The Role of Fibrinogen Combined with Platelet-Rich Plasma in Enhancing Microfracture for Cartilage Damage: A Retrospective Study of 113 Patients with Knee Osteoarthritis

The Role of Fibrinogen Combined with Platelet-Rich Plasma in Enhancing Microfracture for Cartilage Damage: A Retrospective Study of 113 Patients with Knee Osteoarthritis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Role of Fibrinogen Combined with Platelet-Rich Plasma in Enhancing Microfracture for Cartilage Damage: A Retrospective Study of 113 Patients with Knee Osteoarthritis Qiongmei Zhang, Haolin Zhou, Daoxiong Li, Yuan Zhong, Ye-Feng Zhao, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4840275/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Oct, 2024 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted 12 You are reading this latest preprint version Abstract Objective: Knee osteoarthritis is the most common osteoarthritis and imposes a significant burden on patients' lives. Several treatment methods can promote cartilage repair to varying extents, but there are limited studies on the combined application of different treatments. The purpose of this study is to evaluate the clinical efficacy of microfracture combined with fibrinogen and platelet-rich plasma (PRP) under arthroscopic in treating knee osteoarthritis, so as to provide a basis for clinical treatment decisions. Method: A total of 113 patients with knee osteoarthritis who received orthopedic treatment from January 2022 to December 2023 were selected. They were divided into two groups according to whether they received fibrinogen and PRP treatment in addition to microfracture treatment. The two groups were followed up for 2 years to compare the differences in knee joint function and quality of life. Results: The study compared changes in knee joint function scores and quality of life between the two groups after treatment and found that the quality of life of patients in the combined treatment group was significantly better than that of patients who received microfracture only (at 12-month follow-up, EuroQol-VAS scores were 64.32±5.63 for the microfracture group (MFx) and 75.65±8.57 for the fibrinogen combined with platelet-rich plasma-assisted microfracture group (FPRPA MFx); P=0.015; at 24-month follow-up, EuroQol-VAS scores were 66.47±5.18 for the MFx group and 79.40±7.43 for the FPRPA MFx group, P=0.022). There was also a strong correlation between patients’ quality of life and knee joint function score index (IKDC score correlation coefficient r=-0.375, Lysholm score correlation coefficient r=0.497, MOCART score correlation coefficient r=0.579, VAS score correlation coefficient r=0.242, T2 value correlation coefficient r=-0.293, P<0.001). Age-stratified analysis of the patients in the microfracture combined with fibrinogen platelet-rich plasma treatment group showed that the effect of the combined treatment was more pronounced in elderly patients. Conclusions: The results of the study showed that compared with microfracture alone, microfracture combined with fibrinogen platelet-rich plasma therapy can further improve patients' knee joint-related function and their quality of life after treatment. The improvement was more obvious in elderly patients. Fibrin Platelet-rich plasma Microfracture Cartilage injury Knee osteoarthritis Figures Figure 1 Figure 2 Introduction Knee osteoarthritis (KOA) is the most common osteoarthritis, predominantly affecting middle-aged and elderly individuals and poses a serious burden on their lives[ 1 ]. With the growing issue of population aging, the incidence of KOA is rising year by year, with over half of the elderly population in China experiencing KOA-related clinical symptoms[ 2 ]. In addition, the incidence of KOA is also increasing among the young and middle-aged populations, with more symptomatic KOA patients presenting a substantial economic burden on global healthcare systems. Research on the treatment of anteromedial knee osteoarthritis has been a major focus of clinical studies[ 3 ]. Various treatment methods are available for KOA, including medication, exercise prescription, physical therapy (such as laser therapy), and surgical treatment. For patients with mild to moderate KOA, current clinical treatment primarily focuses on symptomatic relief and delaying the development of KOA. Nonsteroidal anti-inflammatory analgesics are used to relieve clinical symptoms, but the effect is not satisfactory. Arthroscopic microfracture surgery is usually used to treat cartilage damage caused by trauma. Microfracture can repair cartilage defects and effectively alleviate clinical symptoms, and offers advantages such as relatively quick recovery, low cost, high surgical feasibility, high success rate, and low recurrence rate, making it widely accepted[ 4 ]. The mechanism by which microfracture repairs full-thickness defects of joint cartilage involves penetrating the subchondral bone to release bone marrow mesenchymal stem cells, growth factors, and other proteins, forming multiple fibrous blood clots that gradually differentiate into fibrocartilage tissue to achieve functional repair. Although widely used clinically, microfracture does not completely restore damaged hyaline cartilage, primarily resulting in fibrocartilage. In addition, microfracture is less effective for larger cartilage defects (> 2 cm²). In recent years, studies have found that biological interventions are key biochemical pathways in treating KOA, with PRP being one such treatment[ 5 , 6 ]. PRP is a concentration of platelets obtained after whole blood centrifugation. It can release a large amount of growth factors and bioactive proteins, induce the differentiation and proliferation of mesenchymal stem cells into chondrocytes, and promote the synthesis of type II collagen and amino glucosides in joint cartilage[ 7 ]. Fibrinogen (Fg) is a plasma protein involved in blood coagulation[ 8 ]. When the body experiences injury and bleeding, Fg interacts with thrombin to form clots to prevent excessive bleeding. These clots also provide the initial extracellular matrix (ECM) for tissue repair at the injury site. Therefore, Fg plays a crucial role in wound healing and tissue repair[ 9 ]. Previous studies have shown that the aforementioned treatments can promote cartilage repair to some extent. However, there is limited research on the combined application of different treatment methods. The purpose of this study is to evaluate the clinical efficacy of arthroscopic microfracture combined with fibrinogen and PRP in the treatment of knee osteoarthritis, so as to provide a basis for clinical treatment selection. Materials and Methods Participants This study retrospectively collected data from patients with KOA treated in the orthopedic department at Liqun Hospital from January 2022 to December 2023. Patients were divided into two groups according to their treatment methods: the MFx group and the FPRPA MFx group. Information was collected from the start of treatment to 2 years of follow-up. The diagnosis of KOA was based on the diagnostic criteria in the "Guidelines for the Diagnosis and Treatment of Osteoarthritis (2007 Edition)" formulated by the Orthopedic Branch of the Chinese Medical Association. The following patients were excluded at the time of treatment: patients with knee symptoms caused by mechanical factors; patients with contralateral limb diseases, such as injuries or functional disorders; patients who had physical or surgical treatment of the knee within the past 3 months; patients with concurrent infection or rheumatoid arthritis; patients with concurrent severe internal medicine diseases and mental disorders; and patients who were lost to follow-up. This trial has been approved by the Ethics Committee of Liqun Hospital, and all patients signed informed consent forms. Collection of Clinical Data The general clinical data of the patients, such as age, gender, body mass index (BMI), and knee-related scores were collected to analyze the changes in patients' function, pain, frailty, and quality of life. The knee function scores were recorded preoperatively and at 3, 6, 9, 12, 18, and 24 months postoperatively. The International Knee Documentation Committee (IKDC) score is a system commonly used to evaluate the functional status of patients with knee injuries. It combines patient-reported outcomes and objective physician assessments to evaluate knee function comprehensively. In summary, the IKDC score consists of three main parts: subjective patient evaluation, objective physician examination, and patient performance in daily activities. The Lysholm knee scoring scale was created by Lysholm and Gillqui in 1982 and has been proven reliable, valid, and sensitive in international literature. The Magnetic Observation of Cartilage Repair Tissue (MOCART) score, designed by Marlovits et al. in 2004, is a standard for evaluating cartilage repair. T2 mapping is a quantitative method that measures the T2 relaxation time of tissues, reflecting the absolute relaxation time of protons within the tissue, allowing for standardized assessments of tissue composition and water content. The Visual Analogue Scale (VAS) records the degree of pain before and after treatment. The Tilburg Frailty Indicator (TFI) is used to comprehensively and accurately score the patient's frailty status. The EQOL scale is used to evaluate the quality of life, and