Clinical Comparative Trial of Arthroscopic Debridement Combined with PRP Therapy versus Pure PRP Therapy for Knee Joint: A Clinical Comparative Trial

Clinical Comparative Trial of Arthroscopic Debridement Combined with PRP Therapy versus Pure PRP Therapy for Knee Joint: A Clinical Comparative Trial | 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 Clinical Comparative Trial of Arthroscopic Debridement Combined with PRP Therapy versus Pure PRP Therapy for Knee Joint: A Clinical Comparative Trial beibei Chen, Hairui Liang, Lei Yang, Siyu Duan, Rongda Xu, He Zhang, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4085752/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Knee joint diseases have become common musculoskeletal disorders in modern society, causing significant distress in patients' daily lives and activities. Platelet-rich plasma (PRP) therapy for knee osteoarthritis has gained widespread recognition in recent years, while the efficacy of arthroscopic debridement surgery in knee osteoarthritis remains controversial. This study aims to evaluate the differences in improving symptoms and function of knee osteoarthritis (Kellgren-Lawrence grade III) between arthroscopic debridement combined with PRP therapy and pure PRP therapy through a clinical comparative trial. Methods A retrospective analysis was conducted on 108 patients with knee osteoarthritis admitted from January 2021 to January 2022, who underwent PRP injection therapy. Patients who underwent arthroscopic debridement surgery were allocated to the arthroscopic combined with PRP therapy group (Group A), while the remaining patients were allocated to the PRP therapy group (Group B). The improvement of pain, joint symptoms, and function of knee osteoarthritis patients before and after treatment was evaluated using VAS, WOMAC, and Lysholm scores. Results Five months after the initial treatment, the knee-related scores of both groups of patients improved. The VAS pain score and WOMAC osteoarthritis score decreased, while the Lysholm knee function score increased, and all differences were statistically significant. When comparing the arthroscopic debridement combined with PRP treatment group to the pure PRP injection treatment group, the combined treatment group showed a greater decrease in VAS pain score and WOMAC osteoarthritis score, a more significant increase in Lysholm knee function score, with statistically significant differences (P < 0.05). Conclusion PRP therapy can improve symptoms of knee osteoarthritis and promote joint function recovery, with better improvement in joint symptoms and function in the PRP combined with arthroscopic surgery group, and high safety. Knee osteoarthritis Arthroscopic debridement Platelet-rich plasma Clinical efficacy Figures Figure 1 Figure 2 Figure 3 Introduction Knee Osteoarthritis (KOA) is a prevalent musculoskeletal disorder characterized by joint pain and functional impairment, often leading to decreased quality of life and chronic disability, particularly among the elderly [ 1 ]. KOA has a significant global health impact, with its prevalence continuously rising due to the aging population [ 2 ]. The pathogenesis of KOA is complex, involving sustained damage from various factors and gradual structural changes in joint tissues, leading to disease progression, severe pain, and irreversible loss of joint function [ 3 , 4 ]. Currently, there are no curative treatments for KOA, only limited therapeutic approaches aimed at alleviating pain, controlling inflammation, promoting repair, and improving joint function. Early-stage KOA treatment includes medication, physical therapy, intra-articular injections, and debridement therapy [ 5 ]. However, these therapies only provide temporary relief of clinical symptoms and cannot fundamentally restore the function of cartilage, menisci, and ligaments. Total knee replacement may be the only solution for severe late-stage KOA [ 1 ]. Due to the progressive and severe nature of KOA, current orthopedic research primarily focuses on various minimally invasive and novel treatment modalities. In recent years, platelet-rich plasma (PRP) therapy for KOA has gained widespread recognition, with most scholars suggesting that PRP may offer benefits in alleviating arthritis pain, improving joint symptoms, and restoring joint function [ 6 – 9 ]. Knee arthroscopic treatment for osteoarthritis is used to relieve symptoms and delay joint replacement surgery [ 10 ]. However, there is controversy regarding the efficacy of arthroscopic debridement surgery in KOA [ 11 – 13 ]. Some studies suggest that knee arthroscopic debridement surgery may benefit KOA patients, while others disagree. Authors and research teams advise against arthroscopic treatment for elderly patients with severe late-stage osteoarthritis, but some experts still believe that arthroscopic examination may benefit KOA patients [ 14 , 15 ]. With continuous advancements in medical technology, whether knee arthroscopic surgery combined with PRP therapy, as an emerging treatment modality, can provide more satisfactory treatment outcomes for patients compared to pure PRP therapy remains to be determined. This study aims to evaluate the differences in symptom improvement and functional recovery between arthroscopic debridement combined with PRP therapy and pure PRP therapy through a clinical comparative trial, aiming to provide clinicians with more scientifically informed treatment choices. Materials and Methods General Information A total of 120 patients with knee osteoarthritis were selected from Shenyang Medical College Affiliated Central Hospital between January 2021 and January 2022. All patients were clinically diagnosed and confirmed to have knee osteoarthritis. After screening, a total of 108 participants were included in the study. Inclusion Criteria (1) Patients diagnosed with knee osteoarthritis according to the Kellgren-Lawrence grading [ 16 ], classified as grades I-III; with VAS score > 40, WOMAC osteoarthritis index score, and Lysholm knee score system score used to evaluate the condition of knee osteoarthritis in patients. (2) Age ≥ 40 years old, with symptoms for at least 6 months prior to enrollment. (3) Patients with complete follow-up data who actively cooperate with treatment. Exclusion Criteria (1) Cognitive impairment or poor cooperation. (2) Patients with knee joint