Efficacy of Autologous Conditioned Serum (ACS), Platelet-Rich Plasma (PRP), Hyaluronic Acid (HA) and Steroid for Early O
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ORIGINAL ARTICLE
Efficacy of Autologous Conditioned Serum (ACS), Platelet‑Rich Plasma (PRP), Hyaluronic Acid (HA) and Steroid for Early Osteoarthritis Knee: A Comparative Analysis Ankit Khurana1 · Ashish Goyal1 · P. Kirubakaran2 · Gaurav Akhand1 · Rishi Gupta3 · Navneet Goel1 Received: 20 July 2020 / Accepted: 25 September 2020 © Indian Orthopaedics Association 2020
Abstract Background Intra-articular injection therapy constituting corticosteroids, viscosupplements and blood-derived products are considered to have a key role in non-operative management of osteoarthritis knee. While corticosteroids and viscosupplements have proven short-term efficacy in early osteoarthritis; orthobiologics are gaining increased attention in osteoarthritis management. The aim of present study was thus to compare two commonly used biologics (platelet-rich plasma/PRP and autologous conditioned serum/ACS) to each other and to established therapies. Methods After required institutional clearances, all patients presenting with early primary osteoarthritis knee who had failed initial conservative management and received only unilateral knee injection were included. Patients in the PRP group were compared to the other groups (comprising the HA/hyaluronic acid group, steroid group, and a matched cohort who had been administered ACS for the same indication earlier). Clinical outcome was evaluated using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire and Visual Analogue scale (VAS) pre-injection and at 6 months. Results ACS and PRP did not have any significant difference in terms of either WOMAC score (p = 0.154) or VAS score at 6 months (p = 0.850). The scores for both these orthobiologics were better than the control groups (HA group and Steroid group). Between the two control groups, HA group had better VAS scores as compared to the Steroid group (p = 0.008). Conclusion The clinical outcomes following intra-articular injection of ACS and PRP are better than controls (HA and steroid), but a difference between the two orthobiologics could not be demonstrated. Level of Evidence 3b. Keywords Autologous conditioned serum (ACS) · Platelet-rich plasma (PRP) · Osteoarthritis knee · Intra-articular injections · Hyaluronan
Introduction Various conservative treatment modalities are recommended as first line in osteoarthritis management. However, if these are ineffective, then intra-articular (IA) injections (corticosteroids, viscosupplements, blood-derived products) are considered as second line in non-operative management * Ankit Khurana [email protected] 1
Department of Orthopaedics, Dr. BSA Medical College and Hospital, Rohini Sector 6, Delhi 110009, India
2
Department of Orthopaedics, Evangelisches Krakenhaus, HansSachsGasse, Vienna, Austria
3
Department of Biostatitics, Manokalp Clinic, Delhi, India
of osteoarthritis. Viscosupplementation has found its own special niche in management of early osteoarthritis based on potentially therapeutic physicochemical properties. Use of viscosupp
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