the scoring rule is based on the EQVAS visual analogue scale. Arthroscopic Microfracture of the Knee After successful anesthesia, a conventional knee arthroscopy approach was performed. Under the arthroscopy, a curette or shaver was used to clean the irregular and loose cartilage tissue around the cartilage defect area, and the wound surface was freshened under the scope with similar instruments. A microfracture awl was used under the arthroscopy to create vertical holes in the cartilage defect area. After that, the joint cavity was repeatedly flushed to remove any remaining debris. Fibrinogen Combined with Platelet-rich Plasma Treatment Preparation of PRP: Before the operation, 10 ml of venous blood from the patient was drawn, and centrifuged at 2000 r/min at 4°C for 10 min, then the supernatant and the intermediate white blood cells and platelet layer were transferred to another blood collection tube. This was centrifuged again at 2000 r/min at 4°C for 10 min, then 2 ml of supernatant along with the white blood cells and platelet layer was collected. Calcium chloride was added into the suspension to activate platelets, and then PRP was formed. The joint cavity was filled with CO2, the fluid in the joint cavity was extracted, the surface was wiped dry with a cotton swab, and fibrinogen/thrombin (Human Fibrin Sealant, Shanghai RAAS Blood Products Co., Ltd.) was injected with a double-chamber syringe. Then, the gel scaffold was shaped with a McDonalds separator. After about 5 minutes, the scaffold became hard. The appropriate visual channel and injection channel were selected, and the PRP in the spray gun was slowly and evenly sprayed onto the repaired cartilage surface. All incisions were sutured immediately to minimize the loss of PRP. Statistical Analyses All statistical data in this study were processed by IBM SPSS 25.0 statistical software. First, the normality test was performed on the two groups of measurement data. The measurement data that conformed to the normal distribution were characterized by "mean ± standard deviation". Repeated measurement variance analysis was used for comparisons within the same group at different time points. A paired sample t-test was used to compare pre- and post-treatment results for the same treatment method. Independent sample t-test was used to compare the same observational indicators between the two groups. Count data were expressed as frequency, and the measurement unit between the two groups was compared using the chi-square (X²) test. Pearson analysis was used to determine correlations. A P-value of < 0.05 was considered statistically significant. Results Comparison of Clinical Characteristics This study screened a total of 175 patients with KOA treated in the orthopedic department at our hospital from January 2022 to December 2023. Among them, 51 patients were excluded due to the inclusion criteria. One patient was lost after 2 years of follow-up and was also excluded. Eventually, a total of 113 patients remained in the study. According to whether they received subsequent fibrinogen combined with platelet-rich plasma treatment, they were divided into two groups: the microfracture group (MFx, 54 patients) and the fibrinogen combined with platelet-rich plasma assisted microfracture group (FPRPA MFx, 59 patients), as shown in Fig. 1 . This study also analyzed and compared the general clinical characteristics and knee joint scores between the two groups. No statistically significant parameters were found between the two groups. The results are shown in Table 1 . Table 1 Comparison of clinical characteristics between the two groups Characteristic MFx (N = 54) FPRPA MFx (N = 59) P value Age (years) 48.88 ± 14.35 48.44 ± 14.71 0.765 Male, n(%) 28(51.85%) 32(54.23%) 0.800 BMI (kg/m 2 ) 23.61 ± 3.11 23.95 ± 2.65 0.458 Defect size (cm 2 ) 1.95 ± 0.80 2.06 ± 0.87 0.801 VAS score 6.14 ± 2.21 6.52 ± 2.30 0.678 IKDC score 42.42 ± 17.71 48.28 ± 16.62 0.700 Lysholm score 51.27 ± 17.01 48.88 ± 17.57 0.801 MOCART score 51.23 ± 12.77 50.05 ± 15.79 0.170 T2 value (ms) 56.87 ± 18.05 51.98 ± 13.40 0.126 Table 2 Effects of different treatments on patients' knee joint scores Characteristic MFx(N = 54) FPRPA MFx(N = 59) Pre-treatment Post-treatment P value Pre-treatment Post-treatment P value VAS score 6.14 ± 2.21 3.76 ± 1.68 0.041 6.52 ± 2.30 3.51 ± 1.41 0.001 IKDC score 42.42 ± 17.71 70.77 ± 11.96 0.039 48.28 ± 16.62 75.28 ± 11.68 < 0.001 Lysholm score 51.27 ± 17.01 89.08 ± 6.65 < 0.001 48.88 ± 17.57 94.72 ± 8.65 < 0.001 MOCART score 51.23 ± 12.77 75.18 ± 10.16 0.040 50.05 ± 15.79 79.64 ± 9.77 0.002 T2 value (ms) 56.87 ± 18.05 37.03 ± 6.11 < 0.001 51.98 ± 13.40 30.79 ± 5.26 < 0.001 Changes in Patients' knee Joint Scores During Follow-up The study analyzed the changes in knee joint scores before and 2 years after surgery in the two groups of patients. The results showed that both treatments improved knee joint symptoms, with statistically significant (P < 0.05). In the MFx group and FPRPA MFx group, the pre- and post-treatment VAS scores were 6.14 ± 2.21/3.76 ± 1.68 and 6.52 ± 2.30/3.51 ± 1.41, respectively (P values were 0.041 and 0.001). The pre- and post-treatment IKDC scores in the MFx group and FPRPA MFx group were 42.42 ± 17.71/70.77 ± 11.96 and 48.28 ± 16.62/75.28 ± 11.68, respectively (P values were 0.039 and < 0.001). The Lysholm scores before and after treatment in the MFx group and FPRPA MFx group were 51.27 ± 17.01/89.08 ± 6.65 and 48.88 ± 17.57/94.72 ± 8.65, respectively (P values were < 0.001 and < 0.001). The MOCART scores before and after treatment in the MFx group and FPRPA MFx group were 51.23 ± 12.77/75.18 ± 10.16 and 50.05 ± 15.79/79.64 ± 9.77, respectively (P values were 0.040 and 0.002). The T2 values before and after treatment in the MFx group and FPRPA MFx group were 56.87 ± 18.05/37.03 ± 6.11 and 51.98 ± 13.40/30.79 ± 5.26, respectively (P values were < 0.001 and < 0.001). Further analysis of changes in knee joint scores at different time points revealed that the VAS scores of patients in the FPRPA MFx group at 3–12 months postoperative were different from those in the MFx group, although there was only a slight difference between the two groups at 24 months. Additionally, there were no differences in IKDC score, Lysholm score, MOCART score, and T2 value within the first 12 months after surgery, but the differences between the two groups became more pronounced as the follow-up time prolonged, as shown in Fig. 2 . Impact of Age on the Efficacy of Fibrinogen Combined with Platelet-Rich Plasma Treatment In this study, patients in the FPRPA MFx group were stratified by age to observe the effect of age on the efficacy of fibrinogen combined with platelet-rich plasma treatment. The results showed that compared with the efficacy in young patients (< 50 years old), the treatment might be more significant in the elderly population (≥ 50 years old), with P-values for all knee scores being < 0.05. The results are shown in Table 3 . Table 3 Impact of age on the efficacy of fibrinogen combined with platelet-rich plasma treatment Characteristic A​ge < 50 (N = 29) Age ≥ 50 (N = 30) Pre-treatment Post-treatment P value Pre-treatment Post-treatment P value VAS score 4.66 ± 1.19 4.62 ± 1.12 0.623 8.31 ± 1.57 2.45 ± 0.62 < 0.001 IKDC score 62.75 ± 9.40 66.71 ± 5.53 0.074 34.29 ± 7.46 83.56 ± 9.96 0.028 Lysholm score 62.94 ± 12.15 88.66 ± 8.15 0.005 35.30 ± 9.31 100.57 ± 3.64 < 0.001 MOCART score 62.68 ± 9.76 71.81 ± 5.86 0.019 37.85 ± 9.66 87.20 ± 6.11 0.028 T2 value (ms) 40.58 ± 5.97 34.18 ± 5.05 0.158 63.00 ± 8.33 27.52 ± 2.86 < 0.001 Impact of Different Treatments on Patients' Frailty and Quality of Life The study also evaluated the frailty scores of the two groups of patients at 12 and 24 months after surgery, and found no significant difference between the two groups. Additionally, an analysis of the quality of life differences between the groups revealed a significant improvement in the quality of life for patients in the FPRPA MFx group (P-values of 0.015 and 0.043). The results are presented in Table 4 . Table 4 Impact of different treatments on patients' frailty and quality of life Characteristic 12-month visit 24-month visit MFx FPRPA MFx P value MFx FPRPA MFx P value EuroQol-VAS, points 64.32 ± 5.63 75.65 ± 8.57 0.015​ 66.47 ± 5.18 79.40 ± 7.43 0.022​ TFI scores 4.99 ± 2.66 5.26 ± 2.32 0.718​ 6.24 ± 2.38 5.94 ± 2.70 0.375​ Correlation Analysis between Patients' Quality of Life and Knee Joint Scores In patients with knee osteoarthritis, greater improvement in knee joint function is associated with higher quality of life. Specifically, the patient's quality of life was positively correlated with the IKDC score, Lysholm score, MOCART score, and VAS score (P values were all less than 0.001), and negatively correlated with the T2 value (P value 0.002), The results are shown in Table 5 . Table 5 Correlation between quality of life and knee joint scores Characteristic EuroQol-VAS Correlation coefficient P-value IKDC score -0.375 < 0.001 Lysholm score 0.497​ < 0.001 MOCART score 0.579​ < 0.001 VAS score​ 0.242​ < 0.001 T2 value​ -0.293 < 0.001 Discussion KOA is a progressive joint disease associated with articular cartilage degeneration that can lead to loss of mobility and affect the quality of daily life[ 10 ]. KOA is the most common type of osteoarthritis in adults, with a prevalence of 6%, and the incidence can reach 40% with