Clinical Question

Are platelet-rich plasma injections effective for alleviating pain and improving function in adults with symptomatic ankle osteoarthritis?

Bottom Line

This study found no evidence that supports a benefit of platelet-rich plasma injections compared with saline placebo injections for improving function or reducing pain in adults with symptomatic ankle osteoarthritis. (Level of Evidence = 1b)

Synopsis

There have been no published randomized trials evaluating the effectiveness of platelet-rich plasma injections for ankle osteoarthritis. The investigators identified 100 adults, 18 years or older, who presented to orthopedic and sports medicine outpatient clinics with a score of at least 40 for ankle pain severity on a visual analog scale (range = 0 to 100, where 100 is the most severe pain) and definitive radiographic evidence of tibiotalar osteoarthritis. Patients randomly received (concealed allocation assignment) two ultrasound-guided intra-articular injections of platelet-rich plasma six weeks apart (leukocyte poor; prepared with a widely used standard system) or matched saline as placebo. The patients also received lifestyle and exercise counseling. The individuals who assessed outcomes using a standard validated scoring tool for ankle osteoarthritis remained masked to treatment group assignment. Complete follow-up occurred for 100% of patients at 26 weeks. Using intention-to-treat analysis, mean improvement scores were similar in the platelet-rich plasma and placebo groups (10 vs. 11 points, respectively, on the American Orthopaedic Foot and Ankle Society scale of 0 to 100, where higher scores indicate improved function and reduced pain). No significant differences between groups occurred in any of the multiple secondary outcomes reported.

Study design: Randomized controlled trial (double-blinded)

Funding source: Foundation

Allocation: Concealed

Setting: Outpatient (specialty)

Reference: Paget LDA, Reurink G, de Vos RJ, et al. PRIMA Study GroupEffect 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):1595–1605.