tuberculosis or rheumatoid diseases. (3) Patients with significant organ dysfunction. (4) History of knee joint surgery, intra-articular medication, or steroid therapy within the 6 months prior to the study. The study obtained approval from the relevant medical ethics department of the Affiliated Central Hospital of Shenyang Medical College. All patients were informed about the study details and signed written informed consent forms voluntarily before participating in the research. Grouping It is proposed that all patients meeting the inclusion criteria undergo arthroscopic surgery and PRP injection treatment, while patients refusing surgery receive pure PRP injection treatment. Based on this, patients who do not agree to arthroscopic surgery treatment are allocated to the PRP treatment group (Group B) with 54 cases, and patients who agree to arthroscopic surgery treatment are allocated to the arthroscopic combined with PRP treatment group (Group A) with 54 cases. The research process is detailed in Fig. 1 . Treatment Regimen Pure PRP Treatment Group: Patients receive pure PRP injection therapy. The ACP preparation kit from Arthrex, USA, is used, with a 9-gauge blood collection needle connected to draw 15 mL of venous blood from the median cubital vein of the patient, which is then centrifuged in a Drucker Horizon 24 Flex centrifuge. After centrifugation, approximately 4–6 mL of PRP is separated and extracted. During injection, the patient lies supine on the operating table with the knee flexed at 90°, the lower leg hanging naturally, and bony landmarks of the knee marked on the skin surface under ultrasound guidance. The puncture points on both sides of the patellar ligament are marked. A 7-gauge short needle is inserted into the marked point towards the knee joint cavity, ensuring entry into the joint cavity, with no blood or inflammatory fluid aspirated upon withdrawal. The PRP injection tube is connected, and PRP is injected smoothly when there is no resistance. PRP is injected once a month, with 4–6 mL of PRP injected each time, for a total of three consecutive injections. Arthroscopic Debridement Combined with PRP Treatment Group: Patients undergo arthroscopic knee surgery followed by immediate PRP injection therapy. Subsequently, PRP is injected once a month, with 4–6 mL of PRP injected each time, for two consecutive injections. All arthroscopic surgeries are performed by the same group of four experienced surgeons. Before and after arthroscopic treatment, patients undergo X-ray imaging (Fig. 2 ) with image data retained. Arthroscopic surgery includes excision of hypertrophic tissue and synovium, removal of osteophytes and loose bodies, trimming of meniscus and articular cartilage fragments, and joint lavage (Fig. 3 ). After surgery, patients are allowed and encouraged to engage in full weight-bearing activities. Outcome Measures Both groups of patients were requested to complete a questionnaire survey at a follow-up visit 5 months after the initial treatment. The total scores of VAS, WOMAC, and Lysholm were recorded for further analysis. (1) Pain Intensity: Pain severity was assessed using the VAS score, ranging from 0 to 100 points. A score of 0 indicates no pain, while scores of 10–30 represent mild pain, 40–60 represent moderate pain, and 70–100 represent severe pain. (2) Quality of Life and Symptom Improvement: The WOMAC score scale [ 17 ] was used to evaluate patients' quality of life and symptom improvement. Combined with the VAS score, each item is scored out of 10 points, with a total score of 240 points. Lower scores indicate milder symptoms. (3) Knee Joint Function: Knee joint function was assessed using the Lysholm knee score [ 18 ], with a total score of 100 points. A higher score represents better knee joint function. Statistical Analysis Statistical analysis was performed using SPSS 27.0 software. Descriptive statistics included the mean and standard deviation for continuous variables and numbers for categorical variables. The Kolmogorov-Smirnov test was used to test for normality, and the chi-square test was used for categorical variables. Independent samples t-test and Mann-Whitney U test were used for analysis of measurement data and scoring situations. The significance level was set at p < 0.05. Results Baseline Characteristics There were no significant differences between the two groups of patients in terms of age, sex, BMI, etc. Additionally, there were no significant differences between the two groups of patients in terms of knee joint X-ray K-L grading, VAS pain score, WOMAC osteoarthritis score, and Lysholm knee function score. See Table 1 for details. Comparison of Treatment Effects After treatment, the knee joint-related scores of both groups of patients improved, with decreases in VAS pain score and WOMAC osteoarthritis score, and an increase in Lysholm knee function score. These differences were statistically significant. See Table 2 for details. Compared with the group receiving pure PRP injection treatment, the group receiving arthroscopic debridement combined with PRP treatment showed greater decreases in VAS pain score and WOMAC osteoarthritis score, and a more significant increase in Lysholm knee function score. See Table 3 for details. Pain symptoms and joint function significantly improved, with statistically significant differences (P < 0.05). Complications and Treatment Response There were no significant differences in the incidence of complications between the two groups of patients, and no serious adverse reactions were observed during treatment. The arthroscopic examination group did not report any local complications, such as infection or surgical site pain. Table 1. Comparison of Baseline Information between the Two Groups of Patients. Baseline Group A* Group B# P Age 57.6±4.9 59.5±5.5 0.063 Sex 0.433 Male 20 24 Female 34 30 BMI 24.5±2.2 24.2±2.1 0.45 X-ray K-L grading 1.43±0.63 1.52±0.64 0.374 VAS 53.0±10.5 54.0±10.3 0.563 WOMAC 99.9±19.7 104.0±21.7 0.391 Lysholm 68.7±7.7 69.1±8.2 0.631 *Arthroscopic combined with PRP treatment group (Group A); #PRP treatment group (Group B) Table 2. Comparison of Three Knee Joint Scores between the Two Groups of Patients Before Treatment and at 5 Months after the Initial Treatment. Group A Before Treatment 3 Months Post-Surgery P VAS 53.0±10.5 33.5±8.2 ＜0.001 WOMAC 99.9±19.7 80.8±16.9 ＜0.001 