increasing age[ 11 ]. In the past two decades, many experts and scholars have been dedicated to clinical research on KOA, and fibrin and PRP have always been the key areas of focus[ 12 ]. Fibrinogen combined with PRP treatment is an emerging therapeutic approach that aligns with the concept of histological repair of KOA. Some studies have shown that this treatment can improve the clinical symptoms of KOA patients, but there are currently no reports on combining arthroscopic microfracture with fibrinogen-PRP treatment of KOA. The purpose of this study is to further confirm the exact therapeutic effect of microfracture combined with fibrinogen-PRP in KOA patients. Fibrinogen combined with PRP is a therapeutic approach that benefits from its high concentrations of platelets, white blood cells, and fibrin. After being activated, platelets can secrete various growth factors, such as platelet-derived growth factor (PDGF), transforming growth factor β (TGFβ), insulin-like growth factor (IGF), epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF). White blood cells can prevent infection, while fibrin can construct the three-dimensional structure required for local tissue repair. These components not only provide "concentrated nutrition" for tissue repair but also build a better repair environment, which can promote and accelerate the repair of bone and soft tissue and soft tissue[ 13 – 16 ]. However, the current preparation methods for PRP and fibrinogen, along with the proliferation of related products on the market, remain relatively expensive compared to the economic standards of residents in China. Finding a quick, safe, effective, and cost-efficient preparation solution is of significant importance for the implementation and broader accessibility of this treatment[ 17 – 19 ]. The study results indicate that after 24 months of treatment, patients who received the combination of microfracture and fibrinogen-PRP showed significant improvements in VAS, IKDC, Lysholm, and MOCART scores compared to those who underwent microfracture alone. This suggests that combining microfracture with fibrinogen-PRP can further alleviate clinical symptoms and enhance knee function. Patel et al. found that PRP treatment for early KOA patients led to significant improvements in WOMAC scores at 3 and 6 months post-treatment, which aligns with our study's findings[ 20 ]. Additionally, our study revealed that VAS scores showed a marked difference between the two groups within the first year of treatment, indicating that fibrinogen-PRP treatment may accelerate tissue repair and effectively prevent early infections. As treatment time extended, the differences in IKDC, Lysholm, and MOCART scores between the two groups became more pronounced, suggesting that fibrinogen-PRP treatment may offer sustained therapeutic benefits. Previous studies have also shown that intra-articular PRP injections can significantly reduce joint pain and improve function, with effects lasting up to 12 months or longer post-treatment[ 21 – 25 ]. Patients with long-term KOA often experience reduced physical activity, and decreased sleep quality, and are at higher risk for depression and disability compared to the general population. In this study, we further compared changes in quality of life between the two groups of patients after treatment. We found that the quality of life in the combined treatment group was significantly better than in the group that only received microfracture surgery. Additionally, there was a strong correlation between quality of life and knee function scores. A retrospective analysis of PRP treatment for knee osteoarthritis showed that while early follow-up benefits were not significant, significant clinical differences in VAS pain scale, KOOS pain scale, and quality of life were observed in the PRP group compared to the control group during follow-ups at 6–12 months[ 26 ]. Furthermore, age-stratified analysis of the combined microfracture and fibrinogen with PRP treatment group revealed that the effect of the combined treatment was more pronounced in older patients. Recent advancements in molecular biology have provided new insights into the pathophysiological mechanisms of KOA. Inflammatory mediators, growth factors, chondrocyte apoptosis, and the imbalance between anabolic and decomposable mechanisms play an important role in knee osteoarthritis[ 27 ]. Fibrinogen combined with PRP may activate and release biologically active growth factors and other molecules, including platelet-derived growth factor, vascular endothelial growth factor, and transforming growth factor-β, which play an important role in promoting tissue healing, such as bone and vascular remodeling, inflammation regulation, inhibition of chondrocyte apoptosis, and synthesis of some collagen[ 28 ]. However, the specific mechanism of fibrinogen combined with PRP in treating KOA is still controversial and needs to be further explored in subsequent studies. This study may have certain limitations. First, the knee joint function scores and other indicators used in the study are subjective, and future research should include more objective data to more accurately assess clinical efficacy. Second, the sample size in this study needs to be further expanded to validate the conclusions more robustly. Finally, this study only followed up for 24 months, which is considered a short-term follow-up; future studies will extend the follow-up period to observe the long-term effects on patients. Conclusion The results showed that compared with microfracture alone, the combination of microfracture with fibrinogen platelet-rich plasma treatment further improves knee joint function and post-treatment quality of life in patients. The improvement is more pronounced in elderly patients. The study provides new insights for optimizing microfracture surgery in the management of KOA and holds academic and translational value for further research. Abbreviations PRP Platelet-rich plasma KOA Knee osteoarthritis Fg Fibrinogen MFx Microfracture group FPRPA MFx Fibrinogen combined with platelet-rich plasma-assisted microfracture group BMI Body mass index IKDC International Knee Documentation Committee MOCART Magnetic Observation of Cartilage Repair Tissue VAS Visual Analogue Scale TFI Tilburg Frailty Indicator PDGF Platelet-derived growth factor TGFβ Transforming growth factor β IGF Insulin-like growth factor EGF Epidermal growth factor VEGF Vascular endothelial growth factor Declarations Acknowledgements We thank all patients for their participation in this study. Author contributions Q.Z. and H.Z. were responsible for Investigation, Visualization, Writing original draft. D.L. was responsible for Investigation. Y.Z. and YF. Z were responsible for Methodology, Data curation. H.Z. was responsible for Conceptualization, Funding acquisition, Resources and Software, Supervision, Writing-review & editing. All authors reviewed the manuscript. Funding This work was supported by the Efficacy of arthroscopic microfracture combined with PRP with type 1 collagen gel in the treatment of cartilage injury of the knee joint (NO. ptkwws202321). Data availability No datasets were generated or analysed during the current study. Ethics approval and consent to participate This study was approved by the Ethics Committee of Liqun Hospital, Putuo District, Shanghai. We performed this study in accordance with the principles outlined in the Declaration of Helsinki. The patients/participants provided written informed consent to participate in the study. Competing interests The authors declare no competing interests. References Katz JN, Arant KR, Loeser RF. Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review. JAMA2021 Feb 9;325(6):568-78. Giorgino R, Albano D, Fusco S, Peretti GM, Mangiavini L, Messina C. 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Fixation of platelet-rich plasma and fibrin gels on knee cartilage defects after microfracture with arthroscopy. Int Orthop2022 Aug;46(8):1761-66. