultimately leads to surgical repair such as total ankle replacement or ankle arthrodesis. PRP injections for knee osteoarthritis have been proven to show some benefit and may provide some benefit for patients with ankle osteoarthritis.
Methods: A multi-center, bloc-randomized, double-blinded, placebo-controlled clinical trial performed at 6 sites in the Netherlands included 100 patients with pain greater than 40 on VAS (range 0-100) and tibiotalar joint space narrowing. Patients were randomly assigned to receive two ultrasonography-guided intra-articular injections of PRP (n =48) or placebo (saline; n = 52). Patients were primarily evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score (ranges 0-100 with higher numbers indicating less pain and better function; minimal significant difference, 12 points) over 26 weeks.
Results: Compared to the baseline values, the mean AOFAS score improved by 10 points in PRP group (63 to 73 points, p < 0.001) and 11 points in placebo group (from 64 to 75 points, p < 0.001). In a post-hoc sensitivity analysis, there is no sensitivity between-group difference of PRP vs placebo for AOFAS change over 26 weeks. No statistical significance between group differences were found amongst the 100 randomized patients .
Conclusions: Intra-articular injection of platelet-rich plasma injection, compared with placebo injections did not have a significant difference in improving AOFAS scores. With previous meta-analysis of PRP and placebo in knee osteoarthritis, a clinically significant improvement in pain and functionality was demonstrated. However, in this particular study, that was not reproduced for ankle osteoarthritis . A larger sample size, as well as an in-depth analysis of the composition of the PRP could provide further clarity on optimizing the use of PRP for ankle osteoarthritis.