Lysholm 68.7±7.7 79.5±5.1 ＜0.001 Group B Before Treatment 3 Months Post-Surgery VAS 54.0±10.3 41.3±9.8 ＜0.001 WOMAC 104±21.7 90.6±19.6 ＜0.001 Lysholm 69.1±8.2 76.9±6.5 ＜0.001 Table 3. Comparison of Knee Joint Scores in Both Groups Five Months after Initial Treatment Group A Group B P VAS 33.5±8.2 41.3±9.8 ＜0.001 WOMAC 80.8±16.9 90.6±19.6 0.004 Lysholm 79.5±5.1 76.9±6.5 0.018 Discussion Knee osteoarthritis (KOA) is a common degenerative joint disease, with its etiology often associated with factors such as long-term overuse and exposure to cold temperatures [ 19 ]. This disease progresses slowly, resulting in prolonged restrictions in joint mobility and knee pain symptoms, which inconvenience patients in their work and daily life [ 20 ]. The main pathological features of KOA include abnormalities in the metabolism of chondrocytes, matrix, and subchondral bone in the joint [ 2 , 21 ]. As the disease progresses, patients may experience symptoms such as knee joint pain, stiffness, and functional limitations, severely affecting their quality of life and potentially leading to disability [ 22 , 23 ]. In extreme cases, knee joint replacement surgery may become the only treatment option [ 1 , 24 ]. Therefore, early detection and treatment are crucial for alleviating pain and preventing the condition from worsening further. PRP is a hyper physiological concentration of blood components widely used in the medical field. It contains a high concentration of growth factors that promote tissue regeneration and healing, induce angiogenesis, and stimulate cell proliferation and differentiation [ 25 ]. Additionally, PRP has anti-inflammatory effects and can enhance tissue vitality [ 26 ]. Direct injection of PRP into the joint cavity bypasses biological barriers, increases tissue activity, reduces platelet loss, and maintains the stability of growth factors for an extended period [ 27 ]. These properties help reduce the release of pain factors, alleviate the body's pain stress response, and facilitate early postoperative functional exercise, aiding in the recovery of knee joint function [ 28 , 29 ]. Arthroscopic debridement is a minimally invasive surgery used to remove proliferative, inflamed synovium, small bone spurs, and loose bodies within the knee joint [ 30 ]. Additionally, it can repair meniscal tears, clean and flush the joint cavity, and improve the microenvironment within the joint cavity [ 31 ]. Through this approach, it helps reduce the aggregation of inflammatory factors, effectively alleviating symptoms such as pain and restricted movement caused by arthritis [ 32 ]. Trials by Desmoineaux et al. demonstrated that arthroscopic debridement reliably alleviates pain, increases range of motion, and facilitates good functional recovery in elbow arthritis [ 33 ]. However, studies have indicated that following arthroscopic debridement, the volume and secretion of synovial fluid decrease, which may result in insufficient lubrication and nutrition for the articular cartilage surface, exacerbating symptoms such as pain and swelling, and affecting treatment outcomes [ 34 ]. In such cases, the application of PRP can promote chondrocyte proliferation and differentiation, induce angiogenesis, and facilitate soft tissue repair. Moreover, following arthroscopic debridement, the cartilage and ligament tissues undergo freshening under a shaver or burr, making it an opportune moment for PRP injection to capitalize on the regenerative repair effects of growth factors [ 35 ]. Therefore, the research team believes that the combination of PRP with arthroscopic debridement of the knee joint holds promise for enhancing treatment outcomes and more effectively improving clinical symptoms and joint function in patients. To date, both of these methods have been widely used in the treatment of osteoarthritis, yet there is limited research on the combined effects of PRP and arthroscopic debridement in knee osteoarthritis, warranting further investigation into their therapeutic efficacy [ 36 ]. This study analyzed the pain level (VAS), quality of life, symptom improvement (WOMAC), and knee joint function score (Lysholm) of patients. The results showed that at 5 months after the initial treatment, both groups of patients demonstrated significant improvements in VAS, WOMAC, and Lysholm scores, with the treatment group outperforming the control group (P < 0.05). This indicates that both treatment modalities can alleviate pain and improve function, achieving favorable therapeutic effects. At 5 months after the initial treatment, the treatment protocol of PRP combined with arthroscopic debridement for knee osteoarthritis (KOA) demonstrated better treatment outcomes compared to PRP therapy alone. Arthroscopic debridement of the knee joint may lead to pain and swelling; however, postoperative application of PRP therapy can harness the regenerative effects of growth factors while reducing inflammation levels and alleviating pain symptoms, facilitating early rehabilitation exercises for patients[ 37 ]. No serious adverse reactions or complications such as incision pain or infection were observed in either group of patients during the treatment process. The application of PRP combined with arthroscopic debridement for knee osteoarthritis provides a safe and effective solution for addressing patient pain issues and preventing the further progression of osteoarthritis. This study has several limitations. Firstly, the number of participants was relatively small, and a single preparation kit from the American company Arthrex was used for ACP preparation. Different PRP preparation methods may affect treatment outcomes. Secondly, the inclusion of patients who refused arthroscopic surgery resulted in selection bias in the pure PRP treatment group. Additionally, there was a predominance of patients with K-L grade I-II knee osteoarthritis in this study, and no separate analysis was conducted for K-L grades I, II, and III. Conclusion Minimally invasive and innovative treatments for knee osteoarthritis have been a focal point of orthopedic research. In this study, both treatment modalities demonstrated short-term improvements in pain and joint function for patients with knee osteoarthritis. Arthroscopic debridement combined with PRP treatment showed more significant advantages over pure PRP treatment in symptom relief and functional