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 18 Oct, 2024 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted Editorial decision: Revision requested 22 Aug, 2024 Reviews received at journal 21 Aug, 2024 Reviews received at journal 19 Aug, 2024 Reviewers agreed at journal 17 Aug, 2024 Reviewers agreed at journal 09 Aug, 2024 Reviewers agreed at journal 09 Aug, 2024 Reviewers agreed at journal 08 Aug, 2024 Reviewers agreed at journal 07 Aug, 2024 Reviewers invited by journal 07 Aug, 2024 Editor assigned by journal 01 Aug, 2024 Submission checks completed at journal 01 Aug, 2024 First submitted to journal 01 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4840275","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":343920028,"identity":"966904d7-0787-4116-8348-9f0cd706e6fe","order_by":0,"name":"Qiongmei Zhang","email":"","orcid":"","institution":"Liqun Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qiongmei","middleName":"","lastName":"Zhang","suffix":""},{"id":343920029,"identity":"fce4ba30-10d8-43c7-9706-c986803b0b73","order_by":1,"name":"Haolin Zhou","email":"","orcid":"","institution":"Liqun Hospital","correspondingAuthor":false,"prefix":"","firstName":"Haolin","middleName":"","lastName":"Zhou","suffix":""},{"id":343920030,"identity":"40f0a87c-c339-4770-9151-e4e6f5eaf876","order_by":2,"name":"Daoxiong Li","email":"","orcid":"","institution":"Liqun Hospital","correspondingAuthor":false,"prefix":"","firstName":"Daoxiong","middleName":"","lastName":"Li","suffix":""},{"id":343920031,"identity":"95f5239a-d740-40c5-9685-77a8a2e0a2ba","order_by":3,"name":"Yuan Zhong","email":"","orcid":"","institution":"Liqun Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yuan","middleName":"","lastName":"Zhong","suffix":""},{"id":343920032,"identity":"0806d1a3-8603-44ff-ba86-804f4e238dc8","order_by":4,"name":"Ye-Feng Zhao","email":"","orcid":"","institution":"Liqun Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ye-Feng","middleName":"","lastName":"Zhao","suffix":""},{"id":343920033,"identity":"4e4a7c3e-79f4-4d1b-953b-e7692587cd63","order_by":5,"name":"Hongxiao Zhao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYBACNv7mAwc+GNgw8zMcPvggoaKGsBY+iWOJB2dUpLFLNh5LNnhw5hhhLXIMOcaHOc4c4jc4fMZM8mELMxEOYzhjcJix7YC0wbFjaRWJDWwM/O3dCfi1MLcVHC5su2MseebwsRuJO2QYJM6c3UDAlsMbDs9se5bMd+NY2o3EM2wMBhK5hLQkGBzmbTtc33D/jVlBYhszMVpSDA7znDnMLHDgjBkDcVokjiWAAplZsuFYskTCmWM8BP0i3998+AMsKj/+qKiR42/vxa8FA/CQpnwUjIJRMApGAVYAAJLSVq7T65iUAAAAAElFTkSuQmCC","orcid":"","institution":"Liqun Hospital","correspondingAuthor":true,"prefix":"","firstName":"Hongxiao","middleName":"","lastName":"Zhao","suffix":""}],"badges":[],"createdAt":"2024-08-01 07:52:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4840275/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4840275/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13018-024-05145-5","type":"published","date":"2024-10-18T15:58:03+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":64009751,"identity":"0f2fc3fe-7da7-4d42-877b-b97660229984","added_by":"auto","created_at":"2024-09-04 23:21:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41255,"visible":true,"origin":"","legend":"\u003cp\u003eEnrollment of the study participants in the primary cohort\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4840275/v1/a3df8bc440d227c01ee56d55.png"},{"id":64009750,"identity":"1e470e8f-fe6f-4157-91e5-f4157d141796","added_by":"auto","created_at":"2024-09-04 23:20:59","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":77593,"visible":true,"origin":"","legend":"\u003cp\u003eChanges of various parameters in the MFx group and the FPRPA MFx group at different time points\u003c/p\u003e\n\u003cp\u003eNote: *: The difference is statistically significant\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4840275/v1/af1615250c5e1bfc9277f2a1.png"},{"id":67149073,"identity":"d0d4a901-0427-4d23-b99b-7712ef3f9d1c","added_by":"auto","created_at":"2024-10-21 16:11:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":754112,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4840275/v1/4c13fecb-54c3-4566-9a3e-96f55f5ddc7c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Role of Fibrinogen Combined with Platelet-Rich Plasma in Enhancing Microfracture for Cartilage Damage: A Retrospective Study of 113 Patients with Knee Osteoarthritis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eKnee osteoarthritis (KOA) is the most common osteoarthritis, predominantly affecting middle-aged and elderly individuals and poses a serious burden on their lives[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. With the growing issue of population aging, the incidence of KOA is rising year by year, with over half of the elderly population in China experiencing KOA-related clinical symptoms[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In addition, the incidence of KOA is also increasing among the young and middle-aged populations, with more symptomatic KOA patients presenting a substantial economic burden on global healthcare systems. Research on the treatment of anteromedial knee osteoarthritis has been a major focus of clinical studies[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Various treatment methods are available for KOA, including medication, exercise prescription, physical therapy (such as laser therapy), and surgical treatment. For patients with mild to moderate KOA, current clinical treatment primarily focuses on symptomatic relief and delaying the development of KOA. Nonsteroidal anti-inflammatory analgesics are used to relieve clinical symptoms, but the effect is not satisfactory.\u003c/p\u003e \u003cp\u003eArthroscopic microfracture surgery is usually used to treat cartilage damage caused by trauma. Microfracture can repair cartilage defects and effectively alleviate clinical symptoms, and offers advantages such as relatively quick recovery, low cost, high surgical feasibility, high success rate, and low recurrence rate, making it widely accepted[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The mechanism by which microfracture repairs full-thickness defects of joint cartilage involves penetrating the subchondral bone to release bone marrow mesenchymal stem cells, growth factors, and other proteins, forming multiple fibrous blood clots that gradually differentiate into fibrocartilage tissue to achieve functional repair. Although widely used clinically, microfracture does not completely restore damaged hyaline cartilage, primarily resulting in fibrocartilage. In addition, microfracture is less effective for larger cartilage defects (\u0026gt;\u0026thinsp;2 cm\u0026sup2;). In recent years, studies have found that biological interventions are key biochemical pathways in treating KOA, with PRP being one such treatment[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. PRP is a concentration of platelets obtained after whole blood centrifugation. It can release a large amount of growth factors and bioactive proteins, induce the differentiation and proliferation of mesenchymal stem cells into chondrocytes, and promote the synthesis of type II collagen and amino glucosides in joint cartilage[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Fibrinogen (Fg) is a plasma protein involved in blood coagulation[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. When the body experiences injury and bleeding, Fg interacts with thrombin to form clots to prevent excessive bleeding. These clots also provide the initial extracellular matrix (ECM) for tissue repair at the injury site. Therefore, Fg plays a crucial role in wound healing and tissue repair[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious studies have shown that the aforementioned treatments can promote cartilage repair to some extent. However, there is limited research on the combined application of different treatment methods. The purpose of this study is to evaluate the clinical efficacy of arthroscopic microfracture combined with fibrinogen and PRP in the treatment of knee osteoarthritis, so as to provide a basis for clinical treatment selection.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThis study retrospectively collected data from patients with KOA treated in the orthopedic department at Liqun Hospital from January 2022 to December 2023. Patients were divided into two groups according to their treatment methods: the MFx group and the FPRPA MFx group. Information was collected from the start of treatment to 2 years of follow-up. The diagnosis of KOA was based on the diagnostic criteria in the \"Guidelines for the Diagnosis and Treatment of Osteoarthritis (2007 Edition)\" formulated by the Orthopedic Branch of the Chinese Medical Association. The following patients were excluded at the time of treatment: patients with knee symptoms caused by mechanical factors; patients with contralateral limb diseases, such as injuries or functional disorders; patients who had physical or surgical treatment of the knee within the past 3 months; patients with concurrent infection or rheumatoid arthritis; patients with concurrent severe internal medicine diseases and mental disorders; and patients who were lost to follow-up. This trial has been approved by the Ethics Committee of Liqun Hospital, and all patients signed informed consent forms.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eCollection of Clinical Data\u003c/h2\u003e \u003cp\u003eThe general clinical data of the patients, such as age, gender, body mass index (BMI), and knee-related scores were collected to analyze the changes in patients' function, pain, frailty, and quality of life. The knee function scores were recorded preoperatively and at 3, 6, 9, 12, 18, and 24 months postoperatively. The International Knee Documentation Committee (IKDC) score is a system commonly used to evaluate the functional status of patients with knee injuries. It combines patient-reported outcomes and objective physician assessments to evaluate knee function comprehensively. In summary, the IKDC score consists of three main parts: subjective patient evaluation, objective physician examination, and patient performance in daily activities. The Lysholm knee scoring scale was created by Lysholm and Gillqui in 1982 and has been proven reliable, valid, and sensitive in international literature. The Magnetic Observation of Cartilage Repair Tissue (MOCART) score, designed by Marlovits et al. in 2004, is a standard for evaluating cartilage repair. T2 mapping is a quantitative method that measures the T2 relaxation time of tissues, reflecting the absolute relaxation time of protons within the tissue, allowing for standardized assessments of tissue composition and water content. The Visual Analogue Scale (VAS) records the degree of pain before and after treatment. The Tilburg Frailty Indicator (TFI) is used to comprehensively and accurately score the patient's frailty status. The EQOL scale is used to evaluate the quality of life, and the scoring rule is based on the EQVAS visual analogue scale.