PRP is NOT Recommended for Your Patient with Grade 2 Knee Osteoarthritis
The American College of Rheumatology/Arthritis Foundation explicitly recommends against using PRP for knee osteoarthritis, including patellofemoral and medial compartment involvement, and this should guide your clinical decision-making. 1
Why PRP Should Be Avoided
The 2019 ACR/Arthritis Foundation guideline specifically lists intra-articular PRP as a therapy "recommended against" for knee osteoarthritis 1. This recommendation stems from:
- Lack of standardization: PRP preparations vary wildly in platelet concentration, leukocyte content, activation methods, volume, and number of injections, making it impossible to determine what "PRP" actually means in clinical practice 1, 2
- Inconsistent evidence: While some meta-analyses show short-term pain reduction compared to placebo 3, 4, the overall quality of evidence remains low with high risk of bias across most trials 3, 5
- No Medicare coverage: Given the strong recommendations against PRP from major organizations, Medicare does not cover this treatment 2
What You Should Offer Instead
First-Line Interventions (Strongly Recommended)
Exercise therapy is the cornerstone of treatment for both patellofemoral and tibiofemoral osteoarthritis 1, 2:
- Knee-targeted strengthening exercises
- Hip-targeted exercises if indicated
- Supervised programs show better outcomes than unsupervised 1
- Walking, neuromuscular training, and aquatic exercise are all effective 1
Education should underpin all interventions, adjusted to the patient's specific needs and understanding 1
Weight management if the patient is overweight 2
Adjunctive Interventions Based on Specific Presentation
For patellofemoral involvement specifically 1:
- Patellofemoral braces (conditionally recommended) if pain/instability warrants assistive device use 1
- Prefabricated foot orthoses (consider based on individual assessment) 1
- Kinesiotaping for the patellofemoral joint (conditionally recommended) 1
- Movement/running retraining if applicable 1
For medial tibiofemoral involvement 1:
- Tibiofemoral braces (strongly recommended) if disease impact warrants bracing 1
Pharmacologic Options
Oral or topical NSAIDs as appropriate 2
Intra-articular corticosteroid injections if inadequate response to first-line treatments 2:
- Benefits typically last approximately 3 months 2
- Medicare covers this intervention 2
- Should be considered before any experimental therapies
Critical Pitfalls to Avoid
- Do not offer PRP as a "cutting-edge" option: Despite marketing claims, major medical societies recommend against it 1, 2
- Avoid the "nothing to lose" mentality: PRP is expensive, not covered by insurance, and diverts resources from evidence-based treatments 2
- Don't be swayed by individual case reports: The systematic evidence shows high risk of bias and lack of standardization 3, 5
The Bottom Line
For your 45-year-old patient with grade 2 osteoarthritis involving both patellofemoral and medial compartments, prescribe supervised exercise therapy combined with education as the primary intervention, consider patellofemoral bracing and NSAIDs as needed, and reserve intra-articular corticosteroid injections for inadequate response to conservative measures. 1, 2 PRP should not be part of the treatment algorithm given current guideline recommendations 1, 2.