recovery. However, further research with larger sample sizes and long-term follow-up is needed to validate the conclusions of this study. This study offers new insights into the treatment of knee joint diseases and holds promise for providing more effective treatment strategies in clinical practice. Declarations Ethics statement All procedures were in accordance with the ethical standards of institutional and/or national research councils. The study received approval from the Ethics Board of Central Hospital affiliated with Shenyang Medical College. Informed consent was obtained from the patient. Author Contributions statement All authors listed have significantly contributed to the investigation, development and writing of this article. Conceptualization : Cai ZH. Data curation : Liang HR ,Yang L, Duan SY, Xu RD. Formal analysis : Cai ZC, Chen BB. Funding acquisition : Cai ZC. Investigation : Yang L, Zhou XT, Liu HF, Wen H. Validation : Zhang H, Sun M. Writing - original draft : Liang HR. Writing - review & editing : Liang HR, Cai ZC, Chen BB. All individuals are members of the surgical team. Funding statement This study was supported by Natural Science Foundation of Liaoning Province (2014),Liaoning Provincial Department of Education Fund Project (2014) and the Science and Technology Plan Project of Shenyang City (Grant no. 22-321-32-13). Data availability statement Data will be made available on request. Declaration of interest statement The authors declare that they have no conflicts of interest concerning this article. References Katz J N, Arant K R, Loeser R F. 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Cai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsUlEQVRIiWNgGAWjYHACNhAhx8befoA0LcZ8PGcSSNOSOE/CwYA49fIzkp89+PHHLr1NgiGB4UfFNsJaDG6kmRv28CTntkk3HmDsOXObCC0SOWzSDBIHcttkDiQwM7YRoUV+BkiLwYF0NokEA+K0MNwAaUk4kEC8FoMzz8wkew4kG7YBA/kgUX6Rb09+JgEMMXn59vaDD35UEOMwgQQE+wAR6oGAn0h1o2AUjIJRMIIBAKBwN5C6GnSIAAAAAElFTkSuQmCC","orcid":"","institution":"Central Hospital affiliated to Shenyang Medical College","correspondingAuthor":true,"prefix":"","firstName":"Zhencun","middleName":"","lastName":"Cai","suffix":""}],"badges":[],"createdAt":"2024-03-12 16:18:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4085752/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4085752/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52791257,"identity":"3feb08f3-fae2-494c-bacd-35bc57f2a90d","added_by":"auto","created_at":"2024-03-15 19:58:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54603,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of the study\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4085752/v1/df94611c8f329513eb8e3bb8.png"},{"id":52790578,"identity":"3c6d7565-85f9-4450-b954-964e8dc2bc6c","added_by":"auto","created_at":"2024-03-15 19:50:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":263351,"visible":true,"origin":"","legend":"\u003cp\u003eX-ray images before and after arthroscopic treatment for a 62-year-old female patient with osteoarthritis in the joint. (\u003cstrong\u003eA\u003c/strong\u003e): Preoperative X-ray anteroposterior view. (\u003cstrong\u003eB\u003c/strong\u003e): Preoperative X-ray lateral view. (\u003cstrong\u003eC\u003c/strong\u003e): Postoperative X-ray anteroposterior view. (\u003cstrong\u003eD\u003c/strong\u003e): Postoperative X-ray lateral view.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4085752/v1/a3394d200b24d5481af01686.png"},{"id":52790579,"identity":"a453dad5-d4ec-4b0b-ade9-b3a057b41cdc","added_by":"auto","created_at":"2024-03-15 19:50:38","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":550203,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative arthroscopic images of a 62-year-old female patient with osteoarthritis in the joint in the arthroscopic treatment group. (\u003cstrong\u003eA\u003c/strong\u003e): Removal of hypertrophic synovium within the joint. (\u003cstrong\u003eB\u003c/strong\u003e): Removal of cartilage fragments. (\u003cstrong\u003eC\u003c/strong\u003e): Removal of hypertrophic tissue within the joint. (\u003cstrong\u003eD\u003c/strong\u003e): Removal of small osteophytes.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4085752/v1/d1825715b86d662b3573998e.png"},{"id":53398430,"identity":"02a08ba2-f859-466a-b4c2-f502c6bd4853","added_by":"auto","created_at":"2024-03-25 14:00:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1085300,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4085752/v1/c1db11a9-96b4-4b2b-9e97-4fd033f52584.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Comparative Trial of Arthroscopic Debridement Combined with PRP Therapy versus Pure PRP Therapy for Knee Joint: A Clinical Comparative Trial","fulltext":[{"header":"Introduction","content":"\u003cp\u003eKnee Osteoarthritis (KOA) is a prevalent musculoskeletal disorder characterized by joint pain and functional impairment, often leading to decreased quality of life and chronic disability, particularly among the elderly [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. KOA has a significant global health impact, with its prevalence continuously rising due to the aging population [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe pathogenesis of KOA is complex, involving sustained damage from various factors and gradual structural changes in joint tissues, leading to disease progression, severe pain, and irreversible loss of joint function [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Currently, there are no curative treatments for KOA, only limited therapeutic approaches aimed at alleviating pain, controlling inflammation, promoting repair, and improving joint function. Early-stage KOA treatment includes medication, physical therapy, intra-articular injections, and debridement therapy [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, these therapies only provide temporary relief of clinical symptoms and cannot fundamentally restore the function of cartilage, menisci, and ligaments. Total knee replacement may be the only solution for severe late-stage KOA [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Due to the progressive and severe nature of KOA, current orthopedic research primarily focuses on various minimally invasive and novel treatment modalities.