Document Type : Original article


College of Medicine, University of AL-Qadisiyah, Al-Diwanya , Iraq.


Background: knee osteoarthritis (KOA) is a complex disease that causes metabolic, structural, biochemical, and functional alterations in afflicted tissues. Physical examination and radiological findings are the present methods for the diagnosis of knee osteoarthritis. Traditionally, KOA medication focused on symptom management. Clinical trials focused on delaying or reversing disease development have gained popularity in recent years. PRP is among the medicinal approaches used to manage KOA.Purpose: By assessing the cartilage degradation marker collagen-II, the study's aim was to figure out whether the use of pure-PRP may help KOA patients' damaged cartilage layers regenerate.
Methods: This non-randomized controlled trial study involved 66 patients with knee OA and 28 healthy control subjects from December 2021 to February 2022. There were 2 categories of knee OA patients: 34 with moderate (grade-3) and 32 with mild (grade-2) KOA. So, every group of KOA patients is divided into three subgroups based to the frequency of injections (single, double, or triple) in addition to severity. Based on clinical and radiological data using the Kellgren-Lawence (KL) 0–4 grading system, the patients' diagnoses and classifications are made. This study was designed at AL-Imam Ali hospital, Babylon governorate, Iraq and approved by the medical human research ethics committee at Al-Qadisiyah university/ collage of medicine.
Results: The findings of this investigation show that the serum collagen type-II content was considerably greater in KOA patients were compared to control subjects, and in moderate compared to mild KOA as the severity of the disease progressed. But following pure-PRP injection, the serum level of collagen type-II did not significantly decrease, and increasing the number of injections had no better effect.
Conclusions: PRP therapy was generally acceptable for patients in terms of improving symptoms and there were no complications following injection. However, there is insufficient indication that platelet rich plasma regenerates cartilage damage in knee OA patients, as there was no significant decrease in the amount of collagen type-II.


