Is platelet-rich plasma (PRP) therapy effective for treating Osgood-Schlatter disease?

Platelet-Rich Plasma (PRP) for Osgood-Schlatter Disease

PRP therapy is a potentially effective treatment for Osgood-Schlatter disease, particularly in the acute phase of the condition, though it lacks strong guideline support and should be considered after traditional conservative measures have failed.

Understanding Osgood-Schlatter Disease

• Osgood-Schlatter disease (OSD) is a painful, growth-related overuse condition affecting the tibial tuberosity, causing inflammation of the patellar ligament where it attaches to the tibial tuberosity 1
• It primarily affects physically active adolescents and usually resolves with skeletal maturity 2
• The condition causes significant physical activity restrictions in affected individuals 3

Current Treatment Approaches

First-Line Conservative Treatment

• Traditional conservative management is the standard first-line approach for most cases of OSD 4
• Conservative treatment includes:
  • Rest and activity modification
  • Ice application
  • Physical therapy with specific exercises
  • Anti-inflammatory medications
  • Stretching protocols 4
• Most cases (approximately 82% in one study) respond well to conservative treatment 1

When Conservative Treatment Fails

• Approximately 18% of patients may have persistent symptoms despite conservative management 1
• For treatment-resistant cases, alternative interventions may be considered, including PRP therapy 2
• Surgical intervention is typically reserved for severe cases that fail all conservative measures 1

Evidence for PRP in Osgood-Schlatter Disease

Recent Research Findings

• Recent studies show promising results for leukocyte-rich PRP (LR-PRP) in treating OSD 3
• A 2024 study demonstrated statistically significant improvements in pain and function after LR-PRP treatment, with better outcomes observed in acute rather than chronic OSD 3
• Treatment satisfaction reached 95% in acute OSD cases versus 64% in chronic cases 3
• Another study reported 75% patient satisfaction and 72% return to full physical activity after PRP treatment 5

Timing of PRP Treatment

• Earlier intervention with PRP shows better outcomes than delayed treatment 5
• The MCID (Minimal Clinically Important Difference) achievement rates after LR-PRP injection were significantly higher in acute versus chronic OSD:
  • VAS pain scale: 100% vs. 81%
  • Tegner activity scale: 95.5% vs. 55%
  • Lysholm knee score: 95% vs. 47%
  • KOOS score: 91% vs. 27% 3

Safety Profile

• No adverse effects were reported in studies examining PRP for OSD, suggesting a favorable safety profile 3, 5
• The procedure appears to be well-tolerated in the adolescent population 2

Limitations and Considerations

Lack of Guideline Support

• Major orthopedic and rheumatology guidelines do not specifically address PRP for OSD 6
• The American College of Rheumatology/Arthritis Foundation strongly recommends against PRP for knee and hip osteoarthritis due to concerns about standardization and heterogeneity in preparations 6, 7
• While these guidelines don't specifically address OSD, they highlight general concerns about PRP standardization 7

Technical Considerations

• A major limitation in evaluating PRP efficacy is the lack of standardization in preparation methods 8
• PRP products vary widely in platelet concentration, presence of leukocytes, activation methods, and administration protocols 6
• The International Society on Thrombosis and Haemostasis recommends that clinical trials on PRP should report:
  • Baseline number, volume, and concentration of platelets
  • Purity of the final PRP preparation
  • Activation procedure used 6

Practical Approach to PRP for OSD

Patient Selection

• Consider PRP for patients who:
  • Have failed traditional conservative treatment for at least 3-6 months
  • Experience significant functional limitations affecting sports or daily activities
  • Are in the acute rather than chronic phase of the disease 3, 5

Treatment Protocol

• Use leukocyte-rich PRP preparation for better outcomes 3
• Consider combining PRP with a structured rehabilitation program before and after injection for improved results 5
• A single PRP procedure may be particularly beneficial for young athletes where prolonged absence from training can have serious consequences 3

Expected Outcomes

• Patients should be counseled that:
  • Better outcomes are expected in acute versus chronic cases
  • Return to sports activities is likely (72-95% depending on disease phase)
  • Pain reduction and functional improvement typically occur within weeks of treatment 3, 5

Conclusion

While PRP shows promise for treating Osgood-Schlatter disease based on recent research, it should be considered as a second-line treatment after traditional conservative measures have failed. The best outcomes appear to be in acute cases and when combined with appropriate rehabilitation. More high-quality studies are needed to establish definitive guidelines for its use in this specific condition.