\u003c/p\u003e \u003cp\u003eIn recent years, platelet-rich plasma (PRP) therapy for KOA has gained widespread recognition, with most scholars suggesting that PRP may offer benefits in alleviating arthritis pain, improving joint symptoms, and restoring joint function [\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Knee arthroscopic treatment for osteoarthritis is used to relieve symptoms and delay joint replacement surgery [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, there is controversy regarding the efficacy of arthroscopic debridement surgery in KOA [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Some studies suggest that knee arthroscopic debridement surgery may benefit KOA patients, while others disagree. Authors and research teams advise against arthroscopic treatment for elderly patients with severe late-stage osteoarthritis, but some experts still believe that arthroscopic examination may benefit KOA patients [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. With continuous advancements in medical technology, whether knee arthroscopic surgery combined with PRP therapy, as an emerging treatment modality, can provide more satisfactory treatment outcomes for patients compared to pure PRP therapy remains to be determined. This study aims to evaluate the differences in symptom improvement and functional recovery between arthroscopic debridement combined with PRP therapy and pure PRP therapy through a clinical comparative trial, aiming to provide clinicians with more scientifically informed treatment choices.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e \u003cstrong\u003eGeneral Information\u003c/strong\u003e \u003cp\u003eA total of 120 patients with knee osteoarthritis were selected from Shenyang Medical College Affiliated Central Hospital between January 2021 and January 2022. All patients were clinically diagnosed and confirmed to have knee osteoarthritis. After screening, a total of 108 participants were included in the study.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInclusion Criteria\u003c/h2\u003e \u003cp\u003e(1) Patients diagnosed with knee osteoarthritis according to the Kellgren-Lawrence grading [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], classified as grades I-III; with VAS score\u0026thinsp;\u0026gt;\u0026thinsp;40, WOMAC osteoarthritis index score, and Lysholm knee score system score used to evaluate the condition of knee osteoarthritis in patients.\u003c/p\u003e \u003cp\u003e(2) Age\u0026thinsp;\u0026ge;\u0026thinsp;40 years old, with symptoms for at least 6 months prior to enrollment.\u003c/p\u003e \u003cp\u003e(3) Patients with complete follow-up data who actively cooperate with treatment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eExclusion Criteria\u003c/h2\u003e \u003cp\u003e(1) Cognitive impairment or poor cooperation.\u003c/p\u003e \u003cp\u003e(2) Patients with knee joint tuberculosis or rheumatoid diseases.\u003c/p\u003e \u003cp\u003e(3) Patients with significant organ dysfunction.\u003c/p\u003e \u003cp\u003e(4) History of knee joint surgery, intra-articular medication, or steroid therapy within the 6 months prior to the study.\u003c/p\u003e \u003cp\u003e The study obtained approval from the relevant medical ethics department of the Affiliated Central Hospital of Shenyang Medical College. All patients were informed about the study details and signed written informed consent forms voluntarily before participating in the research.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eGrouping\u003c/h2\u003e \u003cp\u003eIt is proposed that all patients meeting the inclusion criteria undergo arthroscopic surgery and PRP injection treatment, while patients refusing surgery receive pure PRP injection treatment. Based on this, patients who do not agree to arthroscopic surgery treatment are allocated to the PRP treatment group (Group B) with 54 cases, and patients who agree to arthroscopic surgery treatment are allocated to the arthroscopic combined with PRP treatment group (Group A) with 54 cases. The research process is detailed in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eTreatment Regimen\u003c/h2\u003e \u003cp\u003ePure PRP Treatment Group: Patients receive pure PRP injection therapy. The ACP preparation kit from Arthrex, USA, is used, with a 9-gauge blood collection needle connected to draw 15 mL of venous blood from the median cubital vein of the patient, which is then centrifuged in a Drucker Horizon 24 Flex centrifuge. After centrifugation, approximately 4\u0026ndash;6 mL of PRP is separated and extracted. During injection, the patient lies supine on the operating table with the knee flexed at 90\u0026deg;, the lower leg hanging naturally, and bony landmarks of the knee marked on the skin surface under ultrasound guidance. The puncture points on both sides of the patellar ligament are marked. A 7-gauge short needle is inserted into the marked point towards the knee joint cavity, ensuring entry into the joint cavity, with no blood or inflammatory fluid aspirated upon withdrawal. The PRP injection tube is connected, and PRP is injected smoothly when there is no resistance. PRP is injected once a month, with 4\u0026ndash;6 mL of PRP injected each time, for a total of three consecutive injections.\u003c/p\u003e \u003cp\u003eArthroscopic Debridement Combined with PRP Treatment Group: Patients undergo arthroscopic knee surgery followed by immediate PRP injection therapy. Subsequently, PRP is injected once a month, with 4\u0026ndash;6 mL of PRP injected each time, for two consecutive injections. All arthroscopic surgeries are performed by the same group of four experienced surgeons. Before and after arthroscopic treatment, patients undergo X-ray imaging (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) with image data retained. Arthroscopic surgery includes excision of hypertrophic tissue and synovium, removal of osteophytes and loose bodies, trimming of meniscus and articular cartilage fragments, and joint lavage (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). After surgery, patients are allowed and encouraged to engage in full weight-bearing activities.\u003c/p\u003e\u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eOutcome Measures\u003c/h2\u003e \u003cp\u003eBoth groups of patients were requested to complete a questionnaire survey at a follow-up visit 5 months after the initial treatment. The total scores of VAS, WOMAC, and Lysholm were recorded for further analysis.