Editorial Commentary: High-Platelet-Dose Platelet-Rich Plasma May Be the Nonoperative Treatment of Choice for Knee Osteoarthritis

Knee osteoarthritis (OA) affects 30% of individuals older than 60 and 40% older than 70 years old. The incidence of radiologic knee OA is 373 per 10,000 person-years, but symptomatic knee OA registers at a considerably lower rate of 50 per 10,000 person-years. For symptomatic cases that are not candidates for surgical intervention, various treatment options include exercise, weight loss, pharmacologic management, bracing, physical therapy, oral supplementation, and intra-articular injection with corticosteroids, hyaluronic acid, or orthobiologics such as platelet-rich plasma (PRP). Recent network meta-analysis has affirmed the superiority of PRP over the other alternatives. It appears that a mean absolute platelet count in the final product of less than 2,500 × 106 is not effective, whereas an average platelet count of greater than 5,000 × 106 displays a positive clinical effect at both 6 and 12 months. Yet, aspects like the definition of PRP, whether activation is necessary, the frequency of injections, the optimal dosage, and the preparation method remain unclear.