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eArthroscopic Microfracture of the Knee\u003c/h2\u003e \u003cp\u003eAfter successful anesthesia, a conventional knee arthroscopy approach was performed. Under the arthroscopy, a curette or shaver was used to clean the irregular and loose cartilage tissue around the cartilage defect area, and the wound surface was freshened under the scope with similar instruments. A microfracture awl was used under the arthroscopy to create vertical holes in the cartilage defect area. After that, the joint cavity was repeatedly flushed to remove any remaining debris.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eFibrinogen Combined with Platelet-rich Plasma Treatment\u003c/h2\u003e \u003cp\u003ePreparation of PRP: Before the operation, 10 ml of venous blood from the patient was drawn, and centrifuged at 2000 r/min at 4\u0026deg;C for 10 min, then the supernatant and the intermediate white blood cells and platelet layer were transferred to another blood collection tube. This was centrifuged again at 2000 r/min at 4\u0026deg;C for 10 min, then 2 ml of supernatant along with the white blood cells and platelet layer was collected. Calcium chloride was added into the suspension to activate platelets, and then PRP was formed.\u003c/p\u003e \u003cp\u003eThe joint cavity was filled with CO2, the fluid in the joint cavity was extracted, the surface was wiped dry with a cotton swab, and fibrinogen/thrombin (Human Fibrin Sealant, Shanghai RAAS Blood Products Co., Ltd.) was injected with a double-chamber syringe. Then, the gel scaffold was shaped with a McDonalds separator. After about 5 minutes, the scaffold became hard. The appropriate visual channel and injection channel were selected, and the PRP in the spray gun was slowly and evenly sprayed onto the repaired cartilage surface. All incisions were sutured immediately to minimize the loss of PRP.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analyses\u003c/h2\u003e \u003cp\u003eAll statistical data in this study were processed by IBM SPSS 25.0 statistical software. First, the normality test was performed on the two groups of measurement data. The measurement data that conformed to the normal distribution were characterized by \"mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\". Repeated measurement variance analysis was used for comparisons within the same group at different time points. A paired sample t-test was used to compare pre- and post-treatment results for the same treatment method. Independent sample t-test was used to compare the same observational indicators between the two groups. Count data were expressed as frequency, and the measurement unit between the two groups was compared using the chi-square (X\u0026sup2;) test. Pearson analysis was used to determine correlations. A P-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eComparison of Clinical Characteristics\u003c/h2\u003e \u003cp\u003eThis study screened a total of 175 patients with KOA treated in the orthopedic department at our hospital from January 2022 to December 2023. Among them, 51 patients were excluded due to the inclusion criteria. One patient was lost after 2 years of follow-up and was also excluded. Eventually, a total of 113 patients remained in the study. According to whether they received subsequent fibrinogen combined with platelet-rich plasma treatment, they were divided into two groups: the microfracture group (MFx, 54 patients) and the fibrinogen combined with platelet-rich plasma assisted microfracture group (FPRPA MFx, 59 patients), as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. This study also analyzed and compared the general clinical characteristics and knee joint scores between the two groups. No statistically significant parameters were found between the two groups. The results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of clinical characteristics between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMFx (N\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFPRPA MFx (N\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.88\u0026thinsp;\u0026plusmn;\u0026thinsp;14.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.44\u0026thinsp;\u0026plusmn;\u0026thinsp;14.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28(51.85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(54.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.800\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.61\u0026thinsp;\u0026plusmn;\u0026thinsp;3.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.458\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDefect size (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.801\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.52\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.678\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIKDC score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.42\u0026thinsp;\u0026plusmn;\u0026thinsp;17.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.28\u0026thinsp;\u0026plusmn;\u0026thinsp;16.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.700\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLysholm score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.27\u0026thinsp;\u0026plusmn;\u0026thinsp;17.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.88\u0026thinsp;\u0026plusmn;\u0026thinsp;17.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.801\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMOCART score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.23\u0026thinsp;\u0026plusmn;\u0026thinsp;12.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.05\u0026thinsp;\u0026plusmn;\u0026thinsp;15.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2 value (ms)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56.87\u0026thinsp;\u0026plusmn;\u0026thinsp;18.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.98\u0026thinsp;\u0026plusmn;\u0026thinsp;13.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffects of different treatments on patients' knee joint scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eMFx(N\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eFPRPA MFx(N\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePre-treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePost-treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e6.52\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e3.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIKDC score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e42.42\u0026thinsp;\u0026plusmn;\u0026thinsp;17.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e70.77\u0026thinsp;\u0026plusmn;\u0026thinsp;11.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e48.28\u0026thinsp;\u0026plusmn;\u0026thinsp;16.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e75.28\u0026thinsp;\u0026plusmn;\u0026thinsp;11.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLysholm score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e51.27\u0026thinsp;\u0026plusmn;\u0026thinsp;17.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e89.08\u0026thinsp;\u0026plusmn;\u0026thinsp;6.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e48.88\u0026thinsp;\u0026plusmn;\u0026thinsp;17.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e94.72\u0026thinsp;\u0026plusmn;\u0026thinsp;8.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMOCART score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e51.23\u0026thinsp;\u0026plusmn;\u0026thinsp;12.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e75.18\u0026thinsp;\u0026plusmn;\u0026thinsp;10.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e50.05\u0026thinsp;\u0026plusmn;\u0026thinsp;15.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e79.64\u0026thinsp;\u0026plusmn;\u0026thinsp;9.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2 value (ms)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e56.87\u0026thinsp;\u0026plusmn;\u0026thinsp;18.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e37.03\u0026thinsp;\u0026plusmn;\u0026thinsp;6.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e51.98\u0026thinsp;\u0026plusmn;\u0026thinsp;13.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e30.79\u0026thinsp;\u0026plusmn;\u0026thinsp;5.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eChanges in Patients' knee Joint Scores During Follow-up\u003c/h2\u003e \u003cp\u003eThe study analyzed the changes in knee joint scores before and 2 years after surgery in the two groups of patients. The results showed that both treatments improved knee joint symptoms, with statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In the MFx group and FPRPA MFx group, the pre- and post-treatment VAS scores were 6.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21/3.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68 and 6.52\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30/3.