Main Subjects

  1. Murphy SL, Lyden AK, Phillips K, Clauw DJ, Williams DA. Subgroups of older adults with osteoarthritis based upon differing comorbid symptom presentations and potential underlying pain mechanisms. Arthritis research & therapy. 2011 Aug;13(4):1-8.
  2. Kraus VB, Karsdal MA. Osteoarthritis: current molecular biomarkers and the way forward. Calcified tissue international. 2021 Sep;109(3):329-38.
  3. Hosnijeh FS, Runhaar J, van Meurs JB, Bierma-Zeinstra SM. Biomarkers for osteoarthritis: can they be used for risk assessment? A systematic review. Maturitas. 2015 Sep 1;82(1):36-49.
  4. Lotz M, Martel-Pelletier J, Christiansen C, Brandi ML, Bruyère O, Chapurlat R, Collette J, Cooper C, Giacovelli G, Kanis JA, Karsdal MA. Republished: Value of biomarkers in osteoarthritis: current status and perspectives. Postgraduate medical journal. 2014 Mar 1;90(1061):171-8.
  5. Kumavat R, Kumar V, Malhotra R, Pandit H, Jones E, Ponchel F, Biswas S. Biomarkers of joint damage in osteoarthritis: current status and future directions. Mediators of Inflammation. 2021 Mar 10;2021.
  6. Lian C, Wang X, Qiu X, Wu Z, Gao B, Liu L, Liang G, Zhou H, Yang X, Peng Y, Liang A. Collagen type II suppresses articular chondrocyte hypertrophy and osteoarthritis progression by promoting integrin β1− SMAD1 interaction. Bone research. 2019 Mar 6;7(1):1-5.
  7. Yang G, Li S, Li B, Cheng L, Jiang P, Tian Z, Sun S. Protective effects of garlic-derived S-allylmercaptocysteine on IL-1β-stimulated chondrocytes by regulation of MMPs/TIMP-1 ratio and type II collagen expression via suppression of NF-κB pathway. BioMed Research International. 2017 Dec 3;2017.
  8. Groen SS, Sinkeviciute D, Bay-Jensen AC, Thudium CS, Karsdal MA, Thomsen SF, Lindemann S, Werkmann D, Blair J, Staunstrup LM, Önnerfjord P. A serological type II collagen neoepitope biomarker reflects cartilage breakdown in patients with osteoarthritis. Osteoarthritis and Cartilage Open. 2021 Dec 1;3(4):100207.
  9. Peter I, Wu K, Diaz R, Borg-Stein J. Platelet-rich plasma. Physical Medicine and Rehabilitation Clinics. 2016 Nov 1;27(4):825-53.
  10. Fibel KH, Hillstrom HJ, Halpern BC. State-of-the-Art management of knee osteoarthritis. World Journal of Clinical Cases: WJCC. 2015 Feb 2;3(2):89.
  11. Arden NK, Perry TA, Bannuru RR, Bruyère O, Cooper C, Haugen IK, Hochberg MC, McAlindon TE, Mobasheri A, Reginster JY. Non-surgical management of knee osteoarthritis: comparison of ESCEO and OARSI 2019 guidelines. Nature Reviews Rheumatology. 2021 Jan;17(1):59-66.
  12. Primorac D, Molnar V, Matišić V, Hudetz D, Jeleč Ž, Rod E, Čukelj F, Vidović D, Vrdoljak T, Dobričić B, Antičević D. Comprehensive review of knee osteoarthritis pharmacological treatment and the latest professional societies’ guidelines. Pharmaceuticals. 2021 Mar 2;14(3):205.
  13. Cugat R, Cuscó X, Seijas R, Álvarez P, Steinbacher G, Ares O, Wang-Saegusa A, García-Balletbó M. Biologic enhancement of cartilage repair: the role of platelet-rich plasma and other commercially available growth factors. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2015 Apr 1;31(4):777-83.
  14. Anitua E, Sánchez M, Orive G, Padilla S. A biological therapy to osteoarthritis treatment using platelet-rich plasma. Expert Opinion on Biological Therapy. 2013 Dec 1;13(8):1161-72.
  15. Andia I, Maffulli N. Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Nature Reviews Rheumatology. 2013 Dec;9(12):721-30.
  16. Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte-and platelet-rich fibrin (L-PRF). Trends in biotechnology. 2009 Mar 1;27(3):158-67.
  17. Cetinkaya RA, Yilmaz S, Ünlü A, Petrone P, Marini C, Karabulut E, Urkan M, Kaya E, Karabacak K, Uyanik M, Eker I. The efficacy of platelet-rich plasma gel in MRSA-related surgical wound infection treatment: an experimental study in an animal model. European Journal of Trauma and Emergency Surgery. 2018 Dec;44(6):859-67.
  18. Sundman EA, Cole BJ, Fortier LA. Growth factor and catabolic cytokine concentrations are influenced by the cellular composition of platelet-rich plasma. The American journal of sports medicine. 2011 Oct;39(10):2135-40.
  19. Bausset O, Giraudo L, Veran J, Magalon J, Coudreuse JM, Magalon G, Dubois C, Serratrice N, Dignat-George F, Sabatier F. Formulation and storage of platelet-rich plasma homemade product. BioResearch open access. 2012 Jun 1;1(3):115-23.
  20. Garvican ER, Vaughan-Thomas A, Clegg PD, Innes JF. Biomarkers of cartilage turnover. Part 2: Non-collagenous markers. The Veterinary Journal. 2010 Jul 1;185(1):43-9.
  21. Garnero P. Use of biochemical markers to study and follow patients with osteoarthritis. Current rheumatology reports. 2006 Feb;8(1):37-44.
  22. Sharif M, Kirwan J, Charni N, Sandell LJ, Whittles C, Garnero P. A 5-yr longitudinal study of type IIA collagen synthesis and total type II collagen degradation in patients with knee osteoarthritis—association with disease progression.
  23. Valdes AM, Meulenbelt I, Chassaing E, Arden NK, Bierma-Zeinstra S, Hart D, Hofman A, Karsdal M, Kloppenburg M, Kroon HM, Slagboom EP. Large scale meta-analysis of urinary C-terminal telopeptide, serum cartilage oligomeric protein and matrix metalloprotease degraded type II collagen and their role in prevalence, incidence and progression of osteoarthritis. Osteoarthritis and cartilage. 2014 May 1;22(5):683-9.
  24. Huang M, Zhao J, Huang Y, Dai L, Zhang X. Meta-analysis of urinary C-terminal telopeptide of type II collagen as a biomarker in osteoarthritis diagnosis. Journal of orthopaedic translation. 2018 Apr 1;13:50-7.
  25. Xu Q, Sun XC, Shang XP, Jiang HS. Association of CXCL12 levels in synovial fluid with the radiographic severity of knee osteoarthritis. Journal of Investigative Medicine. 2012 Aug 1;60(6):898-901.
  26. Deberg M, Labasse A, Christgau S, Cloos P, Henriksen DB, Chapelle JP, Zegels B, Reginster JY, Henrotin Y. New serum biochemical markers (Coll 2-1 and Coll 2-1 NO2) for studying oxidative-related type II collagen network degradation in patients with osteoarthritis and rheumatoid arthritis. Osteoarthritis and cartilage. 2005 Mar 1;13(3):258-65.
  27. McGrory B, Weber K, Lynott JA, Richmond JC, Davis III CM, Yates Jr A, Kamath AF, Dasa V, Brown GA, Gerlinger TL, Villanueva T. The American Academy of Orthopaedic Surgeons evidence-based clinical practice guideline on surgical management of osteoarthritis of the knee. JBJS. 2016 Apr 20;98(8):688-92.
  28. Zhu Y, Yuan M, Meng HY, Wang AY, Guo QY, Wang Y, Peng J. Basic science and clinical application of platelet-rich plasma for cartilage defects and osteoarthritis: a review. Osteoarthritis and cartilage. 2013 Nov 1;21(11):1627-37.
  29. Henrotin Y, Chevalier X, Deberg M, Balblanc JC, Richette P, Mulleman D, Maillet B, Rannou F, Piroth C, Mathieu P, Conrozier T. Early decrease of serum biomarkers of type II collagen degradation (Coll2‐1) and joint inflammation (Coll2‐1 NO2) by hyaluronic acid intra‐articular injections in patients with knee osteoarthritis: A research study part of the Biovisco study. Journal of Orthopaedic Research. 2013 Jun;31(6):901-7.
  30. Lacko M, Harvanová D, Slovinská L, Matuška M, Balog M, Lacková A, Špaková T, Rosocha J. Effect of intra-articular injection of platelet-rich plasma on the serum levels of osteoarthritic biomarkers in patients with unilateral knee osteoarthritis. Journal of Clinical Medicine. 2021 Dec 11;10(24):5801.
  31. Fawzy RM, Hashaad NI, Mansour AI. Decrease of serum biomarker of type II Collagen degradation (Coll2-1) by intra-articular injection of an autologous plasma-rich-platelet in patients with unilateral primary knee osteoarthritis. European Journal of Rheumatology. 2017 Jun;4(2):93.