\u003c/p\u003e \u003cp\u003e(1) Pain Intensity: Pain severity was assessed using the VAS score, ranging from 0 to 100 points. A score of 0 indicates no pain, while scores of 10\u0026ndash;30 represent mild pain, 40\u0026ndash;60 represent moderate pain, and 70\u0026ndash;100 represent severe pain.\u003c/p\u003e \u003cp\u003e(2) Quality of Life and Symptom Improvement: The WOMAC score scale [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] was used to evaluate patients' quality of life and symptom improvement. Combined with the VAS score, each item is scored out of 10 points, with a total score of 240 points. Lower scores indicate milder symptoms.\u003c/p\u003e \u003cp\u003e(3) Knee Joint Function: Knee joint function was assessed using the Lysholm knee score [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], with a total score of 100 points. A higher score represents better knee joint function.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using SPSS 27.0 software. Descriptive statistics included the mean and standard deviation for continuous variables and numbers for categorical variables. The Kolmogorov-Smirnov test was used to test for normality, and the chi-square test was used for categorical variables. Independent samples t-test and Mann-Whitney U test were used for analysis of measurement data and scoring situations. The significance level was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were no significant differences between the two groups of patients in terms of age, sex, BMI, etc. Additionally, there were no significant differences between the two groups of patients in terms of knee joint X-ray K-L grading, VAS pain score, WOMAC osteoarthritis score, and Lysholm knee function score. See Table\u0026nbsp;1\u0026nbsp;for details.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of Treatment Effects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter treatment, the knee joint-related scores of both groups of patients improved, with decreases in VAS pain score and WOMAC osteoarthritis score, and an increase in Lysholm knee function score. These differences were statistically significant. See Table\u0026nbsp;2\u0026nbsp;for details. Compared with the group receiving pure PRP injection treatment, the group receiving arthroscopic debridement combined with PRP treatment showed greater decreases in VAS pain score and WOMAC osteoarthritis score, and a more significant increase in Lysholm knee function score. See Table\u0026nbsp;3\u0026nbsp;for details. Pain symptoms and joint function significantly improved, with statistically significant differences (P \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComplications and Treatment Response\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were no significant differences in the incidence of complications between the two groups of patients, and no serious adverse reactions were observed during treatment. The arthroscopic examination group did not report any local complications, such as infection or surgical site pain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Comparison of Baseline Information between the Two Groups of Patients.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGroup A*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGroup B#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e57.6\u0026plusmn;4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e59.5\u0026plusmn;5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.433\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24.5\u0026plusmn;2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24.2\u0026plusmn;2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eX-ray K-L grading\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.43\u0026plusmn;0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.52\u0026plusmn;0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.374\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e53.0\u0026plusmn;10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e54.0\u0026plusmn;10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWOMAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e99.9\u0026plusmn;19.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e104.0\u0026plusmn;21.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.391\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLysholm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e68.7\u0026plusmn;7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e69.1\u0026plusmn;8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.631\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Arthroscopic combined with PRP treatment group (Group A); #PRP treatment group (Group B)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Comparison of Three Knee Joint Scores between the Two Groups of Patients Before Treatment and at 5 Months after the Initial Treatment.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGroup A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBefore Treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 Months Post-Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e53.0\u0026plusmn;10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33.5\u0026plusmn;8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWOMAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e99.9\u0026plusmn;19.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e80.8\u0026plusmn;16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLysholm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e68.7\u0026plusmn;7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e79.5\u0026plusmn;5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGroup B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBefore Treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 Months Post-Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e54.0\u0026plusmn;10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41.3\u0026plusmn;9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWOMAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e104\u0026plusmn;21.