Intraosseous Infiltration of Platelet-Rich Plasma for Knee Osteoarthritis
Abstract
A review of a novel biologic approach targeting the subchondral bone (Subchondroplasty) with PRP. Results suggest that combining Intraosseous (IO) and Intra-articular (IA) PRP offers superior pain relief compared to standard injections.
Targeting the Subchondral Root
Key Finding
"Combined Intraosseous + Intra-articular PRP significantly outperformed standard Intra-articular injections alone, showing superior improvement in WOMAC and VAS pain scores (p < 0.05)."
Background: Knee Osteoarthritis (OA) is a disease of the entire organ, not just the cartilage. Subchondral bone marrow lesions (BMLs) are a primary driver of pain and progression. Traditional intra-articular injections fail to penetrate the subchondral plate, leaving the root of the pain untreated. Intraosseous (IO) infiltration aims to biologically modify this underlying bone pathology.
Methods: A systematic review of 5 studies encompassing 112 knees treated with IO PRP. The protocol typically involved fluoroscopically guided injection of PRP directly into the subchondral bone marrow of the distal femur and proximal tibia, often concurrent with standard joint injections. Efficacy was measured via KOOS, WOMAC, and VAS scores against controls receiving HA or IA-PRP alone.
Results: The Hybrid approach (IO + IA PRP) demonstrated varying degrees of superiority over single-modality therapy. Patients reported faster pain relief and better functional scores at 6 and 12 months. The procedure had a benign safety profile, with transient injection site pain being the only notable complication. No cases of osteonecrosis or infection were reported.
Conclusion: Treating the bone-cartilage unit is the future of biologic OA management. For patients with active subchondral edema (BMLs) on MRI, simple joint injections are insufficient. Intraosseous PRP infiltration represents a safe, viable escalation of therapy to delay arthroplasty.