Foot & Ankle International - June 2017 - 600
600
667.0 × 103/μL, which was 5.1 ± 2.3 times higher than that
in whole blood. White blood cells or red blood cells were
not detected in any of the PRP samples. The bacterial cultures were negative in all the samples.
Adverse Events
One patient reported pain and swelling at the injection site
immediately after the first injection. It resolved spontaneously in 2 days. No adverse effects were observed after the
remaining 2 injections in this patient. None of the patients
experienced infections caused by the PRP injection.
Primary Clinical Outcome
Overall, the mean VAS score significantly decreased over
time from baseline after the PRP injection (P < .001) (Table
3). The score was lowest at 12 weeks (P < .001) (Table 3).
The score slightly increased at the 24-week follow-up; however, it was still significantly lower than the baseline value in
the post hoc test (P = .02) (Table 3). Compared with the baseline values, the decrease in scores was more than 20 points in
11 patients at 4 weeks, 12 patients at 12 weeks, and 11
patients at 24 weeks. When the patients were divided into the
early- and late-stage groups, the mean VAS score in the earlystage group was significantly lower than that in the late-stage
group (repeated-measures analysis of variance, P = .02)
(Table 5). In the early-stage group, the mean VAS score significantly
decreased
from
the
baseline
value
at 4 and 12 weeks (P = .01 and P = .03, respectively) (Table
5). In the late-stage group, a significant difference was found
between baseline and 12 weeks (P = .01) (Table 5).
Secondary Clinical Outcomes
Overall, the mean JSSF scale score significantly increased
over time (P < .001) (Table 4). The score was highest at 4
weeks (P < .001) (Table 4). The score slightly decreased at
the 12- and 24-week follow-ups but was still significantly
higher than the baseline value in the post hoc tests (P =
.001 and P = .04, respectively) (Table 4). The JSSF scale
score in the early-stage group was significantly higher than
that in the late-stage group (P = .04) (Table 7). In the earlystage group, the score significantly increased from the
baseline value at 12 weeks (P = .009) (Table 7). In the latestage group, significant increases were found at 4 and 12
weeks from baseline (P = .005 and P = .04, respectively)
(Table 7).
The mean scores of the pain and pain-related subscales
of the SAFE-Q significantly improved from baseline to 12
weeks (P = .04) (Table 4). Similar to the VAS score for pain,
the pain and pain-related subscale scores worsened at the
24-week follow-up (P = .61) (Table 4). No significant
Foot & Ankle International 38(6)
Table 4. Primary Clinical Outcome.
Visual
Analog Scale
Baseline
4 weeks
12 weeks
24 weeks
a
Mean ± SD (95% CI)
59.7 ± 15.3 (53.0-66.4)
39.7 ± 18.7 (31.5-47.9)
33.9 ± 16.5 (26.7-41.1)
42.4 ± 21.9 (32.4-51.2)
P Value
Baseline vs 4 weeks:
Baseline vs 12 weeks:
Baseline vs 24 weeks:
<.001a
.006
<.001
.02
Kruskal-Wallis test. Other P values from post hoc tests.
changes were found in the scores of the other SAFE-Q subscales during the study period (data not shown). When the
patients were divided into the early- and late-stage groups,
the scores of the pain and pain-related subscales of the
SAFE-Q in the early-stage group were significantly higher
than those in the late-stage group (Table 7). The pain and
pain-related subscale scores improved after PRP injections,
compared with the baseline values, in both the early- and
late-stage groups; however, the improvements did not reach
statistical significance (P = .16 and P = .22, respectively)
(Table 7).
Discussion
We assessed the safety and efficacy of intra-articular injections of PRP in ankle OA. No serious complications were
observed during the treatment and follow-up periods.
Furthermore, PRP treatment resulted in a significant pain
reduction over 24 weeks.
Temporary pain and swelling at the injection site
occurred in 1 patient immediately after the first injection.
Fortunately, the pain resolved in 2 days without an infection. Mei-Dan et al26 reported that minor discomfort and
mechanical pressure at the injection site were common after
an intra-articular injection of PRP in the ankle via an anteromedial approach and after a hyaluronic acid injection. A
systematic review on the PRP treatment of knee OA also
showed that intra-articular injections of PRP appeared to
have a higher incidence of postinjection pain when compared with control treatments.21 Pain also resolved in several days, which agrees with our case. One possible
explanation is that PRP activated the proinflammatory signaling pathways such as the TNFα and NFκB pathways,19
resulting in joint inflammation and postinjection pain. We
used leukocyte-poor PRP to minimize the inflammatory
response after injections.42 Nevertheless, postinjection pain
occurred in 1 patient. Another possible explanation is extraarticular injections. We used the ultrasonography-guided
injection technique via the anteromedial approach, which
was reported to have an accuracy of up to 100%.39 Before
the PRP injection, we confirmed on ultrasonography that
the tip of the needle was in the ankle joint. Nevertheless, the
needle might have moved during the injection, and an
Table of Contents for the Digital Edition of Foot & Ankle International - June 2017
Contents
Foot & Ankle International - June 2017 - Intro
Foot & Ankle International - June 2017 - Cover1
Foot & Ankle International - June 2017 - Cover2
Foot & Ankle International - June 2017 - i
Foot & Ankle International - June 2017 - ii
Foot & Ankle International - June 2017 - Contents
Foot & Ankle International - June 2017 - iv
Foot & Ankle International - June 2017 - v
Foot & Ankle International - June 2017 - vi
Foot & Ankle International - June 2017 - vii
Foot & Ankle International - June 2017 - viii
Foot & Ankle International - June 2017 - 1A
Foot & Ankle International - June 2017 - 1B
Foot & Ankle International - June 2017 - ix
Foot & Ankle International - June 2017 - x
Foot & Ankle International - June 2017 - xi
Foot & Ankle International - June 2017 - xii
Foot & Ankle International - June 2017 - 2A
Foot & Ankle International - June 2017 - 2B
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Foot & Ankle International - June 2017 - xv
Foot & Ankle International - June 2017 - xvi
Foot & Ankle International - June 2017 - 3A
Foot & Ankle International - June 2017 - 3B
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Foot & Ankle International - June 2017 - CT1
Foot & Ankle International - June 2017 - CT2
Foot & Ankle International - June 2017 - 4A
Foot & Ankle International - June 2017 - 4B
Foot & Ankle International - June 2017 - Cover3
Foot & Ankle International - June 2017 - Cover4
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