Abstract
Objective:To observe the clinical efficacy and safety of arthroscopic debridement and drilling decompression combined with intra-articular injection of platelet-rich plasma(PRP)in treatment of early-stage knee osteoarthritis(KOA).Methods:Seventy-four patients with early-stage KOA(Kellgren-Lawrence graded Ⅰ-Ⅱ)recruited from January 2023 to January 2024 were randomized into combination group and arthroscopy group,with 37 ones in each group.All patients in the 2 groups were treated with arthroscopic debridement and drilling decompression,moreover,the ones in combination group were further treated with intra-articular injection of PRP at the end of the arthro-scopic procedure and at postoperative week 2 and 4,respectively.The outcome measures including knee pain visual analogue scale(VAS)score and Lysholm knee score were assessed before the treatment,at 1,6,and 12-month post-treatment,respectively,and the knee cartilage damage was evaluated by MRI before the treatment and at 12-month post-treatment,respectively.Furthermore,the complications were observed and recorded throughout the treatment and follow-up periods in the 2 groups.Results:①General information.One patient was lost to follow-up in combination group,while,2 ones were lost to follow-up,and 1 withdrew from the trial in arthroscopy group.②Knee pain VAS score.The knee pain VAS score presented a decreasing trajectory over time in the 2 groups(F=288.267,P=0.000;F=148.047,P=0.000).In addition,the knee pain VAS score was not significantly different between the 2 groups before the treatment and at 1-month post-treatment,respectively,while,at 6 and 12-month post-treatment,it was lower in combination group compared to arthroscopy group(t=3.266,P=0.002;t=3.849,P=0.000).③Lysholm pain and stair-climbing subscores.The Lysholm pain and stair-climbing subscores presented an increasing trajectory over time in the 2 groups(pain subscore:F=76.645,P=0.000;F=39.235,P=0.000;stair-climbing subscore:F=38.059,P=0.000;F=16.262,P=0.000).In addition,the Lysholm pain and stair-climbing subscores were not significantly different between the 2 groups before the treatment and at 1-month post-treatment,respectively,while,at 6 and 12-month post-treatment,the both were higher in combination group compared to arthroscopy group(pain subscore:t=0.010,P=0.030;t=3.366,P=0.010;stair-climbing subscore:t=2.164,P=0.034;t=3.289,P=0.002).④Lysholm swelling subscore.The Lysholm swelling subscore presented an increasing trajectory over time in the 2 groups(F=15.174,P=0.000;F=6.075,P=0.001).In addition,the Lysholm swelling subscore was not significantly different between the 2 groups before the treatment,at 1 and 6-month post-treatment,respectively,while,at 12-month post-treatment,it was higher in combination group compared to arthroscopy group(t=2.740,P=0.008).⑤Lysholm locking and instability subscores.The Lysholm locking and instability subscores presented an increasing trajectory over time in the 2 groups in general(F=130.344,P=0.000;F=523.814,P=0.000),and they were higher in combination group compared to arthroscopy group(F=5.125,P=0.024;F=10.910,P=0.001).⑥Lysholm subscores for limping,squatting,and supporting.The Lysholm subscore for limping showed a biphasic trajectory of initial increase followed by a slight decrease,whereas the Lysholm subscores for squatting and supporting exhibited an increaseing trend over time in the 2 groups in general(F=22.127,P=0.000;F=29.375,P=0.000;F=37.650,P=0.000).However,these three subscores were not significantly different between the 2 groups in general.⑦Knee cartilage damage.At 12-month post-treatment,the knee cartilage damage was improved in 26 patients in combination group and 15 ones in arthroscopy group,with no patients experienced worsened cartilage damage in the 2 groups.The improvement rate of cartilage damage was higher in combination group compared to arthros-copy group(x2=5.692,P=0.017).⑧Complications.No patients experienced neurovascular injuries or infections in the 2 goups.Conclusion:Arthroscopic debridement and drilling decompression combined with intra-articular injection of PRP can effectively alleviate knee pain,improve knee function,and promote the repair of damaged cartilage in patients with early-stage KOA.Its therapeutic efficacy is superior to that of arthroscopic debridement and drilling decompression alone,and it demonstrates a high safety profile.关键词
骨关节炎,膝/富含血小板血浆/注射,关节内/关节镜检查/软骨,关节/随机对照试验专题Key words
osteoarthritis,knee/platelet-rich plasma/injections,intra-articular/arthroscopy/cartilage,articular/randomized controlled trials as topic