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41, respectively (P values were 0.041 and 0.001). The pre- and post-treatment IKDC scores in the MFx group and FPRPA MFx group were 42.42\u0026thinsp;\u0026plusmn;\u0026thinsp;17.71/70.77\u0026thinsp;\u0026plusmn;\u0026thinsp;11.96 and 48.28\u0026thinsp;\u0026plusmn;\u0026thinsp;16.62/75.28\u0026thinsp;\u0026plusmn;\u0026thinsp;11.68, respectively (P values were 0.039 and \u0026lt;\u0026thinsp;0.001). The Lysholm scores before and after treatment in the MFx group and FPRPA MFx group were 51.27\u0026thinsp;\u0026plusmn;\u0026thinsp;17.01/89.08\u0026thinsp;\u0026plusmn;\u0026thinsp;6.65 and 48.88\u0026thinsp;\u0026plusmn;\u0026thinsp;17.57/94.72\u0026thinsp;\u0026plusmn;\u0026thinsp;8.65, respectively (P values were \u0026lt;\u0026thinsp;0.001 and \u0026lt;\u0026thinsp;0.001). The MOCART scores before and after treatment in the MFx group and FPRPA MFx group were 51.23\u0026thinsp;\u0026plusmn;\u0026thinsp;12.77/75.18\u0026thinsp;\u0026plusmn;\u0026thinsp;10.16 and 50.05\u0026thinsp;\u0026plusmn;\u0026thinsp;15.79/79.64\u0026thinsp;\u0026plusmn;\u0026thinsp;9.77, respectively (P values were 0.040 and 0.002). The T2 values before and after treatment in the MFx group and FPRPA MFx group were 56.87\u0026thinsp;\u0026plusmn;\u0026thinsp;18.05/37.03\u0026thinsp;\u0026plusmn;\u0026thinsp;6.11 and 51.98\u0026thinsp;\u0026plusmn;\u0026thinsp;13.40/30.79\u0026thinsp;\u0026plusmn;\u0026thinsp;5.26, respectively (P values were \u0026lt;\u0026thinsp;0.001 and \u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eFurther analysis of changes in knee joint scores at different time points revealed that the VAS scores of patients in the FPRPA MFx group at 3\u0026ndash;12 months postoperative were different from those in the MFx group, although there was only a slight difference between the two groups at 24 months. Additionally, there were no differences in IKDC score, Lysholm score, MOCART score, and T2 value within the first 12 months after surgery, but the differences between the two groups became more pronounced as the follow-up time prolonged, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eImpact of Age on the Efficacy of Fibrinogen Combined with Platelet-Rich Plasma Treatment\u003c/b\u003e In this study, patients in the FPRPA MFx group were stratified by age to observe the effect of age on the efficacy of fibrinogen combined with platelet-rich plasma treatment. The results showed that compared with the efficacy in young patients (\u0026lt;\u0026thinsp;50 years old), the treatment might be more significant in the elderly population (\u0026ge;\u0026thinsp;50 years old), with P-values for all knee scores being \u0026lt;\u0026thinsp;0.05. The results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eImpact of age on the efficacy of fibrinogen combined with platelet-rich plasma treatment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eA​ge\u0026thinsp;\u0026lt;\u0026thinsp;50 (N\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;50 (N\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePre-treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePost-treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.66\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e8.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e2.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIKDC score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e62.75\u0026thinsp;\u0026plusmn;\u0026thinsp;9.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e66.71\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e34.29\u0026thinsp;\u0026plusmn;\u0026thinsp;7.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e83.56\u0026thinsp;\u0026plusmn;\u0026thinsp;9.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLysholm score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e62.94\u0026thinsp;\u0026plusmn;\u0026thinsp;12.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e88.66\u0026thinsp;\u0026plusmn;\u0026thinsp;8.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e35.30\u0026thinsp;\u0026plusmn;\u0026thinsp;9.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e100.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMOCART score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e62.68\u0026thinsp;\u0026plusmn;\u0026thinsp;9.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e71.81\u0026thinsp;\u0026plusmn;\u0026thinsp;5.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e37.85\u0026thinsp;\u0026plusmn;\u0026thinsp;9.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e87.20\u0026thinsp;\u0026plusmn;\u0026thinsp;6.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2 value (ms)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e40.58\u0026thinsp;\u0026plusmn;\u0026thinsp;5.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e34.18\u0026thinsp;\u0026plusmn;\u0026thinsp;5.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e63.00\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e27.52\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eImpact of Different Treatments on Patients' Frailty and Quality of Life\u003c/h2\u003e \u003cp\u003eThe study also evaluated the frailty scores of the two groups of patients at 12 and 24 months after surgery, and found no significant difference between the two groups. Additionally, an analysis of the quality of life differences between the groups revealed a significant improvement in the quality of life for patients in the FPRPA MFx group (P-values of 0.015 and 0.043). The results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eImpact of different treatments on patients' frailty and quality of life\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e12-month visit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003e24-month visit\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMFx\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFPRPA MFx\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMFx\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFPRPA MFx\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEuroQol-VAS, points\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e64.32\u0026thinsp;\u0026plusmn;\u0026thinsp;5.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e75.65\u0026thinsp;\u0026plusmn;\u0026thinsp;8.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.015​\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e66.47\u0026thinsp;\u0026plusmn;\u0026thinsp;5.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e79.40\u0026thinsp;\u0026plusmn;\u0026thinsp;7.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.022​\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTFI scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.99\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.718​\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e6.24\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e5.94\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.375​\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation Analysis between Patients' Quality of Life and Knee Joint Scores\u003c/h2\u003e \u003cp\u003eIn patients with knee osteoarthritis, greater improvement in knee joint function is associated with higher quality of life. Specifically, the patient's quality of life was positively correlated with the IKDC score, Lysholm score, MOCART score, and VAS score (P values were all less than 0.001), and negatively correlated with the T2 value (P value 0.002), The results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between quality of life and knee joint scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEuroQol-VAS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorrelation coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIKDC score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLysholm score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.497​\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMOCART score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.579​\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS score​\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.242​\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2 value​\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eKOA is a progressive joint disease associated with articular cartilage degeneration that can lead to loss of mobility and affect the quality of daily life[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. KOA is the most common type of osteoarthritis in adults, with a prevalence of 6%, and the incidence can reach 40% with increasing age[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In the past two decades, many experts and scholars have been dedicated to clinical research on KOA, and fibrin and PRP have always been the key areas of focus[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Fibrinogen combined with PRP treatment is an emerging therapeutic approach that aligns with the concept of histological repair of KOA. Some studies have shown that this treatment can improve the clinical symptoms of KOA patients, but there are currently no reports on combining arthroscopic microfracture with fibrinogen-PRP treatment of KOA. The purpose of this study is to further confirm the exact therapeutic effect of microfracture combined with fibrinogen-PRP in KOA patients.