What is the comparison between Platelet-rich plasma (PRP) and steroid injections for the treatment of meniscal cartilage tears?

From the Guidelines

For meniscal cartilage tears, PRP (platelet-rich plasma) is generally preferred over corticosteroid injections for long-term healing due to its potential for tissue regeneration and reduced inflammation. PRP therapy involves injecting concentrated platelets from the patient's own blood into the injured area, promoting tissue regeneration and reducing inflammation through growth factors and cytokines 1. A typical PRP regimen includes 1-3 injections spaced 2-4 weeks apart, with activity modification for 24-48 hours after each injection.

Key Considerations

• Corticosteroid injections, while providing faster short-term pain relief (within days), may impair healing and potentially accelerate cartilage degeneration with repeated use 1.
• The choice between treatments depends on patient factors including age, activity level, and tear severity.
• PRP is more suitable for younger, active patients seeking tissue healing, while steroids may be appropriate for older patients with degenerative tears primarily seeking pain relief.
• Both treatments should be considered alongside other approaches like physical therapy, which is essential for strengthening surrounding muscles and improving joint stability regardless of injection choice.

Evidence Summary

The most recent and highest quality study, published in 2022, found that platelet-rich plasma is an alternative with two high-quality studies and one moderate-quality study supporting reduced pain and improved function in patients with knee osteoarthritis 1. However, the evidence demonstrated inconsistency with a worse treatment response in patients with severe knee osteoarthritis. In contrast, corticosteroid injections had considerable evidence with 19 high-quality and six moderate-quality studies supporting their use, although the duration of benefits was often only 3 months 1.

Treatment Approach

Given the potential benefits and risks of each treatment option, PRP is recommended for patients with meniscal cartilage tears who are seeking long-term healing and are willing to undergo a series of injections. Corticosteroid injections may be considered for patients who require rapid pain relief and are aware of the potential risks of repeated use. Ultimately, the choice of treatment should be individualized based on patient factors and preferences, and should be made in consultation with a healthcare professional.

From the Research

Comparison of PRP and Steroid Injections for Meniscal Cartilage Tears

• There are no direct comparisons between Platelet-rich plasma (PRP) and steroid injections for the treatment of meniscal cartilage tears in the provided studies 2, 3, 4, 5, 6.
• However, the studies suggest that PRP injections can be an effective treatment for meniscal cartilage tears, with improvements in pain and functionality reported in several studies 2, 3, 6.
• A systematic review of PRP injections for nonoperative management of degenerative meniscal tears found that most studies demonstrated improved pain and functionality by 3 months that persisted for at least one year 3.
• Another study found that intra-meniscal administration of PRP under ultrasound guidance directly into meniscal degenerative lesions is feasible and safe, with significant improvements in KOOS total score and return to competition and training 6.
• A study comparing PRP augmentation with meniscal repair found no difference in reoperation rates or functional outcome measures between the PRP and non-PRP groups, but noted that the study was underpowered to detect modest size differences in outcome 4.

Mechanism of Action of PRP

• PRP has been shown to release growth factors that can initiate a healing cascade, leading to cellular chemotaxis, angiogenesis, collagen matrix synthesis, and cell proliferation 5.
• The growth factors released by PRP have been associated with the initiation of a healing cascade, and have been shown to positively affect meniscal cell function 5.

Limitations of Current Evidence

• The current evidence is limited by the lack of direct comparisons between PRP and steroid injections for the treatment of meniscal cartilage tears 2, 3, 4, 5, 6.
• Many of the studies had small sample sizes and were underpowered to detect modest size differences in outcome 4.
• Further randomized controlled studies are needed to confirm the effectiveness of PRP injections for the treatment of meniscal cartilage tears 3, 6.