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e90.6\u0026plusmn;19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLysholm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e69.1\u0026plusmn;8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e76.9\u0026plusmn;6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Comparison of Knee Joint Scores in Both Groups Five Months after Initial Treatment\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGroup A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGroup B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33.5\u0026plusmn;8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41.3\u0026plusmn;9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWOMAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e80.8\u0026plusmn;16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e90.6\u0026plusmn;19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLysholm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e79.5\u0026plusmn;5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e76.9\u0026plusmn;6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eKnee osteoarthritis (KOA) is a common degenerative joint disease, with its etiology often associated with factors such as long-term overuse and exposure to cold temperatures [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This disease progresses slowly, resulting in prolonged restrictions in joint mobility and knee pain symptoms, which inconvenience patients in their work and daily life [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The main pathological features of KOA include abnormalities in the metabolism of chondrocytes, matrix, and subchondral bone in the joint [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. As the disease progresses, patients may experience symptoms such as knee joint pain, stiffness, and functional limitations, severely affecting their quality of life and potentially leading to disability [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In extreme cases, knee joint replacement surgery may become the only treatment option [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Therefore, early detection and treatment are crucial for alleviating pain and preventing the condition from worsening further.\u003c/p\u003e \u003cp\u003ePRP is a hyper physiological concentration of blood components widely used in the medical field. It contains a high concentration of growth factors that promote tissue regeneration and healing, induce angiogenesis, and stimulate cell proliferation and differentiation [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Additionally, PRP has anti-inflammatory effects and can enhance tissue vitality [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Direct injection of PRP into the joint cavity bypasses biological barriers, increases tissue activity, reduces platelet loss, and maintains the stability of growth factors for an extended period [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. These properties help reduce the release of pain factors, alleviate the body's pain stress response, and facilitate early postoperative functional exercise, aiding in the recovery of knee joint function [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eArthroscopic debridement is a minimally invasive surgery used to remove proliferative, inflamed synovium, small bone spurs, and loose bodies within the knee joint [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Additionally, it can repair meniscal tears, clean and flush the joint cavity, and improve the microenvironment within the joint cavity [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Through this approach, it helps reduce the aggregation of inflammatory factors, effectively alleviating symptoms such as pain and restricted movement caused by arthritis [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Trials by Desmoineaux et al. demonstrated that arthroscopic debridement reliably alleviates pain, increases range of motion, and facilitates good functional recovery in elbow arthritis [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. However, studies have indicated that following arthroscopic debridement, the volume and secretion of synovial fluid decrease, which may result in insufficient lubrication and nutrition for the articular cartilage surface, exacerbating symptoms such as pain and swelling, and affecting treatment outcomes [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. In such cases, the application of PRP can promote chondrocyte proliferation and differentiation, induce angiogenesis, and facilitate soft tissue repair. Moreover, following arthroscopic debridement, the cartilage and ligament tissues undergo freshening under a shaver or burr, making it an opportune moment for PRP injection to capitalize on the regenerative repair effects of growth factors [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Therefore, the research team believes that the combination of PRP with arthroscopic debridement of the knee joint holds promise for enhancing treatment outcomes and more effectively improving clinical symptoms and joint function in patients. To date, both of these methods have been widely used in the treatment of osteoarthritis, yet there is limited research on the combined effects of PRP and arthroscopic debridement in knee osteoarthritis, warranting further investigation into their therapeutic efficacy [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study analyzed the pain level (VAS), quality of life, symptom improvement (WOMAC), and knee joint function score (Lysholm) of patients. The results showed that at 5 months after the initial treatment, both groups of patients demonstrated significant improvements in VAS, WOMAC, and Lysholm scores, with the treatment group outperforming the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This indicates that both treatment modalities can alleviate pain and improve function, achieving favorable therapeutic effects. At 5 months after the initial treatment, the treatment protocol of PRP combined with arthroscopic debridement for knee osteoarthritis (KOA) demonstrated better treatment outcomes compared to PRP therapy alone. Arthroscopic debridement of the knee joint may lead to pain and swelling; however, postoperative application of PRP therapy can harness the regenerative effects of growth factors while reducing inflammation levels and alleviating pain symptoms, facilitating early rehabilitation exercises for patients[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. No serious adverse reactions or complications such as incision pain or infection were observed in either group of patients during the treatment process. The application of PRP combined with arthroscopic debridement for knee osteoarthritis provides a safe and effective solution for addressing patient pain issues and preventing the further progression of osteoarthritis.