\u003c/p\u003e \u003cp\u003eFibrinogen combined with PRP is a therapeutic approach that benefits from its high concentrations of platelets, white blood cells, and fibrin. After being activated, platelets can secrete various growth factors, such as platelet-derived growth factor (PDGF), transforming growth factor β (TGFβ), insulin-like growth factor (IGF), epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF). White blood cells can prevent infection, while fibrin can construct the three-dimensional structure required for local tissue repair. These components not only provide \"concentrated nutrition\" for tissue repair but also build a better repair environment, which can promote and accelerate the repair of bone and soft tissue and soft tissue[\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, the current preparation methods for PRP and fibrinogen, along with the proliferation of related products on the market, remain relatively expensive compared to the economic standards of residents in China. Finding a quick, safe, effective, and cost-efficient preparation solution is of significant importance for the implementation and broader accessibility of this treatment[\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study results indicate that after 24 months of treatment, patients who received the combination of microfracture and fibrinogen-PRP showed significant improvements in VAS, IKDC, Lysholm, and MOCART scores compared to those who underwent microfracture alone. This suggests that combining microfracture with fibrinogen-PRP can further alleviate clinical symptoms and enhance knee function. Patel et al. found that PRP treatment for early KOA patients led to significant improvements in WOMAC scores at 3 and 6 months post-treatment, which aligns with our study's findings[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Additionally, our study revealed that VAS scores showed a marked difference between the two groups within the first year of treatment, indicating that fibrinogen-PRP treatment may accelerate tissue repair and effectively prevent early infections. As treatment time extended, the differences in IKDC, Lysholm, and MOCART scores between the two groups became more pronounced, suggesting that fibrinogen-PRP treatment may offer sustained therapeutic benefits. Previous studies have also shown that intra-articular PRP injections can significantly reduce joint pain and improve function, with effects lasting up to 12 months or longer post-treatment[\u003cspan additionalcitationids=\"CR22 CR23 CR24\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients with long-term KOA often experience reduced physical activity, and decreased sleep quality, and are at higher risk for depression and disability compared to the general population. In this study, we further compared changes in quality of life between the two groups of patients after treatment. We found that the quality of life in the combined treatment group was significantly better than in the group that only received microfracture surgery. Additionally, there was a strong correlation between quality of life and knee function scores. A retrospective analysis of PRP treatment for knee osteoarthritis showed that while early follow-up benefits were not significant, significant clinical differences in VAS pain scale, KOOS pain scale, and quality of life were observed in the PRP group compared to the control group during follow-ups at 6\u0026ndash;12 months[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Furthermore, age-stratified analysis of the combined microfracture and fibrinogen with PRP treatment group revealed that the effect of the combined treatment was more pronounced in older patients.\u003c/p\u003e \u003cp\u003eRecent advancements in molecular biology have provided new insights into the pathophysiological mechanisms of KOA. Inflammatory mediators, growth factors, chondrocyte apoptosis, and the imbalance between anabolic and decomposable mechanisms play an important role in knee osteoarthritis[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Fibrinogen combined with PRP may activate and release biologically active growth factors and other molecules, including platelet-derived growth factor, vascular endothelial growth factor, and transforming growth factor-β, which play an important role in promoting tissue healing, such as bone and vascular remodeling, inflammation regulation, inhibition of chondrocyte apoptosis, and synthesis of some collagen[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. However, the specific mechanism of fibrinogen combined with PRP in treating KOA is still controversial and needs to be further explored in subsequent studies.\u003c/p\u003e \u003cp\u003eThis study may have certain limitations. First, the knee joint function scores and other indicators used in the study are subjective, and future research should include more objective data to more accurately assess clinical efficacy. Second, the sample size in this study needs to be further expanded to validate the conclusions more robustly. Finally, this study only followed up for 24 months, which is considered a short-term follow-up; future studies will extend the follow-up period to observe the long-term effects on patients.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results showed that compared with microfracture alone, the combination of microfracture with fibrinogen platelet-rich plasma treatment further improves knee joint function and post-treatment quality of life in patients. The improvement is more pronounced in elderly patients. The study provides new insights for optimizing microfracture surgery in the management of KOA and holds academic and translational value for further research.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePRP \u0026nbsp; Platelet-rich plasma\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKOA \u0026nbsp; Knee osteoarthritis\u003c/p\u003e\n\u003cp\u003eFg \u0026nbsp; Fibrinogen\u003c/p\u003e\n\u003cp\u003eMFx \u0026nbsp; Microfracture group\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFPRPA MFx \u0026nbsp; Fibrinogen combined with platelet-rich plasma-assisted microfracture group\u003c/p\u003e\n\u003cp\u003eBMI \u0026nbsp; Body mass index\u003c/p\u003e\n\u003cp\u003eIKDC \u0026nbsp; International Knee Documentation Committee\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMOCART \u0026nbsp; Magnetic Observation of Cartilage Repair Tissue\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVAS \u0026nbsp; Visual Analogue Scale\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTFI \u0026nbsp; Tilburg Frailty Indicator\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePDGF \u0026nbsp; Platelet-derived growth factor\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTGF\u0026beta; \u0026nbsp; Transforming growth factor \u0026beta;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIGF \u0026nbsp; Insulin-like growth factor\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEGF \u0026nbsp; Epidermal growth factor\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVEGF \u0026nbsp; Vascular endothelial growth factor\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all patients for their participation in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQ.Z. and H.Z. were responsible for Investigation, Visualization, Writing original draft.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eD.L. was responsible for Investigation. Y.Z. and YF. Z were responsible for Methodology, Data curation. H.Z. was responsible for Conceptualization, Funding acquisition, Resources and Software, Supervision, Writing-review \u0026amp; editing. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Efficacy of arthroscopic microfracture combined with PRP with type 1 collagen gel in the treatment of cartilage injury of the knee joint (NO.\u0026nbsp;ptkwws202321).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Liqun Hospital, Putuo District, Shanghai. We performed this study in accordance with the principles outlined in the Declaration of Helsinki. The patients/participants provided written informed consent to participate in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKatz JN, Arant KR, Loeser RF. Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review. JAMA2021 Feb 9;325(6):568-78.\u003c/li\u003e\n\u003cli\u003eGiorgino R, Albano D, Fusco S, Peretti GM, Mangiavini L, Messina C. Knee Osteoarthritis: Epidemiology, Pathogenesis, and Mesenchymal Stem Cells: What Else Is New? An Update. Int J Mol Sci2023 Mar 29;24(7).\u003c/li\u003e\n\u003cli\u003eSiddiq MAB, Clegg D, Jansen TL, Rasker JJ. Emerging and New Treatment Options for Knee Osteoarthritis. Curr Rheumatol Rev2022;18(1):20-32.\u003c/li\u003e\n\u003cli\u003eBasciani S, Longo UG, Papalia GF, Papalia R, Marinozzi A. Arthroscopic microfracture and associated techniques in the treatment of osteochondral lesions of the talus: A systematic review and metanalysis. Foot Ankle Surg2024 Apr;30(3):219-25.\u003c/li\u003e\n\u003cli\u003eHuang M, Li Y, Liao C, Lai Q, Peng J, Guo N. Microfracture surgery combined with platelet-rich plasma injection in treating osteochondral lesions of talus: A system review and update meta analysis. Foot Ankle Surg2024 Jan;30(1):21-26.\u003c/li\u003e\n\u003cli\u003eBoffa A, Previtali D, Altamura SA, Zaffagnini S, Candrian C, Filardo G. Platelet-Rich Plasma Augmentation to Microfracture Provides a Limited Benefit for the Treatment of Cartilage Lesions: A Meta-analysis. Orthop J Sports Med2020 Apr;8(4):2325967120910504.\u003c/li\u003e\n\u003cli\u003eGupta S, Paliczak A, Delgado D. Evidence-based indications of platelet-rich plasma therapy. Expert Rev Hematol2021 Jan;14(1):97-108.