Comparative Efficacy of Leukocyte-Poor Platelet-Rich Plasma, Leukocyte-Rich Platelet-Rich Plasma, Injectable Platelet-Rich Fibrin, and Corticosteroid Injections in Kellgren–Lawrence Grade 2–3 Knee Osteoarthritis: A Prospective Comparative Study

Abstract

Abstract Introduction: The use of biologic and pharmacologic intra-articular injections for knee osteoarthritis (OA) is common for symptomatic OA, but the long-term efficacy of platelet-based therapies compared with corticosteroid injections is still controversial. Leukocyte-poor platelet-rich plasma (LP-PRP), leukocyte-rich platelet-rich plasma (LR-PRP), injectable platelet-rich fibrin (iPRF), and intra-articular corticosteroids were not different in their clinical efficacy in treating knee OA with Kellgren–Lawrence (KL) Grade 2–3. Materials and Methods: A prospective, single-center, parallel-group, comparative study with 100 patients with knee OA (Grade 2–3) who were randomly divided into 4 groups of 25 patients and received a single intra-articular injection of either LP-PRP, LR-PRP, iPRF, or corticosteroid. At baseline and 1, 3, 6, and 12 months, Visual Analog Scale (VAS) and Western Ontario and McMaster Universities OA Index (WOMAC) scores were obtained. Groups 1–4 had 2, 3, 1, and 4 losses to follow-up, respectively. Results: VAS and WOMAC scores were significantly improved in all groups at 1 month. The initial relief was the most rapid with corticosteroid, but this effect reduced within 3 months and reverted to baseline at 12 months. The treatment effect of LP-PRP and LR-PRP was similar and was seen to last up to 12 months. iPRF showed the lowest improvement time, but the highest and longest sustained relief from pain at 6 and 12 months, with 56% VAS and 58% WOMAC reductions from baseline at 12 months. Conclusion: In KL Grade 2–3 knee OA, platelet-based biologics, particularly iPRF, were associated with a more sustained clinical benefit than corticosteroids over 12 months, although this single-center study without a placebo control and with modest per-group sample sizes cannot establish a disease-modifying effect.