\u003c/p\u003e \u003cp\u003eThis study has several limitations. Firstly, the number of participants was relatively small, and a single preparation kit from the American company Arthrex was used for ACP preparation. Different PRP preparation methods may affect treatment outcomes. Secondly, the inclusion of patients who refused arthroscopic surgery resulted in selection bias in the pure PRP treatment group. Additionally, there was a predominance of patients with K-L grade I-II knee osteoarthritis in this study, and no separate analysis was conducted for K-L grades I, II, and III.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMinimally invasive and innovative treatments for knee osteoarthritis have been a focal point of orthopedic research. In this study, both treatment modalities demonstrated short-term improvements in pain and joint function for patients with knee osteoarthritis. Arthroscopic debridement combined with PRP treatment showed more significant advantages over pure PRP treatment in symptom relief and functional recovery. However, further research with larger sample sizes and long-term follow-up is needed to validate the conclusions of this study. This study offers new insights into the treatment of knee joint diseases and holds promise for providing more effective treatment strategies in clinical practice.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures were in accordance with the ethical standards of institutional and/or national research councils. The study received approval from the Ethics Board of Central Hospital affiliated with Shenyang Medical College. Informed consent was obtained from the patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors listed have significantly contributed to the investigation, development and writing of this article. Conceptualization : Cai ZH. Data curation : Liang HR ,Yang L, Duan SY, Xu RD. Formal analysis : Cai ZC, Chen BB. Funding acquisition : Cai ZC. Investigation : Yang L, Zhou XT, Liu HF, Wen H. Validation : Zhang H, Sun M. Writing - original draft : Liang HR. Writing - review \u0026amp; editing : Liang HR, Cai ZC, Chen BB. All individuals are members of the surgical team.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Natural Science Foundation of Liaoning Province (2014),Liaoning Provincial Department of Education Fund Project (2014) and the Science and Technology Plan Project of Shenyang City (Grant no. 22-321-32-13).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData will be made available on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest concerning this article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKatz J N, Arant K R, Loeser R F. Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review. 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Cytokine Profiling and Intra-Articular Injection of Autologous Platelet-Rich Plasma in Knee Osteoarthritis. Int J Mol Sci, 2022;23.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Knee osteoarthritis, Arthroscopic debridement, Platelet-rich plasma, Clinical efficacy","lastPublishedDoi":"10.21203/rs.3.rs-4085752/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4085752/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eKnee joint diseases have become common musculoskeletal disorders in modern society, causing significant distress in patients' daily lives and activities. Platelet-rich plasma (PRP) therapy for knee osteoarthritis has gained widespread recognition in recent years, while the efficacy of arthroscopic debridement surgery in knee osteoarthritis remains controversial. This study aims to evaluate the differences in improving symptoms and function of knee osteoarthritis (Kellgren-Lawrence grade III) between arthroscopic debridement combined with PRP therapy and pure PRP therapy through a clinical comparative trial.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective analysis was conducted on 108 patients with knee osteoarthritis admitted from January 2021 to January 2022, who underwent PRP injection therapy. Patients who underwent arthroscopic debridement surgery were allocated to the arthroscopic combined with PRP therapy group (Group A), while the remaining patients were allocated to the PRP therapy group (Group B). The improvement of pain, joint symptoms, and function of knee osteoarthritis patients before and after treatment was evaluated using VAS, WOMAC, and Lysholm scores.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFive months after the initial treatment, the knee-related scores of both groups of patients improved. The VAS pain score and WOMAC osteoarthritis score decreased, while the Lysholm knee function score increased, and all differences were statistically significant. When comparing the arthroscopic debridement combined with PRP treatment group to the pure PRP injection treatment group, the combined treatment group showed a greater decrease in VAS pain score and WOMAC osteoarthritis score, a more significant increase in Lysholm knee function score, with statistically significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePRP therapy can improve symptoms of knee osteoarthritis and promote joint function recovery, with better improvement in joint symptoms and function in the PRP combined with arthroscopic surgery group, and high safety.\u003c/p\u003e","manuscriptTitle":"Clinical Comparative Trial of Arthroscopic Debridement Combined with PRP Therapy versus Pure PRP Therapy for Knee Joint: A Clinical Comparative Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-15 19:50:31","doi":"10.21203/rs.3.rs-4085752/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"42692340-6562-44b4-8138-17ccebff2b5e","owner":[],"postedDate":"March 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-25T13:52:03+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-15 19:50:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4085752","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4085752","identity":"rs-4085752","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}