\u003c/li\u003e\n\u003cli\u003eWolberg AS. Fibrinogen and fibrin: synthesis, structure, and function in health and disease. J Thromb Haemost2023 Nov;21(11):3005-15.\u003c/li\u003e\n\u003cli\u003eBayer IS. Advances in Fibrin-Based Materials in Wound Repair: A Review. Molecules2022 Jul 14;27(14).\u003c/li\u003e\n\u003cli\u003eJang S, Lee K, Ju JH. Recent Updates of Diagnosis, Pathophysiology, and Treatment on Osteoarthritis of the Knee. Int J Mol Sci2021 Mar 5;22(5).\u003c/li\u003e\n\u003cli\u003eBichsel D, Liechti FD, Schlapbach JM, Wertli MM. Cross-sectional Analysis of Recommendations for the Treatment of Hip and Knee Osteoarthritis in Clinical Guidelines. Arch Phys Med Rehabil2022 Mar;103(3):559-69 e5.\u003c/li\u003e\n\u003cli\u003eAllaeys C, Arnout N, Van Onsem S, Govaers K, Victor J. Conservative treatment of knee osteoarthritis. Acta Orthop Belg2020 Sep;86(3):412-21.\u003c/li\u003e\n\u003cli\u003eSimental-Mendia M, Ortega-Mata D, Acosta-Olivo CA. Platelet-Rich Plasma for Knee Osteoarthritis: What Does the Evidence Say? Drugs Aging2023 Jul;40(7):585-603.\u003c/li\u003e\n\u003cli\u003eEverts P, Onishi K, Jayaram P, Lana JF, Mautner K. Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020. Int J Mol Sci2020 Oct 21;21(20).\u003c/li\u003e\n\u003cli\u003eSzwedowski D, Szczepanek J, Paczesny L, Zabrzynski J, Gagat M, Mobasheri A\u003cem\u003e et al.\u003c/em\u003e The Effect of Platelet-Rich Plasma on the Intra-Articular Microenvironment in Knee Osteoarthritis. Int J Mol Sci2021 May 23;22(11).\u003c/li\u003e\n\u003cli\u003ePrimorac D, Molnar V, Rod E, Jelec Z, Cukelj F, Matisic V\u003cem\u003e et al.\u003c/em\u003e Knee Osteoarthritis: A Review of Pathogenesis and State-Of-The-Art Non-Operative Therapeutic Considerations. Genes (Basel)2020 Jul 26;11(8).\u003c/li\u003e\n\u003cli\u003eCollins T, Alexander D, Barkatali B. Platelet-rich plasma: a narrative review. EFORT Open Rev2021 Apr;6(4):225-35.\u003c/li\u003e\n\u003cli\u003eDashore S, Chouhan K, Nanda S, Sharma A. Preparation of Platelet-Rich Plasma: National IADVL PRP Taskforce Recommendations. Indian Dermatol Online J2021 Nov;12(Suppl 1):S12-S23.\u003c/li\u003e\n\u003cli\u003ePachito DV, Bagattini AM, de Almeida AM, Mendrone-Junior A, Riera R. Technical Procedures for Preparation and Administration of Platelet-Rich Plasma and Related Products: A Scoping Review. Front Cell Dev Biol2020;8:598816.\u003c/li\u003e\n\u003cli\u003ePatel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med2013 Feb;41(2):356-64.\u003c/li\u003e\n\u003cli\u003eFang J, Wang X, Jiang W, Zhu Y, Hu Y, Zhao Y\u003cem\u003e et al.\u003c/em\u003e Platelet-Rich Plasma Therapy in the Treatment of Diseases Associated with Orthopedic Injuries. Tissue Eng Part B Rev2020 Dec;26(6):571-85.\u003c/li\u003e\n\u003cli\u003eBansal H, Leon J, Pont JL, Wilson DA, Bansal A, Agarwal D\u003cem\u003e et al.\u003c/em\u003e Platelet-rich plasma (PRP) in osteoarthritis (OA) knee: Correct dose critical for long term clinical efficacy. Sci Rep2021 Feb 17;11(1):3971.\u003c/li\u003e\n\u003cli\u003eBennell KL, Paterson KL, Metcalf BR, Duong V, Eyles J, Kasza J\u003cem\u003e et al.\u003c/em\u003e Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial. JAMA2021 Nov 23;326(20):2021-30.\u003c/li\u003e\n\u003cli\u003ePaget LDA, Reurink G, de Vos RJ, Weir A, Moen MH, Bierma-Zeinstra SMA\u003cem\u003e et al.\u003c/em\u003e Platelet-Rich Plasma Injections for the Treatment of Ankle Osteoarthritis. Am J Sports Med2023 Aug;51(10):2625-34.\u003c/li\u003e\n\u003cli\u003eGilat R, Haunschild ED, Knapik DM, Evuarherhe A, Jr., Parvaresh KC, Cole BJ. Hyaluronic acid and platelet-rich plasma for the management of knee osteoarthritis. Int Orthop2021 Feb;45(2):345-54.\u003c/li\u003e\n\u003cli\u003eFilardo G, Previtali D, Napoli F, Candrian C, Zaffagnini S, Grassi A. PRP Injections for the Treatment of Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials. Cartilage2021 Dec;13(1_suppl):364S-75S.\u003c/li\u003e\n\u003cli\u003eDu X, Liu ZY, Tao XX, Mei YL, Zhou DQ, Cheng K\u003cem\u003e et al.\u003c/em\u003e Research Progress on the Pathogenesis of Knee Osteoarthritis. Orthop Surg2023 Sep;15(9):2213-24.\u003c/li\u003e\n\u003cli\u003eWang M, Gao W. Fixation of platelet-rich plasma and fibrin gels on knee cartilage defects after microfracture with arthroscopy. Int Orthop2022 Aug;46(8):1761-66.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Fibrin, Platelet-rich plasma, Microfracture, Cartilage injury, Knee osteoarthritis","lastPublishedDoi":"10.21203/rs.3.rs-4840275/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4840275/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e Knee osteoarthritis is the most common osteoarthritis and imposes a significant burden on patients' lives. Several treatment methods can promote cartilage repair to varying extents, but there are limited studies on the combined application of different treatments. The purpose of this study is to evaluate the clinical efficacy of microfracture combined with fibrinogen and platelet-rich plasma (PRP) under arthroscopic in treating knee osteoarthritis, so as to provide a basis for clinical treatment decisions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eA total of 113 patients with knee osteoarthritis who received orthopedic treatment from January 2022 to December 2023 were selected. They were divided into two groups according to whether they received fibrinogen and PRP treatment in addition to microfracture treatment. The two groups were followed up for 2 years to compare the differences in knee joint function and quality of life.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe study compared changes in knee joint function scores and quality of life between the two groups after treatment and found that the quality of life of patients in the combined treatment group was significantly better than that of patients who received microfracture only (at 12-month follow-up, EuroQol-VAS scores were 64.32±5.63 for the microfracture group (MFx) and 75.65±8.57 for the fibrinogen combined with platelet-rich plasma-assisted microfracture group (FPRPA MFx); P=0.015; at 24-month follow-up, EuroQol-VAS scores were 66.47±5.18 for the MFx group and 79.40±7.43 for the FPRPA MFx group, P=0.022). There was also a strong correlation between patients’ quality of life and knee joint function score index (IKDC score correlation coefficient r=-0.375, Lysholm score correlation coefficient r=0.497, MOCART score correlation coefficient r=0.579, VAS score correlation coefficient r=0.242, T2 value correlation coefficient r=-0.293, P\u0026lt;0.001). Age-stratified analysis of the patients in the microfracture combined with fibrinogen platelet-rich plasma treatment group showed that the effect of the combined treatment was more pronounced in elderly patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The results of the study showed that compared with microfracture alone, microfracture combined with fibrinogen platelet-rich plasma therapy can further improve patients' knee joint-related function and their quality of life after treatment. The improvement was more obvious in elderly patients.\u003c/p\u003e","manuscriptTitle":"The Role of Fibrinogen Combined with Platelet-Rich Plasma in Enhancing Microfracture for Cartilage Damage: A Retrospective Study of 113 Patients with Knee Osteoarthritis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-04 23:20:55","doi":"10.21203/rs.3.rs-4840275/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-23T01:10:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-21T06:14:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-19T05:13:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"124149092081082846277633313427956726479","date":"2024-08-17T09:12:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"135856111700305625617917799144874090669","date":"2024-08-09T05:28:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"285761425434543289561174907978537485102","date":"2024-08-09T04:59:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"323980325390591739846555701944330169712","date":"2024-08-08T12:59:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"270914471196784707480205500602379634351","date":"2024-08-07T06:38:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-07T04:46:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-02T02:06:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-02T01:31:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Orthopaedic Surgery and Research","date":"2024-08-01T07:50:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7187286f-6bb4-4067-90f2-6dacf552b109","owner":[],"postedDate":"September 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-21T16:04:18+00:00","versionOfRecord":{"articleIdentity":"rs-4840275","link":"https://doi.org/10.1186/s13018-024-05145-5","journal":{"identity":"journal-of-orthopaedic-surgery-and-research","isVorOnly":false,"title":"Journal of Orthopaedic Surgery and Research"},"publishedOn":"2024-10-18 15:58:03","publishedOnDateReadable":"October 18th, 2024"},"versionCreatedAt":"2024-09-04 23:20:55","video":"","vorDoi":"10.1186/s13018-024-05145-5","vorDoiUrl":"https://doi.org/10.1186/s13018-024-05145-5","workflowStages":[]},"version":"v1","identity":"rs-4840275","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4840275","identity":"rs-4840275","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}